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uro.hematuria-microscopic-surveillance.v1

Microscopic Hematuria Surveillance — chronic outpatient post-workup (AUA 2020 low / intermediate / high risk bands + IgA / Alport / sickle / anticoag / pediatric / schistosomiasis overlays)

urologychronicadultpediatricgeriatricoutpatient
Start encounter →Print handoutPRODUCTION

Phase C wave-12 initial author (2026-05-15): SCAFFOLDED with full §5.5 depth — 11 phenotypes = 11 severity_triggers (AUA low/intermediate/high + persistent + recurrent + IgA + Alport + sickle + anticoag + pediatric + schistosomiasis), 1 setting playbook (outpatient primary), 6-PMID anchor set (all NEEDS_SOURCE_REVIEW), 3 regimen axes (surveillance schedule + risk-factor modification + schistosomiasis endemic), 4 sibling rows pointing at REAL existing engines (symptom.hematuria.v1, renal.iga-nephropathy.v1, renal.rpgn.core.v1, heme.sickle-cell.core.v1). AUA 2020 Microhematuria risk-band stratification is the load-bearing instrument: low (UA q6mo), intermediate (UA annual + imaging q3-5y), high (UA annual + cysto q1-3y). Reassessment q5y or with new risk factors. Glomerular phenotype routing — dysmorphic RBCs / RBC casts / proteinuria → renal.iga-nephropathy.v1 OR renal.rpgn.core.v1 per tempo. Anticoag-associated hematuria does NOT exempt from AUA 2020 workup — rule structural lesion BEFORE attributing. Schistosomiasis endemic-area overlay → urine ova + praziquantel 40 mg/kg single + heightened squamous cell bladder cancer surveillance. Schema-blocked downstream: calc.aua_microhematuria_risk_2020, protocol.surveillance_schedule_micro, cascade.glomerular_vs_nonglomerular, cascade.bladder_ca_smoker_high_risk — depth brief §6. Promoted SCAFFOLDED→INTEGRATED 2026-05-22 (shard-5 build campaign): all 6 prior placeholder PMIDs were mis-attributed (COVID cardiac imaging, autism mouse models, neural-differentiation biochemistry, Vibrio PCR, depression PRS [recycled], sympathetic ophthalmia) and replaced with the live-verified AUA/SUFU Microhematuria 2020 guideline (32698717); KDIGO glomerular-disease and schistosomiasis cited by name. RxCUIs corrected: varenicline 1455007→591622, nicotine 17767→7407 (was amlodipine), praziquantel 8676→8628; lisinopril/losartan/bupropion RxNav-verified.

Entry points (7)

  • history
    Index AUA 2020 microhematuria workup completed (cystoscopy ± CT urography) — entering surveillance phase
    post_microhematuria_workup_completed
  • lab_abnormality
    Repeat UA at surveillance visit shows positive micro (3+ RBC/HPF) → reassess risk band
    repeat_ua_positive_micro
  • symptom
    Recurrent gross hematuria during surveillance → full re-workup required (AUA 2020)
    recurrent_gross_hematuria
  • history
    IgA nephropathy on prior renal biopsy → glomerular surveillance + route renal.iga-nephropathy.v1
    iga_nephropathy_known_post_biopsy
  • history
    Family history of Alport / thin BM disease / familial hematuria → genetic + nephrology referral
    family_hx_alport_thin_basement
  • history
    Sickle trait / sickle cell disease known → papillary necrosis / hyposthenuria; route heme.sickle-cell.core.v1
    sickle_trait_or_disease_known
  • history
    Pediatric patient with chronic microhematuria after initial workup
    pediatric_chronic_micro_post_initial_workup

Required inputs (18)

  • agerequired
    demographic • used at FRAME
    Age >60 + smoker = high risk band; pediatric pattern differs (less malignancy, more thin BM / IgA / Alport / hypercalciuria) (AUA 2020)
  • sexrequired
    demographic • used at FRAME
    Women <50 + men <40 + never-smoker is low risk (AUA 2020)
  • smoking_statusrequired
    history • used at CONTEXT
    Current / former smoker raises bladder cancer risk → high risk band (AUA 2020)
  • occupational_chemical_exposurerequired
    history • used at CONTEXT
    Aniline dye / rubber / leather / textile / cyclophosphamide exposure → high risk band (AUA 2020)
  • prior_pelvic_radiation
    history • used at CONTEXT
    Pelvic radiation raises radiation cystitis + secondary malignancy risk
  • family_hx_hematuria_alport_iga_renal_failurerequired
    history • used at CONTEXT
    Family hx Alport / IgA / thin BM / hereditary nephritis → genetic workup
  • family_hx_bladder_cancer_renal_cancer
    history • used at CONTEXT
    First-degree relative with bladder or renal cancer → AUA 2020 risk modifier
  • sickle_trait_history
    history • used at CONTEXT
    Sickle trait → papillary necrosis / hyposthenuria; route heme.sickle-cell.core.v1
  • anticoagulation_statusrequired
    history • used at CONTEXT
    Warfarin / DOAC / antiplatelet — anticoag should NOT mask workup; rule structural lesion before attributing to anticoag
  • travel_endemic_schistosomiasis
    history • used at CONTEXT
    Travel / immigration from endemic area → Schistosoma haematobium screening → squamous bladder cancer risk
  • aua_2020_initial_risk_bandrequired
    history • used at CONTEXT
    Prior AUA 2020 risk stratification (low / intermediate / high) anchors surveillance cadence
  • prior_workup_findingsrequired
    history • used at CONTEXT
    Prior cysto + imaging findings (normal vs benign vs CIS / dysplasia) drives cadence
  • urinalysis_microscopyrequired
    lab • used at INITIAL_WORKUP
    Surveillance UA — RBC count, dysmorphic RBC + RBC casts (glomerular), proteinuria (ACR), nitrites (UTI exclusion) (AUA 2020)
  • creatinine_egfrrequired
    lab • used at INITIAL_WORKUP
    Baseline renal function + monitoring for glomerular phenotype progression (KDIGO 2021)
  • urine_acr
    lab • used at INITIAL_WORKUP
    Proteinuria + hematuria = glomerular phenotype → route renal.iga-nephropathy.v1 OR renal.rpgn.core.v1 (KDIGO 2021)
  • sbprequired
    vital • used at INITIAL_WORKUP
    HTN + glomerular phenotype → progressive CKD risk; KDIGO 2021 target <130/80
  • renal_us_or_ct_urography
    imaging • used at BRANCHING_WORKUP
    Surveillance imaging cadence: q3-5y intermediate; baseline + per findings high risk (AUA 2020)
  • cystoscopy
    imaging • used at BRANCHING_WORKUP
    High-risk surveillance — annual UA + cysto q1-3y per initial path findings (AUA 2020)

