Hematuria: Gross and Microscopic

Abstract

The etiology of hematuria in the pediatric population is varied and ranges from infections, trauma, medical renal diseases, and urolithiasis, to congenital urologic conditions and, rarely, malignancies of the urinary tract. More often than not, hematuria in children is caused by medical rather than surgical processes. Hematuria may be characterized as microscopic or macroscopic (gross) and may be present with or without proteinuria. Although microscopic hematuria is much more common than macroscopic hematuria, the yield of an extensive work-up for isolated microscopic hematuria is low. Children with persistent isolated microhematuria should be evaluated with a urine Ca/Cr ratio, parental urinalysis, and annual renal function tests and blood pressure measurements to ensure that they do not develop hypertension or significant proteinuria. Children with gross hematuria should undergo a complete evaluation with CBC, serum C3 and C4, BUN, creatinine, potassium, ASO titers, coagulation parameters, and autoantibody titers such ANA, pANCA, cANCA, dsDNA, and anti-GBM in the setting of a relevant family history. Renal-bladder ultrasound is also recommended, along with renal biopsy for glomerulonephropathy. Invasive tests such as cystoscopy should be reserved for cases where the preceding work-up is inconclusive. Urologic referral is indicated when the work-up is suggestive of an anatomic abnormality, tumor, calculus, trauma, or recurrent macroscopic hematuria of undetermined origin. In contrast, the presence of hematuria in association with hypertension, proteinuria, hypocomplementemia, systemic disease, or a family history of renal disease almost always warrants referral to a nephrologist.