Hematuria as a Marker of Occult Urinary Tract Cancer
Authors: Robert S. Brown
Journal: Annals of Internal Medicine (2016)

Letters18 October 2016Hematuria as a Marker of Occult Urinary Tract CancerRobert S. Brown, MDRobert S. Brown, MDFrom Beth Israel Deaconess Medical Center, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0329 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Although I applaud Nielsen and Qaseem for promoting guidelines for the management of patients with hematuria (1), I believe that their advice needs to be more nuanced for those with microscopic, rather than gross, hematuria. Occult cancer may be the most serious concern in patients with gross hematuria; however, glomerular disease with its attendant risks for chronic kidney disease and premature death is a serious condition in those with microscopic hematuria, particularly when affected patients present in the primary care setting and are not referred to specialty clinics. A careful urinary sediment examination looking for either erythrocyte ...References1. Nielsen M, Qaseem A; High Value Care Task Force of the American College of Physicians. Hematuria as a marker of occult urinary tract cancer: advice for high-value care from the American College of Physicians. Ann Intern Med. 2016;164:488-97. [PMID: 26810935]. doi:10.7326/M15-1496 LinkGoogle Scholar2. Köhler H, Wandel E, Brunck B. Acanthocyturia—a characteristic marker for glomerular bleeding. Kidney Int. 1991;40:115-20. [PMID: 1921146] CrossrefMedlineGoogle Scholar3. Kitamoto Y, Tomita M, Akamine M, Inoue T, Itoh J, Takamori H, et al. Differentiation of hematuria using a uniquely shaped red cell. Nephron. 1993;64:32-6. [PMID: 8502333] CrossrefMedlineGoogle Scholar4. Nagahama D, Yoshiko K, Watanabe M, Morita Y, Iwatani Y, Matsuo S. A useful new classification of dysmorphic urinary erythrocytes. Clin Exp Nephrol. 2005;9:304-9. [PMID: 16362157] CrossrefMedlineGoogle Scholar5. Niemi MA, Cohen RA. Evaluation of microscopic hematuria: a critical review and proposed algorithm. Adv Chronic Kidney Dis. 2015;22:289-96. [PMID: 26088073] doi:10.1053/j.ackd.2015.04.006 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Beth Israel Deaconess Medical Center, Boston, Massachusetts.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L16-0329. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHematuria as a Marker of Occult Urinary Tract Cancer: Advice for High-Value Care From the American College of Physicians Matthew Nielsen , Amir Qaseem , and Hematuria as a Marker of Occult Urinary Tract Cancer Matthew Nielsen and Amir Qaseem Metrics Cited byRaman chemometric urinalysis (Rametrix) as a screen for bladder cancerDipstick analysis of urine chemistry: benefits and limitations of dry chemistry-based assaysCost-Effectiveness of Single Versus Confirmatory Urinalysis in the Evaluation of Asymptomatic Microhematuria 18 October 2016Volume 165, Issue 8Page: 601-602KeywordsChronic kidney diseaseComputed axial tomographyConflicts of interestCystoscopyDisclosureMagnetic resonance imagingMedical risk factorsSpecificityUltrasound imagingUrology ePublished: 18 October 2016 Issue Published: 18 October 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...