Skip to main content

Advertisement

Log in

Management of Hematuria in Children

  • Urology (P Reddy and B Vanderbrink, Section Editors)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Abstract

Purpose of Review

This paper provides a review of the diagnostic evaluation of both microscopic and gross hematuria, as well as an update on the pathogenesis, clinical features, and treatment strategies for several diseases of the kidneys and urinary tract in which hematuria is a prominent finding. The goal is to provide pediatric providers with a framework through which appropriate and expeditious referral to subspecialty care may be made for definitive treatment.

Recent Findings

Although there has been great heterogeneity in published treatment strategies for many causes of hematuria, the Kidney Diseases Improving Global Outcomes (KDIGO) initiative has recently set forth guidelines for glomerular diseases in particular to provide evidence-based strategies for treatment. In addition, recent advances in the understanding of molecular pathogenesis and long-term clinical outcomes for other non-glomerular diseases have led to updates in treatment strategies summarized in this review.

Summary

As the pediatric primary care provider is often the first point of contact for children with microscopic or gross hematuria, updated knowledge as to the epidemiology and management of several of the various causes of hematuria will improve the care of children by both avoiding extraneous testing and interventions and implementing definitive care (either by expectant management and reassurance or by subspecialty referral) in a timely manner.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Dodge WF, West EF, Smith EH, Bunce H. Proteinuria and hematuria in schoolchildren: epidemiology and early natural history. J Pediatr. 1976;88(2):327–47.

    Article  PubMed  CAS  Google Scholar 

  2. Vehaskari VM, Rapola J, Koskimies O, Savilahti E, Vilska J, Hallman N. Microscopic hematuria in schoolchildren: epidemiology and clinicopathologic evaluation. J Pediatr. 1979;95(5):676–84.

    Article  PubMed  CAS  Google Scholar 

  3. Massengill SF. Hematuria. Pediatr Rev. 2008;29(10):342–8.

    Article  PubMed  Google Scholar 

  4. Yap H, Lau P. Hematuria and proteinuria. Second ed. Pediatric Kidney Disease. Springer; 2016.

  5. Ingelfinger JR, Davis AE, Grupe WE. Frequency and etiology of gross hematuria in a general pediatric setting. Pediatrics. 1977;59(4):557–61.

    PubMed  CAS  Google Scholar 

  6. Mazouz B, Almagor M. False-positive microhematuria in dipsticks urinalysis caused by the presence of semen in urine. Clin Biochem. 2003;36(3):229–31.

    Article  PubMed  Google Scholar 

  7. Grossfeld GD, Litwin MS, Wolf JS Jr, Hricak H, Shuler CL, Agerter DC, et al. Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy—part I: definition, detection, prevalence, and etiology 1. Urology. 2001;57(4):599–603.

    Article  PubMed  CAS  Google Scholar 

  8. Simerville JA, Maxted WC, Pahira JJ. Urinalysis: a comprehensive review. Am Fam Physician. 2005;71(6):1153–62.

    PubMed  Google Scholar 

  9. Pearcy RM, Mitchell SC, Smith RL. Beetroot and red urine. Portland Press Limited; 1992.

  10. Patel HP, Bissler JJ. Hematuria in children. Pediatr Clin. 2001;48(6):1519–37.

    Article  CAS  Google Scholar 

  11. Greenfield SP, Williot P, Kaplan D. Gross hematuria in children: a ten-year review. Urology. 2007;69(1):166–9.

    Article  PubMed  Google Scholar 

  12. Jackson EC. Urinary tract infections in children: knowledge updates and a salute to the future. Pediatr Rev. 2015;36(4):153–64. quiz 65–6

    Article  PubMed  Google Scholar 

  13. Asghar M, Ahmed K, Shah S, Siddique M, Dasgupta P, Khan M. Renal vein thrombosis. Eur J Vasc Endovasc Surg. 2007;34(2):217–23.

    Article  PubMed  CAS  Google Scholar 

  14. Siddiqui WJ, Bakar A, Aslam M, Arif H, Bianco BA, Trebelev AE, et al. Left renal vein compression syndrome: cracking the nut of clinical dilemmas–three cases and review of literature. Am J Case Rep. 2017;18:754–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ananthan K, Onida S, Davies A. Nutcracker syndrome: an update on current diagnostic criteria and management guidelines. Eur J Vasc Endovasc Surg. 2017;53:886–94.

