Haematuria – macroscopic

Microscopic haematuria is discussed elsewhere.

Macroscopic haematuria carries different connotations. In haematuria clinics, about one in three cases are associated with malignancy somewhere in the urinary tract. Nephritis is a rare cause.

Of the causes of haematuria listed in the diagram in our patient leaflet on haematuria, some are particularly likely to cause macroscopic haematuria:

Malignancy of kidney, collecting system or bladder
Acute Nephritis severe crescentic nephritis
acute post-streptococcal nephritis (usually pink or smoky rather than frank blood)
IgA nephropathy in young people, usually with an acute respiratory infection (usually pink or smoky rather than frank blood)
Infection usually requires severe cystitis
Rare infarction
Could it be caused by nephritis?

Ask about reduced urine output (oliguria). Refer to risk factors for renal disease (from the guideline on microscopic haematuria).


A clinic for patients with macroscopic haematuria is run by the Department of Urology at WGH.
Flexible cystoscopy is carried out in the clinic followed by IVU, urine cytology and further investigations arranged as required.
How to refer – send a unique referral letter to the Dept of Urology at WGH – ideally faxed to (0131) 537 1019.

Further information

EdRenINFO comprises our web pages containing information about kidney diseases for patients, doctors and all medical staff. The page on haematuria should be useful for patients.

The recommendations above are concordant with the approach recommended in the SIGN Guidelines; however we are told that Guideline 17 is currently withdrawn as revision has not been undertaken.

The EdRenHANDBOOK contains information aimed primarily at hospital doctors about immediate management of renal problems.