Hematuria in children
Evaluation
- History: duration, timing, recent illness, other GU conditions, activity, medications
- Exam: check for hypertension, rash, petechiae, pallor, abdominal masses, external genitalia
- Labs: confirm RBC on microscopy (not dipstick), assess for UTI
- Glomerulonephritis evaluation: serum creatinine, complement C3, CBC, antistreptolysin O, anti-DNase B, urinary Ca/Cr ratio, family history
- Renal biopsy indications: onset < 1yo, hematuria + HTN, systemic symptoms, low C3 > 8wks, family history renal failure, hearing loss
Specific diagnoses
- Benign familial hematuria: family history hematuria without hearing loss or renal failure
- Alport syndrome: hematuria/proteinuria, hearing loss, and ocular abnormalities, males more affected (X-linked), evaluate with nephrology and audiology evaluations
- Post-strep glomerulonephritis: develops 1-3 weeks after skin/URI, usually self-resolving, may require management of fluid retention and HTN, antibiotics will not shorten GN course
- IgA nephropathy: develops within days of URI, occasionally progresses to renal failure, managed with steroids
- Membranoproliferative glomerulonephritis: many inciting factors, usually treated with steroids, often progresses to renal failure
- Henoch Schonlein purpura: systemic vasculitis with palpable lower extremity purpura, hematuria/proteinuria, joint pain/swelling, vomiting/abdominal pain, managed with supportive therapy (steroids)
- Lupus (SLE): variety of presenting symptoms, renal biopsy findings help determine treatment options
- Microscopic polyangiitis nodosa (MPN) + granulomatosis with polyangiitis (GP): rapidly progressive small vessel vasculitis, can have sinusitis, cough, pulmonary hemorrhage, renal biopsy positive for P-ANCA (MPN) or C-ANCA (GP), may require plasmapheresis
- Hypercalciuria: thought to be caused by trauma from calcium crystals, diagnosed with urinary Ca/Cr ratio > 0.2-0.5, screen with spot test and confirm with 24hr collection (> 4mg/kg/d), check serum Ca, Phos, Vit D, and PTH, manage with salt restriction and increased fluid intakes, consider citrate supplements and thiazides
- Sickle cell: hypoxia causes decreased medullary blood flow, leading to congestion and papillary necrosis and bleeding
References
- AUA Core Curriculum
- Baskin, Laurence S. Handbook of pediatric urology. Lippincott Williams & Wilkins, 2018.
- Schlomer, B. and M. Jacobs. "Pediatric Genitourinary Trauma." Campbell-Walsh Urology 12 (2020).