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Hematuria in children. A practical approach
B G Cilento1, J A Stock, G W Kaplan
1Department of Urology, Naval Medical Center, San Diego, California.
Insights
Evaluating pediatric hematuria requires a safe, methodical approach. Microscopic urinalysis is key, identifying causes like glomerulonephritis and guiding further diagnostic imaging for children.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Medicine
Background:
- Hematuria in children necessitates careful evaluation to minimize iatrogenic risk.
- Invasive procedures like angiography and cystoscopy are generally avoided due to potential harm.
Purpose of the Study:
- To outline a safe and effective diagnostic strategy for pediatric hematuria.
- To emphasize the importance of non-invasive methods in initial evaluation.
Main Methods:
- Prioritizing a thorough patient history and physical examination.
- Utilizing microscopic examination of urinary sediment as a primary diagnostic tool.
- Employing tailored genitourinary imaging based on clinical findings.
Main Results:
- Microscopic urinalysis, particularly the presence of red blood cell casts, can strongly suggest specific diagnoses like glomerulonephritis.
- Findings from urinalysis can often obviate the need for more invasive urologic evaluations.
Conclusions:
- A systematic approach starting with history, physical exam, and urinalysis is crucial for evaluating pediatric hematuria.
- Red blood cell casts are a critical indicator for glomerulonephritis, guiding subsequent management.
- Genitourinary imaging should be selectively applied based on the clinical context and initial findings.
Abstract:
The investigation of hematuria in children should never be allowed to pose a greater risk to the child's health than does the problem itself. For this reason, angiography and cystoscopy are rarely employed in the evaluation. The evaluation of the child should proceed methodically and rest firmly on a well-taken history and results of physical examination. The microscopic examination of the urinary sediment is the cornerstone of the evaluation process and can itself suggest the origin of the hematuria. Red cell casts, if present, indicate glomerulonephritis and obviate further urologic evaluation. Genitourinary imaging should be tailored to each clinical situation.