Urinalysis MA guidelines 1 June 2023.pdf

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PURPOSE OF THIS DOCUMENT
This document provides guidance about urinalysis results and how to interpret them when
assessing a visa applicant’s standard of health.
ASSESSING URINALYSIS FOR ASH REQUIREMENTS
Use this general advice to help your assessment, but consider each applicant’s results in
relation to their other medical information and conditions.
If the laboratory report shows abnormalities, check the dates of the tests. If they were all done
on the same day and you believe the abnormality to be significant, consider making a FIR
depending on what the abnormalities show.
Abnormalities include:
• glucosuria
• haematuria
• proteinuria, and
• haematuria and proteinuria.
Making further information requests (FIRs) to applicants with abnormal urinalysis
results
Haematuria
If the result raises concern – for example, the applicant has persistent haematuria, and is older
or male – consider making a FIR for another urinalysis.
If the result remains positive for haematuria then, depending on the applicant and the specific
scenario, consider making a FIR for a renal tract ultrasound or a urologist’s assessment.
Proteinuria
If there is a good reason for the proteinuria – for example, the applicant has known diabetes or
hypertension – then it may be useful to determine the degree of proteinuria as part of any FIRs
you make. For diabetics make a FIR for the microalbumin:creatinine ratio, also known as ACR
or MAU.
For non-diabetics make a FIR for the protein:creatinine ratio, also known as PCR.
Haematuria and proteinuria
Because of their ethnicity, many visa applicants are high risk for renal conditions such as IgA
Nephropathies. If an applicant has haematuria and proteinuria investigate further by making a
FIR for a nephrologist’s assessment.
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ASH OUTCOMES FOR APPLICANTS WITH ABNORMAL URINALYSIS
RESULTS
If an applicant has one abnormal dipstick urinalysis result, and the second is normal, then your
opinion can be likely ASH.
If the applicant has two abnormal dipstick urinalysis results, check if the Panel Physician has
provided a formal laboratory report. If this is normal, then your opinion can be likely ASH.
Glucosuria
Glucosuria is not significant in itself and does not need follow up if there is a good reason for
its presence – for example, if the applicant has uncontrolled diabetes. The diabetes is
significant however and is likely to result in an opinion of NOT ASH or AWC. Make a FIR for an
endocrinologist’s report including HbA1c+/- to help you form an opinion.
If there is no obvious reason for the glucosuria and the applicant is otherwise well, with no
other medical conditions, consider an opinion of AWC. When the applicant next applies for a
visa they need to provide a new urinalysis, HBA1c and a medication list.
Haematuria
If the Panel Physician has provided a good reason for the haematuria result and the applicant
is low risk with no other medical concerns, consider an opinion of likely ASH or AWC.
If there is no obvious reason for the haematuria and the applicant is otherwise well, with no
other medical conditions, consider an opinion of AWC. When the applicant next applies for a
visa they need to provide a new urinalysis, HBA1c and a medication list.
Proteinuria
If the applicant has proteinuria, but normal Creatinine, eGFR and no known medical condition
or other abnormality on their medical assessment, consider an opinion of likely ASH or AWC.
Haematuria and proteinuria
If the applicant has haematuria and proteinuria, and no known medical condition or other
abnormality on their medical assessment, consider an opinion of likely ASH or AWC.
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