Bashyam S, Shankar M. Beyond the bladder: Recognising glomerular hematuria and the role of genetic testing in clinical practice. World J Transl Med 2026; 12(2): 122755 [DOI: 10.5528/wjtm.122755]
Corresponding Author of This Article
Mythri Shankar, Associate Professor, Department of Nephrology, Institute of Nephrourology, Victoria Hospital Campus, Bengaluru 560102, Karnataka, India. mythri.nish@gmail.com
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Urology & Nephrology
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review-article
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Bashyam S, Shankar M. Beyond the bladder: Recognising glomerular hematuria and the role of genetic testing in clinical practice. World J Transl Med 2026; 12(2): 122755 [DOI: 10.5528/wjtm.122755]
World J Transl Med. Jul 28, 2026; 12(2): 122755 Published online Jul 28, 2026. doi: 10.5528/wjtm.122755
Beyond the bladder: Recognising glomerular hematuria and the role of genetic testing in clinical practice
Sairam Bashyam, Mythri Shankar
Sairam Bashyam, Department of Nephrology, Saveetha Medical College and Hospital, Chennai 602105, Tamil Nādu, India
Mythri Shankar, Department of Nephrology, Institute of Nephrourology, Bengaluru 560102, Karnataka, India
Co-first authors: Sairam Bashyam and Mythri Shankar.
Author contributions: Bashyam S drafted the initial version of the manuscript; Shankar M critically reviewed and revised it for important intellectual content; Bashyam S and Shankar M contributed equally to this manuscript and are co-first authors. All authors approved the final version for submission.
AI contribution statement: During the preparation of the manuscript, the authors used the Perplexity Pro AI tool to assist with polishing language and correcting grammar. All outputs were reviewed, adapted and verified by the authors to ensure the final manuscript reflects their expertise, voice and originality.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Mythri Shankar, Associate Professor, Department of Nephrology, Institute of Nephrourology, Victoria Hospital Campus, Bengaluru 560102, Karnataka, India. mythri.nish@gmail.com
Received: April 27, 2026 Revised: June 14, 2026 Accepted: July 8, 2026 Published online: July 28, 2026 Processing time: 93 Days and 14 Hours
Abstract
Hematuria is one of the most common reasons for urological consultation, with microhematuria affecting 2.4%-31.1% of healthy volunteers depending on the population studied. For the urologist, identifying a glomerular source is the critical first step in determining the need for nephrology referral. This review provides a clinically structured approach to hematuria evaluation with an emphasis on distinguishing glomerular from non-glomerular causes, the role of genetic testing in the era of precision medicine, and the practical management of genetic results in a multidisciplinary setting. We discuss indications for next-generation sequencing panels vs whole-exome sequencing, a traffic-light guide for genetic test ordering, pre-test counselling frameworks, and downstream implications including cascade screening and transplant donor evaluation.
Core Tip: This review challenges the traditional perception of isolated hematuria as benign by emphasizing the critical role of genetic testing in precision nephrology. We propose a practical traffic-light framework to guide test ordering, enabling clinicians to recognize glomerular hematuria needing nephrology referral, select between targeted panels and whole-exome sequencing, and incorporate pre-test counselling in busy practice. The approach integrates cascade screening, underscores the impact of molecular diagnosis on immunosuppression, and addresses safeguarding living-related donors through genetic evaluation. By bridging urology and nephrology, it supports personalized care, avoids invasive procedures, enables early nephroprotection, and improves prognostication in hereditary kidney disease overall outcomes.
