Hematuria (pediatric)

Last revised by Henry Knipe on 18 Feb 2018

Hematuria in a child is evaluated differently than in an adult in two main respects:

  • there is a lower likelihood of a malignancy (renal or bladder) causing the hematuria
  • preference is given to nonionizing radiation

Hematuria can be considered in three main forms:

  • "gross" hematuria (>1 mL of blood in the urine, red blood)
  • glomerular hematuria (tea-colored urine with red blood cell casts)
  • microscopic hematuria  (defined as ≥3 red blood cells per HPF on 2 out of 3 urinalysis specimens 2)

There are many possible causes of hematuria in a child (e.g. infection (bacterial or viral), trauma, sexual abuse, bleeding diathesis, renal stones) and a good clinical history is as valuable as imaging.

The imaging strategy depends on whether the child has had trauma or not:

If there is no history of trauma, then the imaging strategy depends on whether the hematuria is painful or not:

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