Haematuria work-up in general care-A German observational study

Eisenhardt, Andreas; Heinemann, Daniel; Rübben, H.; Heß, Jochen

doi:10.1111/ijcp.12982

Cited by 7 publications

(17 citation statements)

References 34 publications

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“…It is known that BC is a disease of the elderly (30). Macroscopic haematuria, male sex, and age over 60 years have been identified as independent risk factors for BC (31,32). The ratio of male to female for BC was 3:1 consistent with other reports.…”

Section: Discussionsupporting

confidence: 88%

Biomarkers to assess the risk of bladder cancer in patients presenting with haematuria are gender-specific

Duggan

O’Rourke²,

Anderson³

et al. 2022

Front. Oncol.

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IntroductionHaematuria is a common red flag symptom of urinary tract cancer. Bladder cancer (BC) is the most common cancer to present with haematuria. Women presenting with haematuria are often underdiagnosed. Currently, no gender-specific tests are utilized in clinical practice. Considerable healthcare resources are needed to investigate causes of haematuria and this study was set up to help identify markers of BC. The aim of the study was to define biomarker algorithms in haematuria patients using an expanded panel of biomarkers to diagnose BC and investigate if the algorithms are gender-specific.Materials and MethodsA total of n=675 patients with a history of haematuria were recruited from Northern Ireland hospitals. Patients were collected on a 2:1 ratio, non-BC (control) n=474: BC n=201. A detailed clinical history, urine and blood samples were collected. Biomarkers, known to be involved in the pathobiology underlying bladder carcinogenesis were investigated. Biomarkers differentially expressed between groups were investigated using Wilcoxon rank sum and linear regression.ResultsBiomarkers were gender specific. Two biomarker-algorithms were identified to triage haematuria patients; male – u_NSE, s_PAI-1/tPA, u_midkine, u_NGAL, u_MMP-9/TIMP-1 and s_prolactin (u=urine; s=serum); sensitivity 71.8%, specificity 72.8%; AUROC 0.795; and female urine biomarkers - IL-12p70, IL-13, midkine and clusterin; sensitivity 83.7%, specificity 79.7%; AUROC 0.865. Addition of the clinical variable infection to both algorithms increased both AUROC to 0.822 (DeLong p=0.014) and to 0.923 (DeLong p=0.004) for males and females, respectively. Combining clinical risk factors with biomarker algorithms would enable application of the algorithms to triage haematuria patients.ConclusionUsing gender-specific biomarker algorithms in combination with clinical risks that are associated with BC would allow clinicians to better manage haematuria patients and potentially reduce underdiagnosis in females. In this study, we demonstrate, for the first time, that blood and urine biomarkers are gender-specific when assessing risk of BC in patients who present with blood in their urine. Combining biomarker data with clinical factors could improve triage when referring patients for further investigations.

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Section: Discussionsupporting

confidence: 88%

Biomarkers to assess the risk of bladder cancer in patients presenting with haematuria are gender-specific

Duggan

O’Rourke²,

Anderson³

et al. 2022

Front. Oncol.

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“…One health services research study evaluated data relating to 1049 patients of a urology group practice in the Ruhr area of Germany who showed evidence of micro-or macrohematuria in the period 2011 to 2012 (28). The study included 570 women and 479 men (median age 58 years).…”

Section: Further Investigationmentioning

confidence: 99%

“…These include higher age, macrohematuria, male sex, exposure to tobacco smoke, and exposure to occupational toxins. The studies cited above tend to suggest that particular risk groups should be referred for rapid and comprehensive specialist diagnosis (28,29). This applies particularly to smokers and ex-smokers, since smoking is recognized as one of the main risk factors for urothelial carcinoma (24).…”

Section: Risk-adapted Investigationmentioning

confidence: 99%

The Investigation of Hematuria

Bolenz

Schröppel

Eisenhardt

et al. 2018

Deutsches Ärzteblatt International

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Background: Hematuria can be either grossly visible (macrohematuria) or only detectable under a microscope (microhematuria). Microhematuria is often asymptomatic and has a prevalence of 4-5% in routine clinical practice. It may be due to an underlying disease of the kidneys or the urogenital tract. In this article, we provide an overview of the causes of hematuria and of the recommendations of current guidelines for its diagnostic evaluation. A risk-adapted diagnostic strategy for the evaluation of asymptomatic microhematuria (aMH) is presented.Methods: This review is based on pertinent publications retrieved by a selective search in PubMed, as well as on guidelines from Germany and abroad.Results: Hematuria has many causes, and a broad urological and nephrological differential diagnosis must be considered. In the absence of high-quality scientific evidence, the recommendations of current guidelines for the diagnostic evaluation of hematuria are not uniform; this is particularly so for aMH. Microhematuria is said to be present when urine microscopy reveals three or more erythrocytes per highpower field. The basic diagnostic evaluation consists of a thorough history and physical examination, measurement of inflammatory parameters and renal function tests, and ultrasonography of the kidneys and bladder. Patients with non-glomerular aMH who have risk factors such as smoking, advanced age, and male sex are more likely to have relevant underlying conditions and should therefore undergo augmented, risk-adapted diagnostic evaluation with urethrocystoscopy, urine cytology, and, when indicated, CT urography. Patients with isolated glomerular hematuria are at elevated risk for renal disease and should undergo follow-up checks at six-month intervals.Conclusion: Although hematuria is common, there is no uniform, internationally accepted, evidence-based algorithm for its diagnostic evaluation. All potential causes of hematuria must be considered, and all individual risk factors taken into account, so that an underlying disease requiring treatment can be identified or ruled out.

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“…Seven studies recommended age thresholds between 50 and 65 years for initiating an evaluation in response to an MH diagnosis. 11 , 26 , 34 , 35 , 36 , 40 , 42 However, a fixed age threshold is difficult to define because several studies have reported bladder cancer in patients younger than 60 years. 6 , 21 One of those studies reported bladder cancer in 1.2% of patients younger than 40 years.…”

Section: Discussionmentioning

confidence: 99%

“…Factors associated with a higher likelihood of developing UTC among individuals with MH include older age, male sex, history of smoking, and history of visible hematuria. Seven studies recommended age thresholds between 50 and 65 years for initiating an evaluation in response to an MH diagnosis . However, a fixed age threshold is difficult to define because several studies have reported bladder cancer in patients younger than 60 years .…”

Section: Discussionmentioning

confidence: 99%