Hematuria is a common clinical symptom that is generally detected by three means: visual observation, test strip detection and microscopic examination. In response to the current tendency to make mistakes in the judgment of hematuria, it is necessary to emphasize the following issues. 1, test strip method Most hospitals currently use the test strip method to detect urinary routine, it should be emphasized that this method can only be used as a screening test, where the positive results must be confirmed by urine sediment microscopy. The test strip method detects urine occult blood, the principle is to use the hemoglobin in the ferrous hemoglobin has a weak oxidation effect, so that the test strip in the peroxide release of new oxygen, the chromogen oxidation into colored compounds. When there is a certain amount of hemoglobin in the urine, the color of the test strip changes from yellow to green or blue, and this qualitative test can often appear as a false negative or false positive. False negatives can occur when taking large amounts of vitamin C. False positives are more common, such as myoglobinuria, hypochlorite in the urine and peroxidase from microorganisms in the urethra can cause false positives. Therefore, the urine must be fresh, without preservatives or drugs, and without centrifugal precipitation. In addition the operator’s knowledge of the performance of different types of test strips and analyzers and the availability of strict quality control can affect the results, so that there is no obvious correspondence between the test strip method and the two methods of microscopy. So far, the test strip method has only been used as a screening test for hematuria, and the diagnosis must be confirmed based on microscopic examination of the urine sediment. At present, there are many patients with the results of the test strip test to the major hospitals across the country to seek medical advice, resulting in unnecessary economic expenditure and mental burden, which deserves attention. 2, urinalysis standardization, including specimen retention, production, detection of three aspects of standardization. Retained urine containers must be clean, the ideal urine specimens taken from the middle 2 hours before waking up in the morning, when the urine is more concentrated, acidic, more formed fractions in the urine and remain more intact. Each laboratory should establish its own protocols to ensure comparable results. Usually, 10 ml of urine is taken, centrifuged at 1800 rpm for 5 minutes, the supernatant is discarded, and about 0.25 ml is left to be mixed and the film is placed under a microscope to observe 20 fields of view, with no more than 2 red blood cells per high-powered field of view under normal conditions. Obviously, the amount of urine taken, the speed and time of centrifugation, and the amount of remaining urine sediment all directly affect the results of red blood cell count. 3, further examination of hematuria Although hematuria is mainly caused by diseases of the urinary system itself, some systemic diseases or diseases of the adjacent organs of the urinary system can also cause hematuria, which shows the complexity of the etiology. Therefore, clinicians should take a detailed medical history and perform a careful physical examination. (1) Accompanying symptoms, such as initial, final or complete hematuria; surgical hematuria is often bright red with blood clots; medical hematuria is dark; infection is often accompanied by urinary frequency, urgency, pain and systemic symptoms; stone or necrotic tissue urinary tract obstruction is accompanied by colic or foreign body discharge; elderly men should pay attention to the smoothness of urination and the presence of the middle part of the urinary line. (2) Family history, some hereditary glomerular diseases clinical hematuria as the main symptom, such as thin basement membrane nephropathy, Alpart syndrome. (3) Blood pressure must be measured on physical examination, and glomerulopathy or polycystic kidney disease is often associated with hypertension. Since the 1980s, phase contrast microscopy has been applied to observe the morphology of urine red blood cells, and hematuria has been classified into homogeneous, polymorphic and mixed types as the basis for the initial screening of the source of hematuria, on the basis of which further examinations, such as urography, cystoscopy, CT, ultrasound, etc., are performed for suspected urinary tract diseases; renal biopsy is performed for suspected glomerular diseases to determine the cause of hematuria. However, there are still a few patients who cannot be diagnosed clearly, and regular follow-up is needed at this time. In elderly people, especially those with normal urine red blood cell pattern should be examined urgently to exclude malignant tumors. Painless hematuria should be given sufficient attention because it is often the first manifestation of malignant tumors.