When to test the urine

Initial assessment of :

• hypertension
• haematuria
• reduced eGFR
• oedema or suspected heart failure
• monitoring diabetic patients
• monitoring patients with known renal disease
• monitoring patients on certain drugs (penicillamine)
• family history of CKD stage 5

What is required

Protein - urine sample (preferably early morning) to pathology dept for ACR

Haematuria - local dipstick of fresh urine

What is the ACR?

 Diabetic microalbuminuria guidelines

 

What to do about positive results of urine testing?

 Send blood for eGFR

 

Urine test results:

Protein only or Protein and blood:

Measure the eGFR and then if

• ACR > 70 and eGFR > 30 - routine referral
• ACR > 30 and blood +ve and eGFR > 30 - routine referral
• ACR 30 - 70 and eGFR > 30 - consider e-Advice
• If suspected Nephrotic syndrome (ACR > 250 and low serum albumin) - urgent referral

Invisible haematuria:

Retest to ensure 2 out of 3 positive

Age > 40 years

• urine stick test: blood +ve - refer to Urology
• urine stick test: blood +ve and urology investigation negative then renal referral

Age < 40 years

• urine stick test: blood +ve, ACR < 30, eGFR > 60 & BP normal - monitor annually in primary care
• urine stick test: blood +ve, ACR > 30, or eGFR < 60 or elevated BP - renal referral 

 

Any finding of new eGFR < 60

Consensus Statement on the Assessment of Haematuria

Haematuria Algorithm for Investigation (click to enlarge)

Visible haematuria

Urology referral