McDonald Mary M, Swagerty Daniel, Wetzel Louis
Department of Family Medicine, University of Kansas School of Medicine, Kansas City, Kansas 66160-7117, USA.
Am Fam Physician. 2006 May 15;73(10):1748-54.
Microscopic hematuria, a common finding on routine urinalysis of adults, is clinically significant when three to five red blood cells per high-power field are visible. Etiologies of microscopic hematuria range from incidental causes to life-threatening urinary tract neoplasm. The lack of evidence-based imaging guidelines can complicate the family physician's decision about the best way to proceed. Patients with proteinuria, red cell casts, and elevated serum creatinine levels should be referred promptly to a nephrology subspecialist. Microscopic hematuria with signs of urinary tract infection should resolve with appropriate treatment of the underlying infection. Patients with asymptomatic microscopic hematuria or with hematuria persisting after treatment of urinary tract infection also need to be evaluated. Because upper and lower urinary tract pathologies often coexist, patients should be evaluated using cytology plus intravenous urography, computed tomography, or ultrasonography. When urine cytology results are abnormal, cystoscopy should be performed to complete the investigation.
镜下血尿是成人尿常规检查中的常见发现，当每高倍视野可见三到五个红细胞时具有临床意义。镜下血尿的病因范围从偶然原因到危及生命的泌尿系统肿瘤。缺乏基于证据的影像学指南会使家庭医生难以决定最佳的处理方式。有蛋白尿、红细胞管型和血清肌酐水平升高的患者应立即转诊至肾脏病专科医生处。伴有尿路感染迹象的镜下血尿应通过对潜在感染进行适当治疗而得到缓解。无症状镜下血尿患者或尿路感染治疗后血尿仍持续的患者也需要进行评估。由于上尿路和下尿路病变常同时存在，应使用细胞学检查加静脉肾盂造影、计算机断层扫描或超声对患者进行评估。当尿液细胞学检查结果异常时，应进行膀胱镜检查以完成检查。
