Hematuria (pediatric)

Hematuria in a child is evaluated differently than in an adult in two main respects:

• there is a lower likelihood of a malignancy (renal or bladder) causing the hematuria
• preference is given to nonionizing radiation

Pathology

Hematuria can be considered in three main forms:

• "gross" hematuria (>1 mL of blood in the urine, red blood)
• glomerular hematuria (tea-colored urine with red blood cell casts)
• microscopic hematuria  (defined as ≥3 red blood cells per HPF on 2 out of 3 urinalysis specimens )

Treatment and prognosis

There are many possible causes of hematuria in a child (e.g. infection (bacterial or viral), trauma, sexual abuse, bleeding diathesis, renal stones) and a good clinical history is as valuable as imaging.

The imaging strategy depends on whether the child has had trauma or not:

• trauma
  • gross or microscopic hematuria: CT of the abdomen and pelvis with contrast
  • blood at the meatus: retrograde urethrography
  • pelvic fractures: CT cystography

If there is no history of trauma, then the imaging strategy depends on whether the hematuria is painful or not:

• painful: renal ultrasound or CT of the abdomen and pelvis without contrast, to assess for renal stones
• not painful
  • gross hematuria: may not need imaging, but renal ultrasound is usually preferred over VCUG for an initial evaluation
  • glomerular hematuria: may not need imaging

See also

• hematuria (adult)