Hematuria (peds)

This page is for pediatric patients. For adult patients, see: hematuria

Background

Macroscopic Hematuria algorithm

• Make sure hematuria is not myoglobin (e.g. 2/2 rhabdomyolysis) or bleeding from non-urinary source

Common Causes

• Pediatric patients
  • Glomerulonephritis
  • UTI
  • Congenital urinary tract anomaly
• Younger adults
  • UTI
  • Nephrolithiasis
• Any age
  • Schistosomiasis (most common cause worldwide)

Clinical Features

Types of hematuria

• Initial hematuria
  • Blood at beginning of micturition with subsequent clearing
  • Suggests urethral disease
• Intervoid hematuria
  • Blood between voiding only (voided urine is clear)
  • Suggests lesions at distal urethra or meatus
• Total hematuria
  • Blood visible throughout micturition
  • Suggests disease of kidneys, ureters, or bladder
• Terminal hematuria
  • Blood seen at end of micturition after initial voiding of clear urine
  • Suggests disease at bladder neck or prostatic urethra
• Gross hematuria
  • Indicates lower tract cause
• Microscopic hematuria
  • Tends to occur with kidney disease
• Brown urine with RBC casts and proteinuria
  • Suggests glomerular source
• Clotted blood
  • Indicates source below kidneys

Differential Diagnosis

Pediatric Hematuria

Macroscopic Hematuria	Transient Microhematuria	Persistent Microhematuria
Blunt abdominal trauma	Strenuous exercise	Benign familial hematuria
Urinary tract infection	Congenital anomalies	Idiopathic hypercalciuria
Nephrolithiasis	Trauma	Immunoglobulin A nephropathy
Infections	Menstruation
Poststreptococcal glomerulonephritis	Bladder catheterization	Alport syndrome
	High fever	Sickle cell trait or anemia
Immunoglobulin A nephropathy		Henoch-Schonlein purpura
Hypercalciuria		Drugs and toxins
Sickle cell disease		Lupus nephritis

Look-Alikes

• Foods or medications
  • For example beets, rifampin, multivitamins, pyridium
• Uric acid crystalluria
• Gastrointestinal bleeding (peds)
• Vaginal bleeding
  • Prepubertal vaginal bleeding
• Other causes of abnormally colored urine

Evaluation

• Urinalysis

Management

• Treatment dependent on cause

Disposition

• Dependent on cause

See Also

• Hematuria (adult)