    Article  PubMed  CAS  Google Scholar 

  16. Raghavan R, Eknoyan G. Acute interstitial nephritis—a reappraisal and update. Clin Nephrol. 2014;82(3):149–62.

    Article  PubMed  PubMed Central  Google Scholar 

  17. West CD. Asymptomatic hematuria and proteinuria in children: causes and appropriate diagnostic studies. J Pediatr. 1976;89(2):173–82.

    Article  PubMed  CAS  Google Scholar 

  18. Meyers KE. Evaluation of hematuria in children. Urol Clin N Am. 2004;31(3):559–73.

    Article  Google Scholar 

  19. Yap H, Quek C, Shen Q, Joshi V, Chia K. Role of urinary screening programmes in children in the prevention of chronic kidney disease. Ann Acad Med Singap. 2005;34(1):3–7.

    PubMed  CAS  Google Scholar 

  20. Murakami M, Yamamoto H, Ueda Y, Murakami K, Yamauchi K. Urinary screening of elementary and junior high-school children over a 13-year period in Tokyo. Pediatr Nephrol. 1991;5(1):50–3.

    Article  PubMed  CAS  Google Scholar 

  21. Davin J-C, Coppo R. Henoch–Schönlein purpura nephritis in children. Nat Rev Nephrol. 2014;10(10):563–73.

    Article  PubMed  CAS  Google Scholar 

  22. Lehman TJ. A practical guide to systemic lupus erythematosus. Pediatr Clin N Am. 1995;42(5):1223–38.

    Article  CAS  Google Scholar 

  23. Kruegel J, Rubel D, Gross O. Alport syndrome—insights from basic and clinical research. Nat Rev Nephrol. 2013;9(3):170–8.

    Article  PubMed  CAS  Google Scholar 

  24. Kashtan CE. Alport syndrome and thin glomerular basement membrane disease. J Am Soc Nephrol. 1998;9(9):1736–50.

    PubMed  CAS  Google Scholar 

  25. Nath KA, Hebbel RP. Sickle cell disease: renal manifestations and mechanisms. Nat Rev Nephrol. 2015;11(3):161–71.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Fogazzi GB, Edefonti A, Garigali G, Giani M, Zolin A, Raimondi S, et al. Urine erythrocyte morphology in patients with microscopic haematuria caused by a glomerulopathy. Pediatr Nephrol. 2008;23(7):1093–100.

    Article  PubMed  Google Scholar 

  27. Omoloja AA, Patel H, Ey E, Jackson E. Common renal problems in pediatric medicine. Curr Probl Pediatr Adolesc Health Care. 2007;37(5):153–94.

  28. •• Hernandez JD, Ellison JS, Lendvay TS. Current trends, evaluation, and management of pediatric nephrolithiasis. JAMA Pediatr. 2015;169(10):964–70. This recent review provides a comprehensive update on the epidemiology, metabolic evaluation, and management of nephrolithasis in children.

    Article  PubMed  Google Scholar 

  29. Tasian GE, Ross ME, Song L, Sas DJ, Keren R, Denburg MR, et al. Annual incidence of nephrolithiasis among children and adults in South Carolina from 1997 to 2012. Clin J Am Soc Nephrol. 2016;11(3):488–96.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Claes DJ, Jackson E. Cystinuria: mechanisms and management. Pediatr Nephrol. 2012;27(11):2031–8.

    Article  PubMed  Google Scholar 

  31. Copelovitch L. Urolithiasis in children: medical approach. Pediatr Clin. 2012;59(4):881–96.

    Article  Google Scholar 

  32. Evan AP. Physiopathology and etiology of stone formation in the kidney and the urinary tract. Pediatr Nephrol. 2010;25(5):831–41.

    Article  PubMed  Google Scholar 

  33. Teichman JM. Acute renal colic from ureteral calculus. N Engl J Med. 2004;350(7):684–93.

    Article  PubMed  CAS  Google Scholar 

  34. Borghi L, Schianchi T, Meschi T, Guerra A, Allegri F, Maggiore U, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med. 2002;346(2):77–84.

