Hematuria

Asymptomatic Microhematuria

A patient with more than 5 rbcs/hpf in urine that otherwise looks normal, who has no other symptoms, has asymptomatic microscopic hematuria. Do not depend on the dipstick hemoglobin for diagnosis.

Check the blood pressure, history and physical exam, serum creatinine, BUN, C3 complement and urinalysis.

A normal evaluation may only require periodic follow up by the PCP to assure normal renal function, no hypertension, and no worsening of urinary findings.

Routine referral to the renal clinic can be made for parental or clinician preference.

Gross Hematuria 

The health care professional should observe with the naked eye that the urine is “reddish” or “coke colored.” The lab will confirm the color of the urine as well as “too numerous to count” or “full fields” rbcs.

Check the history and physical exam, blood pressure, serum creatinine, BUN, C3 complement and urinalysis.

Severe accompanying dysuria suggests viral cystitis. Discomfort with urination is noted in some children with low tolerance of the “chemical” irritation induced by blood on the urinary tract mucosa.

A history of any recent illness (usually preceding gross hematuria by 10-14 days) suggests "post infection” (e.g. strep, viral) glomerulonephritis. An illness at the time of the hematuria suggests IgA nephropathy, but this disorder may occur with no preceding illness or notable event.

Depressed serum C3 supports an acute “post infection” glomerulonephritic etiology, but may also support “chronic” glomerulonephritis, if C3 does not return to normal by 30 days. IgA nephropathy is not expected to produce a depression of serum complement.

Hypertension is common with glomerulonephritis and should be treated (preferably with ACE inhibition) until the problem resolves.

As long as the patient is clinically well, blood pressure easily treated and renal function (as assessed by serum creatinine) is not significantly compromised, the child should generally not require hospitalization.