Diagnosis
Get a good history: Has this happened in the past? OPQRST-A questions. PMH /PSH, FHx of GU cancer, Soc Hx (SAD), sexual history, Medications (any renotoxic meds?), allergies.
Microscopic hematuria vs. gross hematuria.
PE: Examine genital area and general PE.
DDx and Etiology.
CBC, CMP, PT, INR to evaluate for blood loss anemia and coags since the patient is bleeding.
Urine dipstick, UA & Urine culture.
Microscopic Urinalysis / Urine sediment to look for dysmorphic RBCs or RBC casts which may indicate GN and lead to consideration of renal biopsy.
Urine cytology (NB: this is not a substitute for cystoscopy)
Helical CT with or without contrast to r/o stones and neoplasia of upper tract)
Cystoscopy to r/o bladder neoplasia, especially in patients 35 years or older.
May consider MRI, retrograde pyelogram, and U/S as if necessary.
Treatment
Determined by cause.
Consider referral to urology.
**Increasing age is a risk factor for neoplasm. In younger patients who are less than 20 years of age, think first of GN, UTI, and congenital causes. In older patients, UTI is still there but also are nephrolithiasis and cancer. For males, think prostatitis.
Resources:
http://www.aafp.org/afp/2013/1201/p747.html