Urgent considerations
See Differentials for more details
Vascular
If renal infarction, renal vein thrombosis, or papillary necrosis is suspected as the aetiology for NVH, urgent treatment is important to attempt to preserve renal function.
Malignancy
The diagnostic evaluation recommended for NVH may take several weeks to complete and therefore should begin promptly, but the possibility of a malignant cause does not require immediate evaluation or admission to hospital. The UK National Institute for Health and Care Excellence recommends that people ≥60 years with unexplained NVH, and either dysuria or a raised white cell count on a blood test, should be referred using a suspected cancer pathway referral for bladder cancer (for a diagnosis or ruling out of cancer within 28 days of the referral).[13]
Infection
When identified, acute prostatitis and urinary tract infections need prompt appropriate treatment to prevent complications, such as pyelonephritis and sepsis.
Acute glomerulonephritis
Acute glomerulonephritis can lead to rapid loss of renal function. Clinical features include NVH or visible haematuria, proteinuria, oedema and/or hypertension. Urine microscopy may reveal dysmorphic red blood cells and casts. Urgent nephrology consultation is necessary.
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