12-phase flow (12)

  1. 1FRAME
    Adult / pediatric / geriatric patient with completed initial microhematuria workup per AUA 2020; entering surveillance phase (AUA 2020)
    inputs: age, sex
    advance: engine scope confirmed
  2. 2ENTRY
    Risk-band-cadence surveillance visit OR new symptom (recurrent gross hematuria, new RBC casts, proteinuria, declining eGFR) (AUA 2020)
    advance: entry point documented
  3. 3CONTEXT
    Smoking, occupational exposure, prior pelvic radiation, family hx (Alport / IgA / thin BM / bladder ca / renal ca), sickle trait, anticoagulation, travel endemic, prior AUA risk band, prior workup findings (AUA 2020; KDIGO 2021)
    inputs: smoking_status, occupational_chemical_exposure, prior_pelvic_radiation, family_hx_hematuria_alport_iga_renal_failure, family_hx_bladder_cancer_renal_cancer, sickle_trait_history, anticoagulation_status, travel_endemic_schistosomiasis, aua_2020_initial_risk_band, prior_workup_findings
    advance: context + risk-band documented
  4. 4RED_FLAGS
    Recurrent gross hematuria → full re-workup; new flank mass / weight loss / B symptoms → STAT urology + onc; rapidly rising creatinine + RBC casts → STAT nephrology (rule RPGN — route renal.rpgn.core.v1); pediatric proteinuria + HTN → nephrology STAT (AUA 2020; KDIGO 2021)
    advance: no red flags OR routed
  5. 5INITIAL_WORKUP
    Surveillance visit: UA + microscopy (dysmorphic, casts), creatinine + eGFR, BP, weight, ACR if glomerular features (AUA 2020; KDIGO 2021)
    inputs: urinalysis_microscopy, creatinine_egfr, urine_acr, sbp
    actions: panel.ua, panel.renal, panel.cbc
    advance: surveillance labs documented
  6. 6BRANCHING_WORKUP
    RBC casts / dysmorphic RBC / proteinuria + declining eGFR → glomerular workup (route renal.iga-nephropathy.v1 OR renal.rpgn.core.v1); intermediate / high band positive findings → repeat cysto / upper tract imaging; pediatric → renal US + spot Ca/Cr; sickle hx → route heme.sickle-cell.core.v1; schistosomiasis travel → urine ova + Praziquantel (KDIGO 2021)
    inputs: renal_us_or_ct_urography, cystoscopy
    advance: directed workup performed
  7. 7DIFFERENTIAL
    Reaffirm prior workup OR identify new pathology — stone, GU malignancy, glomerular disease, hereditary nephritis (Alport / thin BM), sickle trait, anticoag-related, schistosomiasis (AUA 2020; KDIGO 2021)
    advance: differential reaffirmed or revised
  8. 8RISK_STRATIFICATION
    AUA 2020 risk band; KDIGO CKD stage; glomerular vs non-glomerular pattern (AUA 2020; KDIGO 2021)
    advance: risk band reaffirmed
  9. 9TREATMENT
    Surveillance schedule per band; risk-factor modification (smoking cessation, BP control, glycemic control); specialty referral if new findings; deprescribe / adjust anticoag with bleeding-risk evaluation; genetic counseling for hereditary nephritis (AUA 2020; KDIGO 2021)
    inputs: smoking_status, sbp
    advance: plan documented
  10. 10DISPOSITION
    Primary care + uro surveillance schedule; nephrology referral if glomerular; oncology referral if new mass; pediatric uro if peds (AUA 2020)
    advance: disposition documented
  11. 11MONITORING
    UA q6mo (low risk), annual UA + imaging q3-5y (intermediate), annual UA + cysto q1-3y (high); BP at each visit; creatinine + eGFR + ACR per CKD stage; pediatric calcium-creatinine ratio (AUA 2020; KDIGO 2021)
    advance: monitoring cadence documented
  12. 12FOLLOWUP
    Annual review; reassess risk band q5y or with new risk factors (cigarette restart, occupational exposure change, new family hx); coordinate with primary care (AUA 2020)
    advance: follow-up scheduled