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Urine tests, results, proteinuria and haematuria

When to test the urine

Initial assessment of :

  • hypertension
  • haematuria
  • reduced eGFR
  • oedema or suspected heart failure
  • monitoring diabetic patients
  • monitoring patients with known renal disease
  • monitoring patients on certain drugs (penicillamine)
  • family history of CKD stage 5

What is required

Protein - urine sample (preferably early morning) to pathology dept for ACR

Haematuria - local dipstick of fresh urine

What is the ACR?

 Diabetic microalbuminuria guidelines

 

What to do about positive results of urine testing?

 Send blood for eGFR

 

Urine test results:

Protein only or Protein and blood:

Measure the eGFR and then if

  • ACR > 70 and eGFR > 30 - routine referral
  • ACR > 30 and blood +ve and eGFR > 30 - routine referral
  • ACR 30 - 70 and eGFR > 30 - consider e-Advice
  • If suspected Nephrotic syndrome (ACR > 250 and low serum albumin) - urgent referral

Invisible haematuria:

Retest to ensure 2 out of 3 positive

Age > 40 years

  • urine stick test: blood +ve - refer to Urology
  • urine stick test: blood +ve and urology investigation negative ACR > 30, PCR >50 and eGFR <30ml/min then renal referral

Age < 40 years

  • urine stick test: blood +ve, ACR < 30, eGFR > 60 & BP normal - monitor annually in primary care
  • urine stick test: blood +ve, ACR > 30, or eGFR < 60 or elevated BP - renal referral 

 

Any finding of new eGFR < 60

Consensus Statement on the Assessment of Haematuria

Haematuria Algorithm for Investigation (click to enlarge)

Visible haematuria

Urology referral