Background

 

Blood in the urine (haematuria) can have many different causes.  Blood in urine can be present because of infections, trauma, inflammation, diseases of the prostate and kidney, and cancers.  Patients who see blood in their urine should go to their doctor so that the underlying cause can be identified.  Only a small percentage of patients presenting with haematuria will have bladder cancer. 

Scientists in Queen’s University Belfast are currently working with Randox Laboratories Ltd and doctors in Northern Ireland hospitals to define diagnostic classifiers for patients with blood in the urine.  A classifier is a panel of biomarkers that together reflect the cause of blood in the urine.  A classifier with the accuracy of cystoscopy (the gold standard), would significantly reduce healthcare costs.  Cytoscopy is an examination of the interior of the bladder which is used to detect bladder cancer in patients.  Cystoscopy is a costly and embarrassing examination for patients. Most patients who have blood in their urine will not have cancer and therefore a large proportion of patients will receive “unnecessary” cystoscopy. 

In a pilot study we identified panels of biomarkers for the detection of bladder cancer in haematuria patients. We published these findings in a journal called Cancer (Abogunrin et al, The impact of biomarkers in multivariate algorithms for bladder cancer diagnosis in patients with haematuria. Cancer (2012) 118(10):2641-50. DOI: 10.1002/cncr.26544 ). In a second paper published in BMC Medicine (Frank Emmert-Streib et al Collectives of diagnostic biomarkers identify high risk subpopulations of haematuria patients: exploiting heterogeneity in large-scale biomarker data. BMC Medicine 2013, 11:12 doi:10.1186/1741-7015-11-12), we describe how hematuria patients clustered naturally into clinical groupings on the basis of their biomarker profiles.  This is very promising because it suggests the feasibility of a "biomarker assessment" as a means to categorise patients into low and high risk groupings.  These findings need to be validated in a larger study, HaBio. In addition, we hope to develop classifiers that identify other diseases that present with haematuria and classifiers that predict the outcome for patients.