Urology and nephrology update: proteinuria and hematuria.

Proteinuria and hematuria can be benign or can be signs of more serious underlying pathology. The diagnostic evaluation should take into account the age of the patient as well as medical history, family history, concurrent symptoms, initial physical examination findings, and basic office laboratory test results. There are many tests to consider for proteinuria and hematuria. Routine screening for proteinuria is not recommended in the general population, but it is recommended for high-risk patients, such as those with diabetes and hypertension. Asymptomatic patients should not be screened for hematuria. Patients should be referred to a nephrology subspecialist if proteinuria is drug-resistant, if there is persistent hematuria with concomitant proteinuria, or if a renal biopsy is being considered. Patients should be referred to a urology subspecialist for abnormal genitourinary anatomy, trauma, stones, tumors, nonglomerular gross hematuria, or persistent microscopic hematuria.