How do you approach hematuria in a patient with diabetic nephropathy?

This is a difficult question to answer. If young, no risk factors for GU malignancy and only microscopic hematuria would generally not pursue but make patient aware of small risk and make sure PCP also knows. Helpful to know if red cells are dysmorphic and if there is also proteinuria. Gross hematur...

If it is mild and inconsistent I likely won't do anything about it. If consistently there, then I would strongly consider doing kidney biopsy after doing preliminary serological testing. It is also all dependent on patient's wishes but in general I think it is good idea. Most often coexisting kidney...

Microaneurysmal rupture can be seen which may lead to hematuria.