Hematuria

Hematuria is blood found in your child’s urine. Although this condition is alarming, it is quite common in children, often harmless, and often easily treated once its cause is determined.

There are generally two types of hematuria:

• In microscopic hematuria, there is an abnormal amount of red blood cells in the urine, but the amount is not large enough to see with the naked eye.
• In macroscopic or gross hematuria, there is enough blood to change the color of the urine from yellow to pink, red, or brown. Only one milliliter of blood (less than a tenth of an ounce) can make the urine appear red.

There are at least 50 different causes of hematuria in children. Many of these causes don’t involve the urinary tract, such as menstrual bleeding, strenuous exercise, or irritation of the urethra (the hole where urine comes out).

Here are some causes that do involve the urinary tract:

• Urinary tract infections
• Vesicoureteral reflux
• Kidney or urinary tract stones
• Hypercalciuria (large amounts of calcium in the urine)
• Trauma to the urinary tract
• Ureteropelvic junction (UPJ) obstruction
• Ureterovesical junction (UVJ) obstruction
• Vascular anomalies
• Kidney or bladder disease
• Genitourinary tumors

Hematuria itself doesn’t have any symptoms other than the identification of red urine, in the case of gross hematuria. However, the conditions that cause hematuria may produce symptoms. For example, if the cause is a urinary tract infection, your child may complain of urinary frequency or burning urination. Hematuria caused by urinary stones is often associated with pain from the passage of the stone.

Some underlying conditions, such as vesicoureteral reflux, hypercalciuria, renal vascular abnormalities, UPJ obstruction, UVJ obstruction, and tumors, may have no symptoms at all.

Your child’s doctor could recommend any of these studies:

• Blood tests
• Radiographic imaging
• Cystoscopy: An examination in which a scope is inserted through the urethra to examine the bladder and urinary tract
• Renal bladder ultrasound
• Intravenous pyelogram: A special X-ray of the kidneys, ureters, and bladder that shows how well the kidneys drain urine
• Voiding cystourethrogram (VCUG): A bladder and urethra X-ray that takes moving pictures (see more information for boys and girls)
• Renal biopsy (very rare): Removal of a small sample of kidney tissue through a needle for testing

Your child’s pediatric urologist will determine which treatment is appropriate for your child based on what's causing the hematuria.

• Hematuria caused by urinary stones is generally treated by removal of the stones.
• Hematuria caused by urinary tract infections is treated with antibiotic therapy to eradicate the infection.

The doctor will also consider the extent of the condition, your child’s tolerance for specific medicines and procedures, and your preferences. In many cases, the hematuria goes away by itself and does not return; in this case, your child wouldn’t require any specific therapy other than observation.

Because there are so many possible causes of hematuria, your child’s pediatric urologist will determine which treatment is appropriate for your child based on the underlying problem. In many cases, the hematuria goes away quickly and does not return; in this case, your child wouldn’t require any specific treatment other than observation.