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Urine microscopy showing more than 3 red blood cells per high-power field (hpf) confirms microscopic haematuria, prompting investigation into the source. Dysmorphic red cells or red cell casts indicate the bleeding originates within the kidney glomeruli (glomerulonephritis); normal-shaped red cells suggest lower urinary tract sources like a kidney stone, bladder infection, or tumour. Any persistent unexplained microscopic haematuria in an adult over 40 is considered urological until proven otherwise.
Elevated RBCs above 3/HPF constitute microscopic hematuria. Glomerular sources produce dysmorphic RBCs. Lower urinary tract sources produce isomorphic RBCs.
Optimal is 0-2 /HPF. Vigorous exercise can cause transient hematuria. Persistent hematuria above 3/HPF mandates workup.