#404 Hematuria with Dr. Derek Fine

Hematuria evaluation requires distinguishing between urologic and nephrologic causes, with malignancy remaining the primary concern for gross hematuria. Microscopic hematuria, particularly in patients over 35 or those with smoking histories, necessitates a structured workup starting with imaging, such as CT urography, and potentially cystoscopy. When hematuria presents with albuminuria or erythrocyte casts, the focus shifts toward glomerular diseases like lupus nephritis or vasculitis, requiring a diagnostic approach involving complement levels and serological testing. While many cases of asymptomatic microscopic hematuria remain undiagnosed, persistent or gross hematuria demands vigilant monitoring and, in glomerular cases, often a renal biopsy to confirm the underlying pathology. Nephrologist Dr. Derek Fine emphasizes that a thorough clinical history and physical examination remain the most effective tools for guiding the diagnostic pathway and determining when specialist intervention is necessary.