Бессимптомная микрогематурия в практике врача-терапевта

Драпкина О.М., Самородская И.В., Ларина В.Н. Бессимптомная микрогематурия в практике врача-терапевта. Терапевтический архив. 2021; 93 (1): 71–78. DOI: 10.26442/00403660.2021.01.200596

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Drapkina O.M., Samorodskaya I.V., Larina V.N. The asymptomatic microhematuria in the physician’s practice. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (1): 71–78. DOI: 10.26442/00403660.2021.01.200596

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Аннотация

В обзорной статье представлены данные по вопросам: а) определения понятия «микрогематурия» и методов ее выявления; б) оценки распространенности и причин бессимптомной микрогематурии; в) диагностических подходов при первичном (случайном) выявлении микрогематурии; г) последующего мониторинга пациентов с бессимптомной гематурией; д) целесообразности скрининга на микрогематурию. В анализ включены российские и зарубежные рекомендации профессиональных сообществ, результаты когортных и обсервационных исследований, ранее выполненные обзоры. Микрогематурией следует считать выявление 3 и более эритроцитов при микроскопическом исследовании. В мире отсутствует единый для всех пациентов алгоритм обследования. Основной принцип – индивидуальная диагностическая тактика с учетом анамнеза, возраста, сопутствующих заболеваний и факторов риска. Целью комплексного обследования является исключение жизнеугрожающих состояний (злокачественного новообразования и/или гломерулярного поражения почек). В части случаев после проведения исследований причина микрогематурии остается неясной и требуется мониторинг. Рутинный скрининг населения с целью выявления микрогематурии в настоящее время не считается обоснованным.

Ключевые слова: бессимптомная микрогематурия, рекомендации, диагностика, скрининг, лечение

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The review article presents data on: a) definition of microhematuria and diagnosis; b) prevalence estimation and causes of the asymptomatic microscopic hematuria; c) diagnostic approaches for the first time identified of microhematuria; d) follow-up monitoring of patients with asymptomatic hematuria; e) feasibility of medical screening for microhematuria. The analysis includes recommendations of Russian and foreign urological associations, the results of cohort and observational studies, previous study reviews. The identification of 3 or more red blood cells during microscopic examination should be considered microhematuria. There is no uniform examination algorithm for all patients. The basic principle is an individual diagnostic tactic, taking into account the anamnesis, age, concomitant diseases and risk factors. The purpose of a comprehensive examination is to exclude life-threatening conditions (malignant neoplasms and/or glomerular kidney damage). In some cases, after research, the cause of microhematuria remains unclear and monitoring is required. Routine screening of the population in order to detect microhematuria is currently not justified.

Keywords: asymptomatic microhematuria, guidelines, diagnostics, screening, management

