Evaluation of Microscopic Hematuria in Patients with Simple Renal Cysts

Clinical Implications for Workup

The American College of Radiology notes that while ultrasound may be used to evaluate for occult anatomic abnormalities including cystic renal disease in cases of persistent unexplained microhematuria, the yield of these examinations is low and imaging findings are usually not specific for any underlying pathology 2, 3, 4, 5
Do not attribute the hematuria to the cyst without completing a full urologic evaluation, which should include comprehensive urine examination, assessment for dysmorphic red blood cells or red cell casts, testing for proteinuria and urinary tract infection, measurement of serum creatinine, radiologic imaging of the upper urinary tract, and cystoscopic examination 1
Anticoagulation therapy, BPH, and simple renal cysts are common findings that should not preclude thorough evaluation of persistent microscopic hematuria, as other significant pathology may be present 1, 6

Patients should be stratified based on actual risk factors for urologic malignancy (age, smoking history, degree of hematuria), not on the presence of simple renal cysts 1, 6
For patients with persistent hematuria after negative initial evaluation, repeat urinalysis, urine cytology, and blood pressure determination at 6, 12, 24, and 36 months is recommended, with nephrology referral if hematuria persists with development of hypertension, proteinuria, or evidence of glomerular bleeding 1, 7