Hematuria in Children

Abstract

Presence of red blood cells (RBCs) in urine is hematuria that even in microscopic amounts alarms the patient and parents of the patient, and often prompts physician for many laboratory investigations. Hematuria can be red, dark or cola colored or brown known as macroscopic hematuria, and when it is not visible to unaided eye, it is known as microscopic hematuria. RBCs in urine is one of the most important signs of genitourinary tract disease; however, it is almost never a cause of anemia, since few drops (1 mL) of blood can turn 1 L of urine into red colored urine. Overall the physician should be alert enough not to overlook serious conditions like neoplasms and underlying bleeding disorder, to avoid unnecessary and often expensive laboratory studies. This article provides an approach to the evaluation and management of hematuria in children, and the detection of preventable and treatable conditions at the earliest to limit the disease progression, and overall reduction in cost, energy and anxiety.

Risk Factors for Urinary Tract Infections in Children with Hematuria in the Emergency Department

“…In our study, UTIs (13.7%) and urinary tract stones (5.0%) were the two most common etiologies of hematuria without pyuria in children. The causes of hematuria in children are variable and include glomerular diseases, interstitial and tubular diseases, hematologic causes, urinary tract diseases, structural anomalies, medications, and no identifiable diagnosis [24][25][26]. An acute bacterial urinary tract infection is the most common cause of gross hematuria in children [27].…”

Evaluation for cause of hematuria: Cracking the mystery

“…1 The correct diagnosis of gross hematuria in children poses a unique challenge and requires a protocolised approach. 1,4 Nut cracker syndrome is suspected once the more common causes of gross non-glomerular hematuria like calculi have been excluded. The exact prevalence of NCS is not known as it may be asymptomatic in many cases.…”

Outcome of children with isolated microscopic hematuria without renal biopsy

“…A positive result usually prompts further examination (6). Asymptomatic microscopic hematuria has many etiologies ranging from minor incidental findings to highly significant lesions that are immediately life-threatening (4,7,8). The finding of the study in which children and young adults with persistent asymptomatic isolated microscopic hematuria (IMH) were evaluated is unclear (6), while only a few population based studies have addressed the longterm outcomes of this condition among children.…”

“…However, it can sometimes be an indicator of glomerular or urinary tract disorder (1,2). Hematuria is a common presenting feature of diseases that cause damage to the glomerulus and it was estimated that its frequency varies from 0.18% to 16.1%, depending on the screening strategy used in the population studies (3)(4)(5). RBC in urine can originate from any site along the urinary tract and may be gross or microscopic.…”

“…RBC in urine can originate from any site along the urinary tract and may be gross or microscopic. It may originate from the renal tissue (glomeruli, renal tubules or interstitial area) or urinary tract (collecting system, ureters, bladder and urethra) (4,5). Microscopic hematuria is commonly screened using the urinary dipstick test.…”