1/31/2011 Hematuria in Children

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Hematuria in ChildrenAka: Pediatric Hematuria

I. See Also
A. Hematuria in Adults
II. Epidemiology: Hematuria Incidence
A. Microscopic Hematuria
1. School age Hematuria on single sample: 4%
2. Hematuria on repeat sample: 0.5%
B. Gross Hematuria
1. More commonly found in girls
2. Overall Incidence: 0.13%
III. Definition
A. Gross Hematuria
1. Pink, red or brown color visible to naked eye
2. Confirm by dipstick and sediment exam
B. Microscopic Hematuria significant values
1. Urine Red Blood Cells: 0.5 - 2.4 Million/day
2. Spun urine: 5-10 Red Blood Cells/hpf (50/ul)
3. Confirmed on repeat Urinalysis after 1 month
IV. Differential Diagnosis of Gross Hematuria
A. See Gross Hematuria
V. Causes (Mneumonic: ABCDEFGHI)
A. Anatomy
1. Ureteropelvic junction obstruction
2. Renal cysts (Simple, Polycystic Kidney Disease)
B. Boulders
1. Nephrolithiasis
2. Hypercalciuria
C. Cancer
D. Drugs
E. Exercise
F. Fictitious Causes
1. Munchausen's Syndrome
2. Betadine contaminant
G. Familial
H. Foreign Body
I. Glomerulonephritis
1. Post-Streptococcal Glomerulonephritis
2. Henoch-Schonlein Purpura (HSP)
3. Systemic Lupus Erythematosus (SLE)
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4. IGA Nephropathy
5. Alport's Syndrome
J. Hemoglobinopathies (Sickle Cell Anemia)
K. Hematologic disorders (Platelet disorders)
L. Infection
VI. Family History
A. Renal Failure
1. Renal transplant
2. Dialysis
B. Systemic Lupus Erythematosis
C. Familial Heamturia
VII. History
A. Abdominal Pain
B. Bloody Diarrhea
C. Arthralgias
D. Vigorous Exercise
1. Jogging
2. Biking
3. Snow boarding
E. Child Abuse history
1. Abdominal, back or flank pain
2. Bruising
F. Urinary Tract Infection, cystitis, or Hypercalciuria
1. Dysuria
2. Urinary frequency
3. Suprapubic Pain
G. Medications
1. Aspirin
2. NSAIDs
3. Antibiotics
4. Methyldopa
VIII. Signs
A. Blood Pressure
B. Edema
C. Skin rash
IX. Labs: Indicated for persistant Hematuria >1 month
A. Repeat Urinalysis
B. Urine Culture
C. Urine Calcium to Creatinine ratio (normal <0.2-0.25)
D. Collect 24 hour Urine Collection
1. Urine Calcium Excretion (normal <4 mg/kg/day)
E. Urinalysis of a Family Member
F. Chemistry panel (Chem 10)
1. Blood Urea Nitrogen (BUN)
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2. Creatinine
3. Serum Electrolytes
4. Serum Glucose
5. Serum Calcium
6. Serum Phosphate
7. Serum Magnesium
G. Sickle Cell Screen
H. Complement level (C3)
I. Anti-streptolysin O titer (ASO Titer)
J. Antinuclear Antibody (ANA)
X. Radiology
A. Renal Ultrasound
B. Bladder Ultrasound
C. Voiding Cystourethrogram (VCUG)
XI. Diagnostic Studies
A. Audiogram to assess for Alport's Syndrome
1. Shows bilateral Sensorineural Hearing Loss
XII. Referral Criteria
A. Concurrent systemic signs
1. Pain
2. Fever
3. Hypertension
4. Arthritis
B. Elevated Renal Function testing (BUN, Creatinine)
C. Coexistant Proteinuria
D. Episodes of Gross Hematuria
E. Family History
1. Glomerulonephritis
2. Deafness
3. Renal Failure
4. Renal Transplant
F. Parental anxiety
XIII. Follow-up
A. After negative work-up, rescreen urine every 6-12 month
XIV. References
A. Fitzwater (1994) Pediatr Rev 15:102
B. Shane (1998) Pediatr Rev 19(6):209

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