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What is hematuria?

  • Hematuria refers to blood in the urine. Bleeding can arise within the urinary system in areas such as the kidneys, bladder or other parts of the urinary tract.
  • Sometimes the blood is obvious like a clot and sometimes it is invisible to the naked eye (microscopic).
  • Blood in the urine may appear as reddening or darkened urine or other urine color changes such as a tea colored appearance.
  • Eventhough the urine may appear red, this does not necessarily mean that there is blood in the urine.
    For example, certain foods like beets and certain medicines like rifampin (a tuberculosis medication) can make the urine turn red or orange.
  • Microscopic hematuria without other symptoms, such as swelling, high blood pressure, or kidney problems, occurs in approximately 2% of children.
  • It is important to remember that there are usually other symptoms associated with the most serious causes of hematuria, such as swelling or edema and/or high blood pressure.

What are the causes of blood in a child’s urine?

There are many reasons why a child may have blood in her urine, some potentially serious.

One of the most common causes of hematuria is a urinary tract infection (UTI).

Other common but harmless conditions include:

  1. Irritation of the urethra, the opening where the urine comes out (e.g., from masturbation)
  2. Insertion of a foreign body into the urethra (e.g., a catheter)
  3. Trauma (e.g., injury to the abdomen or lower back)
  4. Menstrual bleeding
  5. Strenous exercise
  6. Genetic factors (e.g., familial benign hematuria)

Some other causes of hematuria which are potentially seriousinclude:

Streptococcal infection

~ after an infection with some strains of Group A Streptococcus
(Streptococcus pyogenes), the bacteria that causes strep throat
and some skin infections, the body can develop an immune
reaction that causes damages to the kidneys

~ the reaction usually shows up one to three weeks after the throat
or skin infection

~ the most common first symptom is swelling around the eyes

Kidney stones

Hemolytic uremic syndrome (HUS)

~ a common cause of acute renal failure in children

~ children under five years of age are at greatest risk of developing

~ the syndrome may be caused by a viral or bacterial infection
(e.g., E. coli)

~ an E. coli infection is usually from ingestion of undercooked
contaminated ground beef products but also raw milk

~ the classic features include anemia, a low platelet count and
kidney failure after a diarrheal illness, which can be bloody

~ treatment may require blood transfusions and dialysis

Henoch-Schonlein purpura

~ the peak incidence is approximately age 4-5 years

~ its onset is preceded by an upper respiratory infection in at least
30% of children

~ a raised, purple rash is seen predominantly on the buttocks and
lower extremities

~ abdominal pain, joint pain, and swelling are often present




~ most children do not require therapy and the symptoms resolve
on there own

Chemicals/Toxins (e.g., blood thinners such as coumadin)

Connective tissue disease (e.g., Lupus)

Tumor (very rare)

What are some important questions my doctor may ask of me concerning hematuria in my child?

  1. Has your child had feverabdominal pain, burning on urination or an increase in the number of times he/she urinates?
  2. Has your child had a history of urinary tract infections?
  3. Has your child had any recent injury to his/her abdomen or genital area?
  4. Has your child had a recent throat or skin infection?
  5. How much exercise does your child do?
  6. Has your child had a recent bladder catheterization?
  7. What foods have your child eaten recently? Any beets or blackberries?
  8. Are their stools loose or bloody?
  9. Has there been any joint pains or swellings?
  10. Is there any history of sickle cell disease or trait?
  11. Is there any family history of kidney disease (including kidney stones), transplants, or dialysis?
  12. Is there a family history of hearing deficits?
  13. What medications does your child take?

What test may be done to find out why my child has blood in their urine?

  • The first step in the evaluation of hematuria is a detailed review of the history and a thorough physical examination.
  • A urine test (urinalysis) will be performed to confirm if blood is present and to look for other things such as protein (a sign that a problem could be present).
  • If the child has no symptoms and the physical exam is normal (including blood pressure) and there is no family history of kidney disease, a recheck of the urine in a several days is probably all that is required.
  • If the initial urine also has protein in it, there are other symptoms present or a follow up urine still shows blood then a further evaluation will be necessary.

The following are some other studies your doctor may consider depending on their evaluation:

  1. Urine culture (to diagnose a urinary tract infection)
  2. Calcium in the urine as a sign for kidney stones
  3. Blood and platelet counts
  4. Blood test for kidney and liver function
  5. Strep test using blood
  6. Immune studies using blood
  7. Kidney ultrasound to determine if there are any kidney abnormalities (e.g., enlarged kidney, tumor, stone)
  8. Kidney CAT scan can determine if a stone is present
  9. Kidney biopsy may be needed in rare cases if the other tests point to the kidney itself as the origin of the bleeding

What is the follow up and prognosis for a child with hematuria?

  • Children with persistent microscopic hematuria will be monitored at 6- to 12-month intervals for the appearance of signs or symptoms indicative of worsening kidney disease (e.g., protein in the urine, high blood pressure).
  • The prognosis of patients with blood in the urine without any other signs or symptoms is good.
  • The ultimate prognosis for the various conditions associated with hematuria is dependent on the primary medical condition that caused the hematuria in the first place.

When should I contact my pediatrician?

  • You should contact your child’s pediatrician anytime you notice blood in their urine.
  • You should also contact your pediatrician anytime other symptoms develop, particularly swelling anywhere on the body.