Haematuria (positive dipstick, microscopic or visible haematuria)

Urology and andrology · Abnormal laboratory result · updated 2026-10-31

BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.

Frequency: In the United States, microscopic haematuria is found in 2.4% to 31.1% of healthy volunteers depending on the population studied ^[1].

Visible haematuria (red urine)

Urine microscopy and culture
Serum creatinine with eGFR
Urine protein:creatinine ratio (spot sample)
Creatine kinase (CK)if needednon-French guidelineDark urine with a dipstick positive for blood but few red cells: consider myoglobinuria ^[2].
FBC (heavy, prolonged or poorly tolerated haematuria)if needednon-French guidelineHeavy haematuria or signs of poor tolerance: FBC is part of the baseline tests for macroscopic haematuria in the emergency department ^[3].
INR (on VKA)if needednon-French guidelineOn a vitamin K antagonist: a coagulation disorder is a criterion for hospital admission ^[3]; overdose alone does not explain the haematuria, the work-up is still necessary ^[4].
Total PSA (in men, after information, to look for prostate cancer)if needednon-French guidelineNICE says to consider PSA and digital rectal examination in men with visible haematuria, then a suspected cancer pathway above an age-dependent threshold: more than 2.5 µg/L from 40 to 49 years, 3.5 from 50 to 59, 4.5 from 60 to 69, 6.5 from 70 to 79 ^[5]. An Australian general practice review proposes it after age 50 ^[6], and a meta-analysis finds prostate cancer in 5.9% of men investigated for macroscopic haematuria ^[7]. In France, the INCa document on PSA addresses men without symptoms and does not deal with haematuria ^[8].
From age 45, unexplained visible haematuria without urinary tract infection: refer to urology (suspected cancer pathway).

Detailed explanation and international comparison (in French): read it in English (machine translation)

Dipstick positive, few red cells? A positive dipstick with few red cells in the pellet suggests myoglobinuria: see the page "CPK élevées".

Detailed explanation and international comparison (in French): read it in English (machine translation)

Serum creatinine with eGFR
Urine protein:creatinine ratio (spot sample)
Urine albumin:creatinine ratio on the same sampleif needednon-French guidelineTo look for associated albuminuria (ACR ≥ 30 mg/mmol with haematuria: nephrology opinion) ^[17].
Repeat urine microscopy and culture (persistence)if needednon-French guidelineLow-risk patient: recheck at 6 months according to the AUA; after a negative urological work-up: recheck within the year ^[4].

Detailed explanation and international comparison (in French): read it in English (machine translation)

Urine cytology and urinary tumour markers in the initial evaluation of microscopic haematuria: to be avoided (10% false positives, rarely contributory after a normal cystoscopy) ^[4].
Urinary sediment (0219) prescribed in addition to the urine culture: the NABM does not allow the two procedures to be combined, the urine culture already includes the red cell count ^[16].
Dipstick or urinary markers to screen for bladder cancer in a person without symptoms: screening not recommended (low incidence) ^[11].

Sources (21)