The Clinical Challenge
Although hematuria has long been appreciated as a clinical presentation requiring medical attention, it still poses several clinical challenges. Because renal biopsy in most countries is not typically part of the evaluation of microscopic hematuria, the main challenge is to predict the future risk for chronic kidney disease (CKD) and, therefore, to design a long-term follow-up evaluation and treatment plan. In this respect, we will try to address two questions; first, can persistent isolated microscopic hematuria with a negative evaluation be considered a benign condition with low risk for progression to chronic disease? Second, if not, do the underlying causes have available therapeutic interventions that could influence the natural history of disease with the aim of preempting or delaying kidney injury?
We focus here on the risk for CKD among young persons with a negative initial diagnostic evaluation of persistent isolated microscopic hematuria. The risk for CKD secondary to transient hematuria or other hematuria-related conditions such as non-glomerular sources of hematuria (e.g. nephrolithiasis), causes involving the lower urinary tract (e.g. disorders of the bladder, urethra, and prostate), and cancers are beyond the scope of this review.