Hematuria

Hematuria is a medical term which describes the presence of blood in the urine. Hematuria can originate from anywhere along the urinary tract, including the kidney, ureter (tube that goes from the kidney to the bladder), the bladder itself, or from the urethra (tube that drains urine from the bladder to the outside of the body). Hematuria in children is often benign with a good prognosis, but can be very distressing for children and their parents.

There are two types of hematuria:

• Microscopic hematuria is the presence of red blood cells that are only visible with a microscope. It can be detected by urine dip sticks (a simple urine test that is often performed in the pediatrician’s office during well-child visits) or by a formal urinalysis in the laboratory.
• Gross hematuria indicates that there are enough blood cells present to change the color of the urine. The visible presence of blood in the urine can range in color from bright red to dark brown.

• Urinary tract infection (UTI): When the bladder lining is disrupted or irritated by bacteria or a virus, it can become inflamed. The inflammation can cause red blood cells to leak into the urine.
• Kidney stones: Kidney stones may bring not only pain, nausea and vomiting, but also hematuria as the stone travels through the urinary tract.
• Blockage in the urinary tract: Ureteral pelvic junction obstructions (UPJO) or ureteral vesicle junction obstructions (UVJO) may present with gross hematuria, especially after a trauma.
• Kidney disease, including post streptococcal glomerulonephritis (APSGN). Hematuria may develop a few weeks after having a streptococcal infection (such as strep throat or impetigo). Blood in the urine can also be caused by other types of glomerulonephritis or kidney diseases.
• Strenuous exercise: Hematuria may be present after vigorous exercise as seen in many marathon runners, it usually resolves after a few days of rest.
• Benign familial hematuria: An inherited family trait that is benign and lifelong.

The studies to determine what is causing the hematuria will depend on whether you child has gross or microscopic hematuria. The first step is typically an ultrasound of the kidney and the bladder. Based on those results, we may ask for additional studies such as a CT scan with and without contrast, functional nuclear scans, or an MRI. In most instances, the cause of the hematuria is benign and the clinical symptoms will resolve on their own.

Less commonly, hematuria indicates significant urologic or kidney disease. In these instances, our team will work with you and your child to determine what additional medical or surgery intervention is needed, including blood tests and evaluation by Urology and/or Nephrology.

Reviewed by: Division of Urology
Date: Nov. 2018