Description
In children, the causes of hematuria can range from simple infections to serious diseases such as kidney disorders or tumors. The color of the urine may vary from pink to red to brown, depending on the amount and type of blood present. Common causes of hematuria in children include urinary tract infections, bladder or kidney stones, and trauma to the urinary tract. Diagnostic tests for hematuria in children may include a physical examination, urine analysis, and imaging studies such as X-rays or ultrasound. Treatment for hematuria will depend on the underlying cause and may include antibiotics, surgery, or medication to manage associated symptoms.
Summary Listen
- Hematuria, defined as blood in the urine, can be either macroscopic (visible) or microscopic (detected via urine analysis). Diagnosis is paramount before treatment, focusing on identifying the underlying causes. Macroscopic hematuria is readily apparent, while microscopic hematuria requires microscopic examination of a urine sample, typically defined as five red blood cells or more per high power field (HPF) of a centrifuged urine sample.
- The pathophysiology of hematuria involves disruption of the structural integrity of the urinary tract, ranging from the glomeruli to the bladder. This disruption can stem from inflammatory or immunological processes affecting the glomerular basement membrane, toxic damage to the renal tubules, or mechanical erosion of the urinary tract lining.
- Causes of hematuria are broadly categorized into glomerular and extra-glomerular. Glomerular causes involve renal issues or systemic diseases, including post-infectious glomerulonephritis, IgA nephropathy, and lupus nephritis. Extra-glomerular causes include infections, congenital anomalies, interstitial nephritis, hydronephrosis, trauma, and vascular abnormalities.
- Common causes encountered in clinical practice include urinary tract infections (UTIs), preputial stenosis, perianal irritation, hypercalciuria, coagulopathies, and trauma. Diagnosis begins with detailed history-taking, considering age, urine color, characteristics of the urine (presence of clots, frequency, amount), and associated symptoms (fever, abdominal pain, joint pain, rashes).
- Diagnostic investigation includes urine dipstick tests, microscopic examination, and further blood and imaging studies based on initial findings. Microscopic examination is crucial to differentiate glomerular and non-glomerular hematuria. Blood tests include CBC, CRP, electrolyte levels, and complement levels.
- Imaging studies begin with renal and bladder ultrasound and potentially extend to Doppler studies, cystourethrograms, or DMSA scans. Renal biopsy is reserved for cases where the diagnosis remains unclear after non-invasive investigations, especially in cases with significant proteinuria, recurrent hematuria, or declining renal function.
- Management depends on the underlying cause, including antibiotics for UTIs, supportive care for CHF or acute renal failure (ARF), and antihypertensives for hypertension. Immunosuppressants like steroids or cyclophosphamide may be used for autoimmune conditions. Surgical correction may be necessary for structural abnormalities like renal vein thrombosis.
Sample Certificate
About the Speakers
Dr Vineet Kwatra
Senior Consultant Department of Paediatrics and Neonatology Medanta Hospital
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