Related Experiment Video
Updated: Jan 11, 2026
Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
Published on: June 21, 2024
Hematuria as a diagnostic marker in pediatric nephrolithiasis without acute obstruction or infection
Zahra Pournasiri1, Momeneh Mohammad Taheri2, Shiva Fatollahierad3
1Pediatric Nephrology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Hematuria is an unreliable marker for pediatric kidney stones, as over half of children with stones show no blood in urine. Imaging is crucial for diagnosing pediatric nephrolithiasis.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Pediatric nephrolithiasis (kidney stones) is increasing globally.
- Hematuria is a common diagnostic marker, but its association with stone characteristics is unclear.
Purpose of the Study:
- To evaluate the relationship between stone characteristics and hematuria in children.
- To assess the diagnostic utility of hematuria in pediatric nephrolithiasis.
Main Methods:
- Observational study of 260 pediatric patients (1 month-18 years) with nephrolithiasis or nephrocalcinosis.
- Exclusion of patients with systemic diseases, UTIs, anomalies, or other confounding factors.
- Statistical analysis of demographics, stone characteristics, and urinalysis to assess associations with hematuria.
Main Results:
- Hematuria was present in 40% of pediatric nephrolithiasis cases.
- Ureteral and bladder stones were significantly associated with hematuria (p<0.05).
- No significant association found between stone size/number and hematuria severity.
Conclusions:
- Over half of pediatric patients with kidney stones lacked hematuria, limiting its diagnostic value.
- Reliance solely on urinalysis for diagnosing pediatric nephrolithiasis is insufficient.
- Imaging is recommended for the work-up of suspected pediatric nephrolithiasis.
Background:
The prevalence of pediatric nephrolithiasis has been rising globally, with hematuria being one of its most frequent diagnostic markers. However, the relationship between stone characteristics and the presence or severity of hematuria in children remains unclear. This study aimed to assess this association in a pediatric population.
Methods:
This observational study included children aged one month to 18 years diagnosed with nephrolithiasis or nephrocalcinosis. Exclusion criteria included patients with systemic diseases, active urinary tract infections, genitourinary anomalies, familial hematuria, recent trauma or fever, urinary tract tumors, or recent episodes of kidney colic. Data on demographics, stones characteristics, urinalysis, and metabolic parameters were analyzed using SPSS v25. Associations with hematuria were assessed using Chi-square and Kruskal-Wallis tests (p < 0.05 significant).
Results:
A total of 260 patients (mean age 5.03 ± 4.57 years; 54.6% male) were included. Hematuria was observed in 40% of cases. Stones located in the ureters and bladder were significantly associated with hematuria (p < 0.05), while lower calyceal stones were linked to lower rates. No significant association was found between stone size or number and hematuria severity.
Conclusions:
Over half of the pediatric patients with nephrolithiasis lacked hematuria, highlighting its limited role as a diagnostic marker. This finding emphasizes the shortcomings of relying solely on urinalysis and supports the need for imaging in the diagnostic work-up of children with suspected nephrolithiasis.
Related Concept Videos
01:29Urine Studies I: Urinalysis
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:30Urinary Tract Calculi III: Medical Management
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:28Urinary Tract Calculi V: Nursing Management