Hematuria is a common clinical presentation caused by a wide range of disorders such as infection, urolithiasis, and increasingly, malignancy. The finding can be burdensome to both patients and clinicians due to associated morbidities and challenges in diagnosing potentially life-threatening etiologies. The lack of a universally accepted evaluation guideline has further complicated clinical decision-making. Guidelines have been evolving over the years, with recent trends favoring an individualized evaluation approach. This chapter reviews the current literature and highlights the emerging trends in diagnosis and management of hematuria, particularly in critically ill cancer patients. It underscores the need for prospective studies to evaluate, streamline, and update current guidelines for hematuria. Additionally, implementing a structured and reflexive system-wide protocol can help address the disparities and outcomes in certain underserved populations.