Patient handout

Hematuria (gross / microscopic)

PRODUCTION

1. Your condition

This handout is for hematuria (gross / microscopic). Your care team identified this based on: visible (gross) hematuria — stat cystoscopy + ctu indication regardless of age (aua 2020 pmid 32698717).

Other reasons your team may use this plan: microhematuria (≥3 rbc/hpf on properly collected sample) — aua 2020 risk-stratified workup; hematuria with flank pain / dysuria — stone vs uti vs pyelonephritis (aua stones 2026); gross hematuria with bladder clot retention — stat cbi + urology (aua 2020).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
nitrofurantoin	100 mg	PO	BID × 5 d	IDSA 2010 PMID 21292654 — first-line uncomplicated cystitis; avoid pyelo / male prostatitis; AUC efficacy excellent at CrCl ≥30
fosfomycin	3 g	PO	single dose	IDSA 2010 single-dose option; lower efficacy than 5-d nitrofurantoin in some studies but excellent for resistant Enterobacterales
cefpodoxime	100-200 mg	PO	BID × 7 d	IDSA 2010 outpatient pyelonephritis option; check local Enterobacterales resistance
ceftriaxone	1 g IV	IV	daily	IDSA 2010 inpatient pyelo; broad Enterobacterales coverage; pair with decompression for obstructed infected stone (AUA Stones 2026)

Plan: UTI-directed antibiotics for cystitis / pyelonephritis (IDSA 2010 PMID 21292654)

3. When to call your provider

Contact your care team if any of the following happen:

New gross hematuria → urgent urology / ED
Persistent micro hematuria after low-risk 6-mo UA → upgrade workup to intermediate-risk pathway
Rising Cr / new proteinuria → nephrology urgently — RPGN consideration (renal.rpgn.core.v1)
Symptomatic anemia → CBC + urology

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Visible (gross) hematuria — at any age = AUA 2020 high-risk (5× malignancy risk vs micro); STAT cystoscopy + CT urography indication (PMID 32698717)
AUA 2020 high-risk microhematuria: age >60 OR >30 pack-years OR >25 RBC/HPF OR risk-factor cluster (FH urothelial / Lynch, dye exposure, prior pelvic XRT, cyclophosphamide, aristolochic herb)
Dysmorphic RBCs + RBC casts + proteinuria (UPCR >0.5 g/g) + HTN ± rising Cr — glomerular hematuria pattern
Obstructing ureteral stone + UTI / sepsis features (fever + WBC + lactate + hypotension) — urologic emergency(life-threatening)
Gross hematuria with bladder clot retention — inability to urinate, suprapubic pain, palpable / scanned bladder distension
Hematuria during or after cyclophosphamide / ifosfamide therapy — acrolein-mediated mucosal injury; also pelvic radiation cystitis

5. Follow-up

Urology referral for non-glomerular per AUA tier; nephrology + biopsy decision for glomerular (KDIGO 2021); smoking cessation counseling (AUA 2020); travel-medicine for schistosomiasis post-treatment serology (Prakash 2015)

6. Sources

Guideline: AUA/SUFU Microhematuria Guideline 2020 + 2025 update (Barocas) + IDSA/ESCMID Uncomplicated UTI 2010 (Gupta) + AUA Surgical Management of Stones Guideline 2026 (Pearle) + KDIGO 2021 Glomerular Diseases + urogenital schistosomiasis (Prakash, Kidney Int 2015)