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Hematuria in children
1Division of Nephrology and Hypertension, Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Pediatric hematuria evaluation requires a tailored approach based on history and urinalysis. Most causes need a pediatric nephrologist, while urologist referral is for specific conditions like large kidney stones or trauma.
Area of Science:
- Pediatrics
- Nephrology
- Urology
Background:
- Hematuria in children necessitates careful evaluation, as investigations vary by presentation.
- A complete urinalysis with microscopic examination is the sole universally required laboratory test.
Purpose of the Study:
- To summarize common causes of pediatric hematuria.
- To provide guidance on tailoring evaluations based on clinical presentation.
Main Methods:
- Review of common causes of pediatric hematuria.
- Emphasis on history, physical examination, and urinalysis findings.
- Guidelines for referral to pediatric nephrologists and urologists.
Main Results:
- Evaluation is individualized, guided by patient history, physical exam, and urinalysis.
- Most pediatric hematuria cases are linked to medical conditions requiring nephrology consultation.
- Urology referral is indicated for specific issues like spontaneous stone passage failure, large stones, trauma, or unexplained gross hematuria.
Conclusions:
- A systematic, yet individualized, approach is crucial for diagnosing pediatric hematuria.
- Nephrology referral is frequently necessary for managing underlying medical conditions.
- Urological intervention is reserved for distinct, often surgical, indications.
Abstract:
Children with hematuria require a thorough history and physical examination. Not all children with hematuria require the same investigations. The only laboratory test uniformly required for children with the various presentations of hematuria is a complete urinalysis with a microscopic examination. The rest of the evaluation is tailored according to the pertinent history, physical examination, and other abnormalities on the urinalysis. This article has provided a brief summary of the more common causes of pediatric hematuria and suggestions for tailoring the patient's evaluation according to the presentation. Most causes of hematuria in pediatrics represent medical conditions that often require referral to a pediatric nephrologist. Indications for referral to a urologist are more limited and include stones that do not pass spontaneously or are more than 5 mm in diameter, renal injury from trauma, anatomic abnormalities, or gross hematuria that seems to originate from the urinary tract and is without an identified cause.