Asymptomatic Microscopic Hematuria in Inpatient Nonsurgical Adults

Objectives: This study sought to determine the proportion of nonsurgical inpatients with asymptomatic microscopic hematuria (AMH) who qualified for urologic investigation according to consensus guidelines. Methods: The study population included all patients acutely admitted to the internal medicine departments of Israeli regional hospitals between 2014 and 2017. Results: Of 29,086 consecutive admissions, 10,116 (34.8%) underwent dipstick urinalysis and 8,389 (28.8%) underwent reflex microscopic urinalysis. After the exclusion of patients with a urethral catheter or a positive urine culture, 2,206 had 3 or more RBCs per high-power field, and as many as 2,052 (7.1% of the entire cohort and 24.4% of all patients undergoing microscopic urinalysis) met the criteria for a urologic workup. Conclusions: We conclude that according to the consensus guidelines, an unreasonably high proportion of hospitalized nonsurgical patients would be referred for a urologic workup of uncertain clinical utility because of an incidental AMH finding.