Список литературы

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27. Horie S, Ito S, Okada H, et al. Japanese guidelines of the management of hematuria 2013. Clin Exp Nephrol. 2014;18:679-89.
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1. Урология. Российские клинические рекомендации. Под ред.
Ю.Г. Аляева, П.В. Глыбочко, Д.Ю. Пушкаря. М.: ГЭОТАР-Медиа, 2015 [Urology. The Russian clinical recommendations. Under the editorship of Y.G. Alyaev, P.V. Glybochko, D.U. Pushkar. Moscow: GEOTAR-Media, 2015 (In Russ.)].
2. American Urological Association. Choosing Wisely: Ten Things Physicians and Patients Should Question. Linthicum, MD: American Urological Association; 2015. Available at: www.choosingwisely.org/
societies/american-urological-association
3. 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.
4. Gulati S, Langman C. Hematuria. 2017. Available at: http://emedicine.
medscape.com/article/981898-overview
5. Bolenz C, Schröppel B, Eisenhardt A, et al. The Investigation of Hematuria. Dtsch Arztebl Int. 2018;115(48):801-7. doi: 10.3238/arztebl.2018.0801
6. Jefferies 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):857-60. doi: 10.1111/bju.13355
7. 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. doi: 10.1016/j.juro.2012.09.078
8. 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;165(8):602. doi: 10.7326/M15-1496
9. Kassouf W, Aprikian A, Black P, et 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), December 2015. Can Urol Assoc J. 2016;10(1-2):E46-80. doi: 10.5489/cuaj.3583
10. Kelly J, Fawcett D, Goldberg L. Assessment and management of non-visible haematuria in primary care. BMJ. 2009;338. doi: 10.1136/bmj.a3021
11. Loo R, Lieberman S, Slezak J, et al. Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria. Mayo Clin Proc. 2013;88(2):129-38. doi: 10.1016/j.mayocp.2012.10.004
12. Kang M, Lee S, Jeong S, et 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):389-93. doi: 10.1111/iju.12697
13. Sundelin M, Jensen J. Asymptomatic microscopic hematuria as a predictor of neoplasia in the urinary tract. Scand J Urol. 2017;5(51):373-5. doi: 10.1080/21681805.2017.1334699
14. Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults. Am Fam Physician. 2013;88(11):747-54.
15. Pillalamarri N, Shalom D, Sanidad S, et al. The prevalence of microscopic hematuria in a cohort of women with pelvic organ prolapse. Int Urogynecol J. 2015;26(1);85-90. doi: 10.1007/s00192-014-2450-6
16. Linder B, Boorjian S, Trabuco E, et al. Defining the Prevalence of Asymptomatic Microscopic Hematuria Among Women With Symptomatic Pelvic Organ Prolapse: Implications for Recommending Subsequent Diagnostic Evaluation. Urology. 2017 May;103:68-72. doi: 10.1016/j.urology.2017.02.003
17. Lee H, Hyun J, Min J, et al. The Natural Course of Biopsy-Proven Isolated Microscopic Hematuria: A Single Center Experience of 350 Patients. J Korean Med Sci. 2016;31:909-14. doi: 10.3346/jkms.2016.31.6.909
18. Vivante A, Calderon-Margalit R, Skorecki K. Hematuria and risk for end-stage kidney disease. Curr Opin Nephrol Hypertens. 2013;22:325-30. doi: 10.1097/MNH.0b013e32835f7241
19. Levey A, Stevens L, Schmid C, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-12. PMID: 19414839
20. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter (Suppl.). 2013;3:1-150.
21. Sountoulides 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):203-16. doi: 10.1080/14737140.2017.1284589
22. Shen L, Raman S, Beland M, et al. Expert Panel on Urologic Imaging. ACR Appropriateness Criteria hematuria [online publication]. Reston (VA): American College of Radiology (ACR) 2014. Available at: https://guideline.gov/summaries/summary/49082/acr-appropriateness-criteria--hematuria?q=ACR+Appropri...
23. Malmstrom P. Time to abandon testing for microscopic haematuria in adults? BMJ. 2003;326(7393):813-5. doi: 10.1136/bmj.326.7393.813
24. Lai KN, Tang SC, Schena FP, et al. IgA nephropathy. Nat Rev Dis Primers. 2016;2:16001. doi: 10.1038/nrdp.2016.1
25. Linder BJ, Bass EJ, Mostafid H, Boorjian SA. Guideline of guidelines: asymptomatic microscopic haematuria. BJU Int. 2018;121:176-83. doi: 10.1111/bju.14016
26. Anderson J, Feehally J, Goldberg L, et al. Jointconsensus statement on the initial assessment of haematuria. Prepared onbehalf of the Renal Association and British Association of UrologicalSurgeons. Available at: http://www.renal.org/docs/default-source/guidelines-resources/joint guidelines/joint-guidelines-archieve/Haematuria-RA-BAUS_consensus_guideline_2008.pdf
27. Horie S, Ito S, Okada H, et al. Japanese guidelines of the management of hematuria 2013. Clin Exp Nephrol. 2014;18:679-89.
28. Van der Molen A, Hovius M. Hematuria: a problem-based imagingalgorithm illustrating the recent Dutch guidelines on hematuria. AJR Am J Roentgenol. 2012;198:1256-65.
29. Scottish Intercollegiate Guidelines Network. Diagnosis and managementof chronic kidney disease 2008. Available at: http://www.sign.ac.uk/pdf/sign103.pdf
30. Gematuriia u vzroslykh. Klinicheskie rekomendatsii. Utverzhdeny Rossiiskim obshchestvom urologov. 2016 (In Russ.) Available at: https://medi.ru/klinicheskie-rekomendatsii/gematuriya-u-vzroslykh_13954/#part_6. Accessed 27rd Feb 2020

Авторы

О.М. Драпкина1, И.В. Самородская1, В.Н. Ларина2

1 ФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России,
Москва, Россия;
2 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия

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O.M. Drapkina1, I.V. Samorodskaya1, V.N. Larina2

1 National Research Center for Therapy and Preventive Medicine, Moscow, Russia;
2 Pirogov Russian National Research Medical University, Moscow, Russia

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