Hematuria (Blood in Urine) in Children

What is hematuria in children? What does blood in the urine of a child mean?

Hematuria refers to a condition of presence of red blood cells in the urine. Generally, red blood cells are not present in urine because the filters in the kidney prevent blood from entering the urine. In hematuria, the filters or other parts of the urinary tract may be responsible for leaking blood into the urine.

There are generally two types of hematuria in children:

Microscopic hematuria

The amount of red blood cells is abnormal in the urine. But the amount is not large enough to see with the naked eye. This is called microscopic hematuria. The blood in urine can only be detected with a microscope. If the child is healthy, microscopic hematuria needs to be investigated only if it is present in minimum 3-4 urine tests over several months. But in case of a child who has high blood pressure, chronic kidney disease or protein in the urine, hematuria should be investigated immediately.

Macroscopic or gross hematuria

Enough number of blood cells is present in the urine to change the color of the urine from yellow to pink, red or brown. Usually, one milliliter of blood can make the urine appear red.

Gross hematuria should be investigated at the first sight of blood in urine.

What are the symptoms of hematuria in children?

Identification of red urine (in case of gross hematuria) is the main symptom of hematuria. Other than this, hematuria doesn't have any other symptoms. However, there are certain conditions that can lead to hematuria and such conditions produce symptoms. For example:

If hematuria occurs because of urinary tract infection, the child may complain of more frequent urinary or burning sensation while urinating.
If the cause is urinary stones, the child may complain of pain (which arise from the passage of the stone).

Some underlying conditions may have no symptoms at all such as:

Vesicoureteral reflux
Hypercalciuria (high levels of calcium in the urine)
Renal vascular abnormalities
UPJ obstruction
UVJ obstruction
Tumors

What causes hematuria in children?

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There are many different causes of hematuria in children. Some of them involve urinary tract while some do not.

Causes that involve the urinary tract are:

Menstrual bleeding
Strenuous exercise
Irritation of the urethra
Trauma
Certain medications like aminoglycosides, aspirin, chlorpromazine, cyclophosphamide, diuretics, penicillin and thorazine

Some causes that do involve the urinary tract are:

Urinary tract infections
Vesicoureteral reflux
Kidney or urinary tract stones
Hypercalciuria
Trauma to the urinary tract
Ureteropelvic junction (UPJ) obstruction
Ureterovesical junction (UVJ) obstruction
Vascular anomalies
Kidney or bladder disease
Genitourinary tumors

How is hematuria in children diagnosed?

The child's doctor may recommend any of the following studies in order to diagnose the condition:

Urinalysis

Under a microscope, the urine of the child is checked for red blood cells, white blood cells, bacteria, protein, and clumps of damaged cells.

A child with microscopic hematuria and no visible symptoms will be asked to retest the urine several times over a few months. If child’s hematuria is ongoing (persistent), the next step is to find the cause. The child’s medical history and physical examination are conducted. The child is examined for:

Puffiness around the eyes
Joint pains or swelling
Pale skin
Skin rashes
High blood pressure
Flank pain

Blood tests

Blood tests are done to check kidney function, along with tests for Glomerulonephritis.

Urine culture

Urine culture is done to check for bacterial growth. This test can find and identify the germs that cause a urinary tract infection (UTI).

Cystoscopy

It is an examination in which a scope is inserted through the urethra to examine the bladder and urinary tract.

Renal bladder ultrasound

A renal ultrasound is a safe and painless test. This test uses sound waves to make images of the ureters, kidneys, and bladder.

Intravenous pyelogram

It is a kind of special x-ray of the kidneys, ureters and bladder that shows how well the kidneys drain urine.

Renal biopsy

Renal biopsy is done in rare cases only. This examination involves removal of a small sample of kidney tissue through a needle and the sample is examined in the lab.

How is hematuria in children treated?

A child's pediatric urologist determines the appropriate treatment for the child based on the underlying cause of the hematuria.

If no cause is found, the child is closely monitored because sometimes blood in the urine goes away on its own.

Hematuria caused by urinary stones is treated by removing the stones.
Hematuria caused by urinary tract infections is treated with antibiotic therapy.
Hematuria caused by very large kidney stones is treated with high-energy laser therapy.
Treatment with medications is recommended to help control high blood pressure, kidney inflammation in the kidneys and high levels of protein in the urine

What are the complications of hematuria in children? Is it dangerous to have blood in urine?

Children with hematuria may suffer from followings conditions. Some of them may not be too worrying, but sometimes the complications could be serious and dangerous. Blood in urine may not always be a cause to worry, but you should contact your doctor without delay if you see traces of blood in the urine or experience any other symptoms.