{
  "schema_version": 1,
  "kind": "condition",
  "id": "microscopic-haematuria-referral",
  "name": "Microscopic Haematuria (Evaluation & Referral)",
  "category": "chronic",
  "sources": "AUA/SUFU Guideline on Microhematuria 2020 · Enalapril Maleate 10mg tablets SmPC section 4.2 Posology and method of administration (eMC product 561) · Gross and Microscopic Hematuria - disease-level clinical article (microscopic-haematuria-referral-full.txt)",
  "review_status": "reviewed",
  "verified_against": "Enalapril Maleate 10mg tablets SmPC section 4.2 Posology and method of administration (eMC product 561) · Gross and Microscopic Hematuria - disease-level clinical article (microscopic-haematuria-referral-clinical.txt)",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 1195,
      "generic": "Enalapril",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 5.0,
      "adult_dose": "2.5-5 mg once daily, titrate up to 10-20 mg once daily if persistent proteinuria or hypertension co-exists",
      "adult_duration": "long-term",
      "dose_source": "Enalapril Maleate 10mg tablets SmPC section 4.2 Posology and method of administration (eMC product 561)",
      "rationale": "Indicated specifically when microscopic haematuria is accompanied by proteinuria (>0.5 g/day) or hypertension.",
      "cautions": [
        "Asymptomatic microscopic hematuria (>=3 RBCs/HPF) requires urological (cystoscopy, CT urography) and nephrological workup to rule out malignancy or glomerulonephritis.",
        "ACE inhibitors are indicated if glomerular etiology is confirmed with associated proteinuria.",
        "Monitor serum creatinine and potassium 1-2 weeks after starting."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Specialist pediatric nephrology referral",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "ACAPRIL 5 MG 10 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ALFACURE PHARMACEUTICALS",
          "price_egp": 6.75,
          "pack_count": 10,
          "unit_price": 0.68,
          "strength_mg": 5.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PRESSLIGHT 5 MG 10 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EL-OBOUR",
          "price_egp": 7.0,
          "pack_count": 10,
          "unit_price": 0.7,
          "strength_mg": 5.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "RENITEC 5MG 28 TAB.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > MERCK SHARP & DOHME",
          "price_egp": 30.6,
          "pack_count": 28,
          "unit_price": 1.09,
          "strength_mg": 5.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "microscopic-haematuria-referral"
    },
    {
      "id": 1196,
      "generic": "Referral & safety-netting (no drug therapy)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": null,
      "adult_duration": null,
      "dose_source": "Gross and Microscopic Hematuria - disease-level clinical article (microscopic-haematuria-referral-clinical.txt)",
      "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.",
      "cautions": [
        "RED FLAG - The nephrology consultation criteria are dysmorphic RBCs, cellular/red-cell casts, abnormal renal function, or significant proteinuria.",
        "Red flag: development of unexplained gross hematuria automatically upgrades the patient to high-risk category requiring urgent urological work-up, even after a prior negative evaluation.",
        "RED FLAG - A risk-stratification pathway (low/intermediate/high risk by age, smoking history, RBC count, other risk factors) determines whether cystoscopy/CT urogram and referral are needed.",
        "RED FLAG - Risk-stratify before deciding how far to investigate (AUA microhaematuria criteria). LOW risk requires all of: woman under 60 or man under 40, non-smoker or under 10 pack-years, 3-10 RBC/HPF, no prior microhaematuria, no other urothelial cancer risk factor - repeat the urinalysis within 6 months. INTERMEDIATE risk is any of: woman 60 or over, man 40-59, 10-30 pack-years, 11-25 RBC/HPF, or any additional risk factor - renal ultrasound and cystoscopy are recommended. HIGH risk is any of: man 60 or over, more than 30 pack-years, more than 25 RBC/HPF, any history of gross haematuria, or prior haematuria never evaluated - these need direct cystoscopic evaluation."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": null,
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "microscopic-haematuria-referral"
    }
  ]
}