Microscopic hematuria: Is it threat?

Last updated: May 18, 2026

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Urine examination is a simple one of the most common in the medical investigations, and it always included in the health checkup package program. Microscopic hematuria is one condition which can possibly be a result from urine examination. Today we will discuss about this issue.

Microscopic hematuria is defined for at least 7 days presenting 3 red blood cells/HPF in 2 consecutive urine examination tests. Where the bloods coming from? And is it threat? That is the most and routinely questions that patients asked me while they are in my urology clinic. First of all, I’m going tell you that, it is fine! Don’t be worry! Mostly it won’t cause any serious problem. If that is a problem, you will see your urine very redness with your bare eyes, not invisible like this, but anyway, a positive red blood cell finding in urine examination, we must do a further investigation to ensure that everything is alright.

All possible bleeding locations which can lead to microscopic hematuria.

1. Contamination – most commonly the etiology is contamination during urine collection, for example incorrect mid-stream collection or testing during menstrual period
2. Kidney – Kidney stone, kidney mass, kidney infection or non-surgical related kidney diseases
3. Ureter – Ureteral stone, ureteral tumor
4. Bladder – Bladder stone, bladder tumor, bladder infection
5. Prostate (Men) – Prostate disease, prostate cancer, prostate infection
6. Urethra – Urethral stone, urethral infection

The proper methodology in order to make clear in term of etiology of the Microscopic hematuria is the accuracy imaging. CT scan is the definite imaging to answer this kind of problem. When we found the positive clue from CT scan, then we will follow the protocol on each suspicious diagnosis. In the other hand, if we found nothing, we can ensure the patient that the symptom is fine, and it required to have the annual simple urine examination is all. The recommendation from American Urology Association guideline in 2020, suggest that we can let go the patient free from the annual following up program if the urine examination turn to negative finding.

Any questions, you can feel free to discuss with me.

If you have a positive urinalysis finding or microscopic hematuria from a health checkup and would like proper urological evaluation, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. Book a Consultation.

Frequently Asked Questions about Microscopic Hematuria

What is microscopic hematuria?

Microscopic hematuria is defined as the presence of 3 or more red blood cells per high-power field (HPF) on at least 2 consecutive urine examinations. Unlike gross hematuria, the blood is not visible to the naked eye and is only detected through laboratory urinalysis, often during a routine health checkup.

Is microscopic hematuria dangerous?

In most cases, microscopic hematuria is not immediately dangerous. The most common cause is sample contamination during urine collection. However, it requires further evaluation to rule out more serious causes such as kidney stones, bladder tumors, or prostate disease, particularly in older patients or those with risk factors.

What are the possible causes of microscopic hematuria?

Possible sources of bleeding include the kidneys (stones, tumors, infection), ureters (stones, tumors), bladder (stones, cancer, infection), prostate in men (BPH, prostatitis, prostate cancer), and urethra (stones, infection). Contamination during urine collection is also a very common reason for a false-positive result.

What investigations are needed for microscopic hematuria?

A CT scan with contrast is the gold-standard imaging investigation for evaluating microscopic hematuria. It can identify stones, masses, or structural abnormalities throughout the urinary tract. If CT findings are negative, the AUA 2020 guideline recommends annual urine monitoring until results normalize.

When can a patient stop follow-up for microscopic hematuria?

According to the American Urological Association 2020 guidelines, patients with microscopic hematuria can be discharged from follow-up monitoring once their urine examination returns a negative result on repeated testing, provided no significant cause has been identified on imaging.

Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any medical treatment.