Title : Beyond cancer exclusion: Modernising urology haematuria pathways to detect missed glomerular disease
Abstract:
Aim: Haematuria pathways primarily target urothelial malignancy, as reflected in current NICE guidance. However, this approach risks missing glomerular disease in younger adults, where early identification of conditions such as IgA nephropathy and inherited haematuric disorders may improve long-term renal outcomes. This project evaluated renal investigation practices in patients with haematuria and normal urological findings and used the results to redesign the local pathway at Oxford University Hospitals (OUH).
Methods: A retrospective review was undertaken of 100 consecutive adults referred to the urology haematuria service at Churchill Hospital (August–September 2025). All patients underwent flexible cystoscopy and ultra-low-dose computed tomography kidneys, ureters and bladder. Data collected included haematuria type, estimated glomerular filtration rate (eGFR), albuminuria testing (uACR/uPCR), urological findings and nephrology referral outcomes.
Results: Median age was 54 years; 71% had non-visible and 29% visible haematuria. Urological malignancy was identified in 9% (all aged ≥60 years). Normal cystoscopy and imaging occurred in 62%, while 29% had benign causes. Among patients with normal investigations, 66% were aged 20–50 years. In this subgroup, eGFR was documented in 60% and uACR/uPCR in only 18%. No patients with persistent haematuria and normal urological investigations were referred for suspected glomerular disease.
Conclusions: Current haematuria pathways under-investigate younger adults at risk of glomerular disease. Based on these findings, OUH implemented a revised pathway mandating eGFR and proteinuria testing in all 20–60-year-olds, with automatic referral to an early-proteinuria clinic for abnormal results, enabling earlier renal diagnosis and pathway modernisation.
