In this module, we will discuss the approach to a patient with hematuria. You will learn the various presentation of blood in the urine, from incidental microscopic finding to active hemorrhage. Bleeding may arise from the kidney, the collecting system, or outside the urinary system. It is important to rule out malignant causes for hematuria, so taking a detailed history and completing a thorough physical exam are important first steps in working up these patients. Important aspects of the history such as what point in the urine stream blood was seen, the strength of the stream, the presence, location and onset of pain with urination, or history of stones will be discussed. A full genitourinary examination must be carried out and important signs will be outlined. We also explain principles of management.