Truniger B
Medizinische Klinik, Kantonsspital Luzern.
Schweiz Med Wochenschr. 1987 Dec 12;117(50):1993-8.
Microhematuria offers a wide spectrum of diagnostic possibilities. Once the finding is confirmed, the diagnosis of prerenal, renal-parenchymatous and postrenal (or even factitious) hematuria and differentiation between glomerular and nonglomerular bleeding sources is based on the patient's history, a complete clinical status, special urinary findings (mainly red cell casts, proteinuria and red cell morphology) and blood chemistry (serum creatinine or creatinine clearance). If on the basis of this information glomerular or renal-parenchymatous microhematuria seems likely, further diagnostic procedures include immunological tests and, if indicated and justified, renal biopsy. Urography and other imaging procedures, urinary cytology and cystoscopy (firmly indicated when doubts persist or all the evidence points to postrenal hematuria) are deferred whenever glomerular hematuria seems likely. The special aspects of isolated renal microhematuria are discussed.
镜下血尿提示多种诊断可能性。一旦确诊，基于患者病史、完整的临床状况、特殊尿液检查结果（主要是红细胞管型、蛋白尿和红细胞形态）以及血液生化指标（血清肌酐或肌酐清除率），对肾前性、肾实质性和肾后性（甚至人为性）血尿进行诊断，并区分肾小球性和非肾小球性出血来源。如果根据这些信息怀疑可能为肾小球性或肾实质性镜下血尿，进一步的诊断程序包括免疫学检查，如有必要且合理，还需进行肾活检。当怀疑为肾小球性血尿时，应推迟进行尿路造影和其他影像学检查、尿液细胞学检查及膀胱镜检查（当仍有疑问或所有证据均指向肾后性血尿时，强烈建议进行膀胱镜检查）。本文讨论了孤立性肾镜下血尿的特殊情况。
