What if my child has blood in urine?

What if my child has blood in urine?

[mme_highlight] 3 to 4% of all children with ages 6 to 15 experience hematuria at least once, but commonly it is not associated with a severe condition. The main causes of hematuria are: infections, kidney stones, trauma and inherited diseases. [/mme_highlight]

The finding of even microscopic amounts of blood in a child’s urine alarms family. Although common, hematuria, which means “urine with blood”, is a sign or symptom but generally it is not related with a severe condition.  3 to 4% of all children with ages 6 to 15 experience hematuria at least once.
To understand hematuria, it is important to distinguish the origin of hematuria – from kidney or from urinary tract – and the types of hematuria – microscopic or macroscopic. Hematuria is macroscopic if blood is visible to the naked eye; otherwise, it is called microscopic.  It is also very useful to have a general knowledge of urinary system’s anatomy: we have two kidneys (that filter urine), two ureters (that move urine from the kidneys to the bladder), a bladder (a “bag” that holds urine), and the urethra (that carries urine out of the bladder).

What are the causes of hematuria?

  • Urinary Tract Infection;
  • Kidney stones;
  • Trauma;
  • Vigorous exercise;
  • Inherited diseases;
  • Drugs;
  • Urinary Tract Cancer (extremely rare in children).

It is also important to know if there is a history of hematuria in the family or test family to investigate it, as Familial hematuria is the most common cause of persistent hematuria in children.

What are the symptoms of hematuria?

Hematuria can occur without any associated symptom. Symptoms depend on the subjacent cause for the hematuria. In a urinary tract infection, children can feel ill, with chills and flank pain; fever, irritability and loss of appetite are frequent in young children, while burning while urinating, urinating many times and lower belly pain can be present in older children.
Flank pain can appear with kidney stones. Other kidney diseases can present with symptoms such as fatigue, abdominal pain, pale skin and high blood pressure.

What tests are used to study hematuria?

The dipstick test is an easy way to test hematuria; it uses a reagent strip embedded in hydrogen peroxide, which catalyses a chemical reaction in which hemoglobin is involved. It is not the most trustable test, but it is used due to its easiness, availability and low cost. It can detect hematuria when there are 5 to 10 red blood cells per microlitre of blood.

Urynalisis is the gold standard to test for microscopic hematuria, considered for values above 2 to 5 red blood cells per high power field (ampliation of 40 times in the microscopy).

A CT (computerized tomography) scan may be needed in selected cases.

What situations can mistake hematuria tests?

There are a number of situations that can cause a “false positive” hematuria result. It is the case of aliments like beet, mushrooms and berries and some medicines, as ibuprofen, rifampin, nitrofurantoin. Let your doctor know about these.

Why Urinary Tract Infections can be a cause of Hematuria?

Normally, there are no bacteria in the urinary tract. However, if bacteria enter the bladder they can cause an infection, which then leads to hematuria. These infections are called urinary tract infections (UTI). If bacteria go up in the urinary tract, they can reach the kidneys, causing one of the most serious type of UTI which, if not treated quickly, can lead to a permanent damage to the kidneys.

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Probability of Urinary Tract Infection (UTI) among girls presenting with fever

Risk Factors in Girls:

–        Caucasian

–        Age < 12 months

–        Temperature ≥ 39ºC

–        Fever ≥ 2 days

–        Absence of another source of infection

 

If no risk factor or 1 risk factor is present: ≤ 1% probability of UTI

If no more than 2 risk factors are present : ≤ 2% probability of UTI

 

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Probability of Urinary Tract Infection (UTI) among boys presenting with fever

Risk Factors in Boys:

–        Non African

–        Temperature ≥ 39ºC

–        Fever ≥ 24 hours

–        Absence of another source of infection

 

If no more than 2 risk factors are present (circumcised): ≤ 1% probability of UTI

If no more than 3 risk factors are present (circumcised): ≤ 2% probability of UTI

If uncircumcised probability of UTI is > 1% even if no risk factor is present.

 

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What is the treatment for hematuria?

There is no specific treatment, as the treatment is not aimed at hematuria, but rather at its underlying cause. In addition, a symptomatic treatment may be necessary to relieve pain or to lower fever. In the case of a urinary tract infection, antibiotics are prescribed. If the cause of your child’s hematuria is a bruise to the kidney, she/he might not need any treatment.

Gross Hematuria

Gross hematuria in children is not a common situation, accounting for approximately 1 in 1000 visits to a pediatrician. There are multiple causes, as seen in the table below, but the implications of gross hematuria tend to be less serious in children when compared to adults, especially because urologic malignancies are much less common in children.

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Gross Hematuria in Children

Study Design: 342 children, 1994-2003

–        Benign Urethrorrhagia: 19% of male patients

–        Urinary Tract Infection: 14% of male patients

–        Trauma: 14% of male patients

–        Congenital urologic abnormalities: 13% o all patients

–        Kidney stones: 5% of all children.

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Summary and Recommendations

  • Hematuria can occur in children, but commonly it is not associated with a severe condition.
  • Hematuria can be classified as microscopic or macroscopic (gross hematuria).
  • The main causes of hematuria are: infections, kidney stones, trauma and inherited diseases.
  • Urinary tract infections can present with hematuria, fever, chills and flank pain.
  • A dipstick test or urinalysis are generally sufficient to investigate hematuria.
  • Treatment is aimed at the underlying cause.
  • If you see blood in your child’s urine or if the urine has a different appearance (like tea stained or pink) take her/him to a doctor.

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References

  1. Subcommittee onUrinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children2 to 24 months. Pediatrics. 2011 Sep;128(3):595-610.
  2. Greenfield SP, Williot P, Kaplan D. Grosshematuria in children: a ten-year review. Urology. 2007 Jan;69(1):166-9.
  3. Meyers Evaluation of hematuria in children. Urol Clin North Am. 2004 Aug;31(3):559-73, x.
  4. Vehaskari VM, Rapola J, Koskimies O, et al. Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation. J Pediatr 1979; 95:676.

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