Hematuria in Children
- 1 September 1994
- journal article
- review article
- Published by SLACK, Inc. in Pediatric Annals
- Vol. 23 (9) , 474-485
- https://doi.org/10.3928/0090-4481-19940901-06
Abstract
A work-up of a child with suspected hematuria should be undertaken once the primary physician has determined that there actually are red blood cells in the urine and that the hematuria is persistent. Evaluation of a child with persistent microscopic hematuria is facilitated with the determination of whether the blood originates from the glomeruli or whether it comes from elsewhere in the urinary tract. Clues to a glomerular origin include the presence of other manifestations of glomerular disease such as significant proteinuria, RBC casts, and dysmorphic erythrocytes in the urinary sediment, hypertension, and renal insufficiency. Clues to the blood originating from the lower urinary tract include blood clots in the urine, normal erythrocyte morphology, and a pertinent history pointing to the lower tract such as that of trauma, urolithiasis, urological or vascular abnormality, or symptoms of bladder inflammation. The initial evaluation should include a detailed patient history and family history as well as a careful physical examination looking for clues to the presence of a familial, hereditary, or chronic kidney disease. A logical, stepwise initial work-up should follow with the goal of ruling out life-threatening and treatable diseases. If there are no indications for immediate further intervention and the cause of the hematuria remains unclear after the initial work-up has been completed, the parents and patient should be reassured that there are no life-threatening conditions and that although the etiology of the blood in the urine is yet unknown, there is time to follow the patient and plan for additional studies if and when they are indicated. The family's concerns (ie, "Is this cancer?," "Will my child require dialysis and transplantation?") should be addressed frankly, and the physician should mention those diagnoses that may lead to renal failure, but have not been absolutely ruled out yet before a kidney biopsy has been performed, such as Alport's syndrome and IgA nephropathy. The child with isolated microhematuria should be evaluated regularly with urinalyses looking for persistence of the hematuria and appearance of proteinuria, blood pressure measurements, and renal function tests. If the microhematuria persists for 6 to 12 months, a kidney biopsy should be considered.(ABSTRACT TRUNCATED AT 400 WORDS)Keywords
This publication has 29 references indexed in Scilit:
- Normal values for random urinary calcium to creatinine ratios in infancyThe Journal of Pediatrics, 1993
- Urinary erythrocyte volume analysis: A simple method for localizing the site of hematuria in pediatric patientsThe Journal of Pediatrics, 1989
- Long term prognosis of recurrent haematuria.Archives of Disease in Childhood, 1985
- Reference values for urinary calcium excretion and screening for hypercalciuria in children and adolescentsEuropean Journal of Pediatrics, 1984
- Hypercalciuria in Children with HematuriaNew England Journal of Medicine, 1984
- Hematuria preceding renal calculus formation in children with hypercalciuriaThe Journal of Pediatrics, 1981
- The association of idiopathic hypercalciuria and asymptomatic gross hematuria in childrenThe Journal of Pediatrics, 1981
- Microscopic hematuria in schoolchildren: Epidemiology and clinicopathologic evaluationThe Journal of Pediatrics, 1979
- Proteinuria and hematuria in schoolchildren: Epidemiology and early natural historyThe Journal of Pediatrics, 1976
- Plasma C3 and C4 Concentrations in Management of GlomerulonephritisBMJ, 1973