Löbig N, Wezel F, Martini T, Schröppel B, Bolenz C
Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland.
Klinik für Innere Medizin I, Sektion Nephrologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
Urologe A. 2017 Sep;56(9):1139-1146. doi: 10.1007/s00120-017-0432-2.
Microscopic hematuria that is not explained by an obvious underlying condition is a frequent and often an incidental finding that commonly triggers urological or nephrological evaluation. Potential underlying conditions range from benign to severe malignant diseases of the kidneys and urinary tract.
A nonsystematic literature search was performed, focusing on potential urological and nephrological causes of hematuria. National and international guidelines were considered and diagnostic as well as follow-up strategies are discussed. We provide a recommendation for practices in the clinical evaluation of hematuria.
The overall prevalence for microscopic hematuria is estimated at approximately 2%, whereas risk populations show an increase to around 30%. In 13-35% of patients presenting with microscopic hematuria, a medical or surgical intervention is required. Malignant tumors of the kidneys or urinary tract can be diagnosed in 2.6-4% of all patients and in up to 25.8% of at-risk populations. "Idiopathic microscopic hematuria" without an obvious underlying medical condition accounts for approximately 80% of patients with asymptomatic hematuria. After exclusion of nephrological diseases, standard diagnostic procedures by means of medical history, physical and laboratory examination as well as ultrasound of the kidneys and the urinary tract should be performed. In the presence of risk factors, an extended diagnostic work-up using cystoscopy, urinary cytology, and cross-sectional imaging of the upper urinary tract is indicated.
Evidence-based strategies of a risk-adapted diagnostic evaluation for microscopic hematuria are not available. The development of reliable clinical and molecular markers offers great potential for the identification of patients at higher risk for harboring severe diseases.
未由明显潜在病因解释的镜下血尿是一种常见且常为偶然发现的情况，通常会引发泌尿外科或肾内科的评估。潜在病因范围从肾脏和尿路的良性疾病到严重恶性疾病。
进行了非系统性文献检索，重点关注血尿的潜在泌尿外科和肾内科病因。参考了国内和国际指南，并讨论了诊断及随访策略。我们为血尿的临床评估实践提供了一项建议。
镜下血尿的总体患病率估计约为2%，而高危人群的患病率则增至约30%。在出现镜下血尿的患者中，13% - 35%需要进行药物或手术干预。在所有患者中，2.6% - 4%可诊断为肾脏或尿路恶性肿瘤，在高危人群中这一比例高达25.8%。无明显潜在内科疾病的“特发性镜下血尿”约占无症状血尿患者的80%。排除肾内科疾病后，应通过病史、体格检查、实验室检查以及肾脏和尿路超声进行标准诊断程序。存在危险因素时，需进行膀胱镜检查、尿细胞学检查以及上尿路横断面成像等进一步的诊断检查。
目前尚无基于证据的针对镜下血尿的风险适应性诊断评估策略。开发可靠的临床和分子标志物对于识别患有严重疾病风险较高的患者具有巨大潜力。
