Asymptomatic Microscopic Hematuria: Validation of a Risk Index

Several years ago, urologists developed a “Hematuria Risk Index” to predict risk for urologic malignancy in patients with hematuria (Mayo Clin Proc 2013; 88:129). Variables in the index were gross hematuria (4 points), age ≥50 (4 points), smoking history (1 point), male sex (1 point), and >25 red cells per high power field on recent urinalysis (1 point). Now, another group has validated this index in a retrospective study of nearly 1000 patients with asymptomatic microscopic hematuria, for which the maximum possible score is 7 points. Most patients underwent both upper-tract imaging and cystoscopy.

Of 643 patients with scores of 0 to 4, none was diagnosed with malignancy. About half these patients underwent computed tomographic urography, an…