nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/1680-4422-2018-1-77-84nid-325Research ArticleШКОЛА НЕФРОЛОГАEDUCATIONAL MATERIALSБессимптомная микрогематурия у взрослых - причины и дифференциальная диагностикаAsymptomatic microscopic hematuria in adults - causes and differential diagnosisЗахароваЕ. В.ZakharovaE. V.noemail@neicon.ruСамородскаяИ. В.SamorodskayaI. V.samor2000@yandex.ruФГБУ ВО "МГМСУ имени А.И. Евдокимова", кафедра нефрологии ФДПО; ФГБОУ ДПО РМАНПО, кафедра нефрологии и гемодиализаРоссияMoscow State University of Medicine and Dentistry, Nephrology; Russian Medical Academy of Continuous Postgraduate Education, Nephrology and HemodialysisRussian FederationФГБУ "НМИЦ профилактической медицины" Минздрава РоссииРоссияNational Medical Center of Preventive MedicineRussian Federation2018120820242017784Copyright © Захарова Е.В., Самородская И.В., 20242024Захарова Е.В., Самородская И.В.Zakharova E.V., Samorodskaya I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/325

В статье представлены существующие в настоящее время определения бессимптомной микрогематурии, предлагаемые для использования в клинической практике согласно рекомендациям ряда профессиональных сообществ и ассоциаций, и приводятся требования к сбору образцов мочи для корректной количественной оценки микрогематурии. Представлены также подробные сведения о распространенности бессимптомной микрогематурии у взрослых пациентов в различных половозрастных группах по данным ряда крупных когортных и скрининговых исследований. Подробно рассмотрены возможные причины как негломерулярной, так и гломерулярной бессимптомной микрогематурии у взрослых пациентов различных половозрастных групп. Детально освещены различные лабораторные и инструментальные методы обследования, рекомендуемые для установления природы бессимптомной микрогематурии у взрослых пациентов. Представлены и обсуждены показания и противопоказания к выполнению различных методов обследования у пациентов в зависимости от пола и возраста. Приводятся данные о характере выявляемой при выполнении тех или иных инструментальных и дополнительных видов обследования патологии. Кроме того, схематично представлен алгоритм обследования взрослых пациентов с бессимптомной микрогематурией с учетом необходимости одновременного исключения как урологической, так и нефрологической патологии.

The review presents current definitions for asymptomatic microscopic hematuria, recommended for clinical application in the Guidelines issued by several associations and societies, and the regulations for urine samples collection for accurate quantitative evaluation of microscopic hematuria. Detailed information about the prevalence of asymptomatic microscopic hematuria in adult patients depending on age and sex are provided according to the data from several large cohorts and screening trials. The causes of non-glomerular and glomerular microscopic hematuria are presented. Different laboratory tests and examination techniques recommended for the evaluation of patients with asymptomatic microscopic hematuria and differential diagnostic are discussed, as well as the indications and contraindications for particular examination techniques application depending on age and sex of the patients. The results of patient’s evaluation with different methods are shown. In addition, the work-up algorithm for the adult patients with asymptomatic microscopic hematuria, considering the need to rule out both urological and glomerular/interstitial disorders, is provided.

