When to refer women with microscopic hematuria

A large number of my female patients have trace blood in their urine that does not clear up with antibiotics. Should all these patients be referred to a urologist?
—REBECCA A. WALDEN, PA-C, Douglas, Ga.

Microscopic hematuria in females can have many etiologies, including menses and trauma. Knowing the age of the patient and her sexual activities is crucial. Other risk factors include past history of stones or kidney infection, exposure to medications or toxins, family history of renal disease, and calcium abnormalities. Oxidizing agents (i.e., hypochlorite, peroxidases) or myoglobinuria may cause false-positive test results. Workup of an asymptomatic, nonmenstruating patient should include a full urinalysis and microscopic analysis, urine culture and cytology, blood urea nitrogen and creatinine levels, and a complete blood count to check for anemia (which may help identify underlying renal disease). If the hematuria is confirmed and no cause is found, referral to urology is recommended. The patient will likely need cystoscopy.
—Claire Babcock O'Connell, MPH, PA-C
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