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Hematuria is a common clinical finding and has a wide spectrum of possible causes. Erythrocytes can originate from any part of the genitourinary tract. An urine dipstick test is the first step in diagnostic approach. Medical history may help to narrow down the range of causes: arterial hypertension or a family history of renal disease may indicate a renal disease. Risk factors for an urinary tract malignoma point to an urological origin. If the microscopy shows more than 5 % acanthocytes in the urine sediment, a glomerular cause can be assumed. Normal erythrocytes suggest a non-glomerular cause. A nephrologist should be consulted if urine sediment microscopy and other clinical features (e. g. clinically relevant proteinuria, elevated serum creatinine) indicate a renal disease. In this case, a renal biopsy should be considered to confirm the diagnosis of glomerulopathy and to develop a treatment plan. If an urological pathology is suspected, sonography should be complemented by a multi-phasic computed tomography. Based on the imaging results, a retrograde ureteroscopy should be considered. Repeated urinalysis on an annual basis for two consecutive years is recommended, if no diagnosis can be established.