Hematuria in Refugee Patients

Overview

Microscopic hematuria (more than 3 RBCs per high-power field on urine microscopy) is a common finding in refugee patients. The approach is similar to the general population, with two additional considerations: schistosomiasis and urinary tuberculosis.

Routine urinalyses are NOT recommended in asymptomatic patients.

Step 1 - Rule Out Schistosomiasis

In patients from endemic countries, confirm that schistosoma serology was completed as part of initial screening. If not, order it now. If schistosomiasis is confirmed, treat with praziquantel (see Schistosomiasis page). Repeat urinalysis at least 1 month after treatment. If hematuria persists, re-treat with a second dose. If it persists after that, investigate for another cause.

Step 2 - Complete the History

Ask about:

*     Macroscopic hematuria (red or brown urine). If present, urgent urology referral alongside investigations.

*     Flank pain, dysuria, pyuria, urinary frequency or retention

*     Smoking history

*     Family or personal history of bleeding disorders

*     Sexual history (STI risk)

*     For women: timing relative to menstruation and recent exercise or trauma

Step 3 - Investigate Common Causes

Order:

*     Repeat urinalysis

*     Urine culture and sensitivity

*     Chlamydia/gonorrhea NAAT (if not already done)

*     Serum creatinine

*     Urine microalbumin

*     Renal and bladder ultrasound

Proteinuria, elevated creatinine, RBC casts, dysmorphic RBCs, hypertension, or cola-coloured urine suggest glomerular bleeding. Refer to Nephrology.

Step 4 - Rule Out Urinary TB

In patients from high TB-incidence countries with unexplained hematuria, order at least 3 early-morning (first void) urine samples for acid-fast stain and mycobacterial culture. Order using the CLS Microbiology Requisition.

Step 5 - Urology Referral

If hematuria remains unexplained after the above workup, refer to a Urologist for cystoscopy.

Calgary: Calgary Zone Urology Referral Quick Reference