Non-visible haematuria

GGC - Primary Care
NHS GGC

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Non-visible haematuria in adults – symptomatic?

YES

See alternate pathways

NO

Repeat urine dipstick between 2–6 weeks if on repeat

  • Negative or trace – No referral required
  • >1+ blood - Primary care assessment

Primary care assessment

  • History: Urolithiasis, urological malignancy, related to menstruation, medication or exercise
  • Examination: Abdomen; consider DRE/PV, BP
  • Investigations: MSSU, FBC, eGFR. Consider whether renal referral is appropriate**
  • If confirmed UTI on MSSU, treat as per UTI

 

If no UTI, further management dependent on age

  • >60 years: GP refer URGENT SUSPICION OF CANCER to Urology

  • 45–60 years: Routine GP referral and Urology to arrange US urinary tract with full bladder
    • ABNORMAL Urgent investigation by Urology
    • NORMAL US Letter to patient and GP
  • <45 years: GP to consider renal referral** No referral to Urology

**Renal referral considered?

If eGFR <30 or 10 mL/min decrease in last 5 years, or 4 mL/min in last year
OR
BP >140/90 and <40 years old OR proteinuria (ACR >30 or PCR >50)
OR
Cola-coloured urine in context of concurrent LTRI

Criteria for USC Referral to Urology

≥60 with persistent blood on repeat dipstick with negative urine culture

Abbreviations

  • ACR, albumin to creatinine ratio
  • BP, blood pressure
  • DRE, digital rectal exam
  • eGFR, estimated glomerular filtration rate
  • FBC, full blood count
  • GP, general practitioner
  • LTRI, lower tract respiratory infection
  • MSSU, midstream specimen of urine
  • PV, vaginal examination
  • UTI, urinary tract infection
  • US, ultrasound. 

References

CfSD. Scottish Referral Guidelines for Suspected Cancer 2024 Full Clinical Review (Draft). December 2024.

Editorial Information

Last reviewed: 12/08/2025

Next review date: 30/06/2026

Author(s): Consultant Urologist.

Version: 1

Approved By: Urology South and North Sector