Your patient presents with microscopic hematuria; what is the next best step?

In cases of microscopic hematuria, the appropriate next step is to repeat the urinalysis with microscopic analysis. This is important because the presence of blood in the urine can be intermittent, and repeat testing helps confirm that hematuria is persistent rather than a transient finding. A single episode of microscopic hematuria may not indicate a serious condition, but consistent findings will warrant further investigation.

Repeating the urinalysis also allows healthcare providers to evaluate for any associated abnormalities, such as proteinuria or signs of urinary tract infection, and to determine if there are additional findings that could guide further diagnostic steps. If the repeat analysis confirms persistent hematuria, then more extensive evaluations, such as imaging studies or cystoscopy, may be considered based on the clinical context.

Immediate cystoscopy might be considered if there are additional alarming features or risk factors for bladder cancer, but a systematic approach recommends confirming the diagnosis first. Similarly, renal ultrasound and CT imaging may be warranted after confirming persistent hematuria to assess for potential urological issues, but these are typically not the first step in management without confirming the finding through urinalysis.