бессимптомная микрогематурияурологияонкологиянефрологияasymptomatic microscopic hematuriaurologyoncologynephrologyReferencesУрология. Российские клинические рекомендации / под ред. Ю.Г. Аляева, П.В. Глыбочко, Д.Ю. Пушкаря. М.: ГЭОТАР-Медиа, 2015. 480 с.Урология. Российские клинические рекомендации / под ред. Ю.Г. Аляева, П.В. Глыбочко, Д.Ю. Пушкаря. М.: ГЭОТАР-Медиа, 2015. 480 с.Brenner D.J., Hall E.J. Computed tomography - an increasing source of radiation exposure. N Engl J Med. 2007. 357(22): 2277-2284.Brenner D.J., Hall E.J. Computed tomography - an increasing source of radiation exposure. N Engl J Med. 2007. 357(22): 2277-2284.Committee Opinion No.703: Asymptomatic Microscopic Hematuria in Women. Obstet Gynecol. 2017 Jun; 129(6):e168-e172. doi: 10.1097/AOG.0000000000002059.Committee Opinion No.703: Asymptomatic Microscopic Hematuria in Women. Obstet Gynecol. 2017 Jun; 129(6):e168-e172. doi: 10.1097/AOG.0000000000002059.Davis R., Jones J., Barocas D. et al. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol. 2012; 188 (6) Suppl: 2473-81. https://doi.org/10.1016/j.juro.2012.09.078Davis R., Jones J., Barocas D. et al. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol. 2012; 188 (6) Suppl: 2473-81. https://doi.org/10.1016/j.juro.2012.09.078Floege J., Feehally J. Introduction to Glomerular Disease: Clinical Presentation. In: Comprehensive Clinical Nephrology, 4-th Edition, ed J Floege, RJ Johnson, J Feehally, ELSEVEIR 2010, p 193-207.Floege J., Feehally J. Introduction to Glomerular Disease: Clinical Presentation. In: Comprehensive Clinical Nephrology, 4-th Edition, ed J Floege, RJ Johnson, J Feehally, ELSEVEIR 2010, p 193-207.Gulati S., Langman C. Hematuria. 2017; http://emedicine.medscape.com/article/981898-overviewGulati S., Langman C. Hematuria. 2017; http://emedicine.medscape.com/article/981898-overviewJefferies E., Brewster S. Oncology BSo. Urological recommendations from the National Institute for Health and Care Excellence (NICE) Guideline, 2016: Suspected cancer: recognition and referral. BJU international. 2016; 117(6): 857-860. https://doi: 10.1111/bju.13355Jefferies E., Brewster S. Oncology BSo. Urological recommendations from the National Institute for Health and Care Excellence (NICE) Guideline, 2016: Suspected cancer: recognition and referral. BJU international. 2016; 117(6): 857-860. https://doi: 10.1111/bju.13355Kang M., Lee S., Jeong S. еt al. Characteristics and significant predictors of detecting underlying diseases in adults with asymptomatic microscopic hematuria: a large case series of a Korean population. Int J Urol. 2015; 22 (4): 389-393. https://doi: 10.1111/iju.12697.Kang M., Lee S., Jeong S. еt al. Characteristics and significant predictors of detecting underlying diseases in adults with asymptomatic microscopic hematuria: a large case series of a Korean population. Int J Urol. 2015; 22 (4): 389-393. https://doi: 10.1111/iju.12697.Kassouf W., Aprikian A., Black P. еt al. Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA). Can Urol Assoc J. 2016; 10 (1-2): 46-80. https://doi: 10.5489/cuaj.3583Kassouf W., Aprikian A., Black P. еt al. Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA). Can Urol Assoc J. 2016; 10 (1-2): 46-80. https://doi: 10.5489/cuaj.3583Kelly J., Fawcett D., Goldberg L. Assessment and management of non-visible haematuria in primary care. BMJ. 2009; 338: a3021. doi: 10.1136/bmj.a3021.Kelly J., Fawcett D., Goldberg L. Assessment and management of non-visible haematuria in primary care. BMJ. 2009; 338: a3021. doi: 10.1136/bmj.a3021.Stevens P.E., Levin A. Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013; 158 (11): 825-830. doi: 10.7326/0003-4819-158-11-201306040-00007.Stevens P.E., Levin A. Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013; 158 (11): 825-830. doi: 10.7326/0003-4819-158-11-201306040-00007.Lee H., Hyun J., Min J., еt al. The Natural Course of Biopsy-Proven Isolated Microscopic Hematuria: A Single CenterLee H., Hyun J., Min J., еt al. The Natural Course of Biopsy-Proven Isolated Microscopic Hematuria: A Single CenterExperience of 350 Patients. J Korean Med Sci. 2016; 31: 909-914. https://doi.org/10.3346/jkms.2016.31.6.909Experience of 350 Patients. J Korean Med Sci. 2016; 31: 909-914. https://doi.org/10.3346/jkms.2016.31.6.909Levey A., Stevens L., Schmid C. еt al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150 (9): 604-612Levey A., Stevens L., Schmid C. еt al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150 (9): 604-612Linder B., Boorjian S., Trabuco E. еt al. Defining the Prevalence of Asymptomatic Microscopic Hematuria Among Women With Symptomatic Pelvic Organ Prolapse: Implications for Recommending Subsequent Diagnostic Evaluation. Urology. 2017; 103: 68-72. https://doi: 10.1016/j.urology.2017.02.003Linder B., Boorjian S., Trabuco E. еt al. Defining the Prevalence of Asymptomatic Microscopic Hematuria Among Women With Symptomatic Pelvic Organ Prolapse: Implications for Recommending Subsequent Diagnostic Evaluation. Urology. 2017; 103: 68-72. https://doi: 10.1016/j.urology.2017.02.003Loo R., Lieberman S., Slezak J. еt al. Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria. Mayo Clin Proc. 2013; 88(2): 129-138. https://doi: 10.1016/j.mayocp.2012.10.004Loo R., Lieberman S., Slezak J. еt al. Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria. Mayo Clin Proc. 2013; 88(2): 129-138. https://doi: 10.1016/j.mayocp.2012.10.004Nielsen M., Qaseem A. Hematuria as a Marker of Occult Urinary Tract Cancer: Advice for High-Value Care from the American College of Physicians. Ann Intern Med. 2016; 164 (7): 488-497. doi: 10.7326/M15-1496.Nielsen M., Qaseem A. Hematuria as a Marker of Occult Urinary Tract Cancer: Advice for High-Value Care from the American College of Physicians. Ann Intern Med. 2016; 164 (7): 488-497. doi: 10.7326/M15-1496.Pillalamarri N., Shalom D., Sanidad S. еt al. The prevalence of microscopic hematuria in a cohort of women with pelvic organ prolapse. International urogynecology journal. 2015; 26 (1); 85-90. https://doi: 10.1007/s00192-014-2450-6Pillalamarri N., Shalom D., Sanidad S. еt al. The prevalence of microscopic hematuria in a cohort of women with pelvic organ prolapse. International urogynecology journal. 2015; 26 (1); 85-90. https://doi: 10.1007/s00192-014-2450-6Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults. Am Fam Physician. 2013; 88(11):747-54.Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults. Am Fam Physician. 2013; 88(11):747-54.Shen L., Raman S., Beland M. еt al. Expert Panel on Urologic Imaging. ACR Appropriateness Criteria hematuria [online publication]. Reston (VA): American College of Radiology (ACR); 2014. 8 p. https://guideline.gov/summaries/summary/49082/acr-appropriateness-criteria--hematuria?q=ACR+Appropriateness+CriteriaShen L., Raman S., Beland M. еt al. Expert Panel on Urologic Imaging. ACR Appropriateness Criteria hematuria [online publication]. Reston (VA): American College of Radiology (ACR); 2014. 8 p. https://guideline.gov/summaries/summary/49082/acr-appropriateness-criteria--hematuria?q=ACR+Appropriateness+CriteriaSountoulides P., Mykoniatis I., Metaxa L. Non-visible asymptomatic haematuria: a review of the guidelines from the urologist's perspective. Expert Rev Anticancer Ther. 2017; 17(3): 203-216. https://doi: 10.1080/14737140.2017.1284589Sountoulides P., Mykoniatis I., Metaxa L. Non-visible asymptomatic haematuria: a review of the guidelines from the urologist's perspective. Expert Rev Anticancer Ther. 2017; 17(3): 203-216. https://doi: 10.1080/14737140.2017.1284589Wollin T., Laroche B., Psooy K. Canadian guidelines for the management of asymptomatic microscopic hematuria in adults. Can Urol Assoc J. 2009; 3(1): 77-80.Wollin T., Laroche B., Psooy K. Canadian guidelines for the management of asymptomatic microscopic hematuria in adults. Can Urol Assoc J. 2009; 3(1): 77-80.

The authors declare that there are no conflicts of interest present.