    Article  PubMed  CAS  Google Scholar 

  35. Srivastava A, Patel N. Autosomal dominant polycystic kidney disease. Am Fam Physician. 2014;90(5).

  36. Malkan AD, Loh A, Bahrami A, Navid F, Coleman J, Green DM, et al. An approach to renal masses in pediatrics. Pediatrics. 2015;135(1):142–58.

    Article  PubMed  Google Scholar 

  37. Howlader N, Noone A, Krapcho M, Garshell J, Neyman N, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975–2010, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2010/, based on November 2012 SEER data submission, posted to the SEER web site, April 2013.

  38. Fischbach BV, Trout KL, Lewis J, Luis CA, Sika M. WAGR syndrome: a clinical review of 54 cases. Pediatrics. 2005;116(4):984–8.

    Article  PubMed  Google Scholar 

  39. Castellino SM, McLean TW. Pediatric genitourinary tumors. Curr Opin Oncol. 2007;19(3):248–53.

    Article  PubMed  Google Scholar 

  40. Weis SM, Cheresh DA. Tumor angiogenesis: molecular pathways and therapeutic targets. Nat Med. 2011;17(11):1359–70.

    Article  PubMed  CAS  Google Scholar 

  41. Escobar MA. Bleeding in the patient with a malignancy. Cancer. 2012;118(2):312–20.

    Article  PubMed  Google Scholar 

  42. O’Connor OJ, McSweeney SE, Maher MM. Imaging of hematuria. Radiol Clin N Am. 2008;46(1):113–32.

    Article  PubMed  Google Scholar 

  43. Fallat M, Hutter J. American Academy of Pediatrics section on hematology oncology, American Academy of Pediatrics section on surgery. Preservation of fertility in pediatric and adolescent patients with cancer. Pediatrics. 2008;121(5):e1461–9.

    Article  PubMed  Google Scholar 

  44. Becker AM. Sickle cell nephropathy: challenging the conventional wisdom. Pediatr Nephrol. 2011;26(12):2099–109.

    Article  PubMed  Google Scholar 

  45. Pham P-TT, Pham P-CT, Wilkinson AH, Lew SQ. Renal abnormalities in sickle cell disease. Kidney Int. 2000;57(1):1–8.

    Article  PubMed  CAS  Google Scholar 

  46. Naik RP, Derebail VK. The spectrum of sickle hemoglobin-related nephropathy: from sickle cell disease to sickle trait. Expert Rev Hematol. 2017;10(12):1087–94.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  47. Alves FR, FdAQ R. Revision about hearing loss in the Alport’s syndrome, analyzing the clinical, genetic and bio-molecular aspects. Rev Bras Otorrinolaringol. 2005;71(6):813–9.

    Article  Google Scholar 

  48. Kashtan CE. Alport syndrome and thin basement membrane nephropathy. 2001 Aug 28 [Updated 2015 Nov 25]. In: Adam MP AH, Pagon RA, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2018. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1207/.

  49. Mehta L, Jim B, editors. Hereditary renal diseases. Semin Nephrol; 2017: Elsevier.

  50. Tarr PI, Gordon CA, Chandler WL. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet. 2005;365(9464):1073–86.

    PubMed  CAS  Google Scholar 

  51. Garg AX, Suri RS, Barrowman N, Rehman F, Matsell D, Rosas-Arellano MP, et al. Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome: a systematic review, meta-analysis, and meta-regression. JAMA. 2003;290(10):1360–70.

    Article  PubMed  CAS  Google Scholar 

  52. Scheiring J, Andreoli SP, Zimmerhackl LB. Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). Pediatr Nephrol. 2008;23(10):1749–60.

    Article  PubMed  Google Scholar 

  53. Chang SL, Shortliffe LD. Pediatric urinary tract infections. Pediatr Clin N Am. 2006;53(3):379–400.

    Article  Google Scholar 

  54. Boeckh M, Erard V, Zerr D, Englund J. Emerging viral infections after hematopoietic cell transplantation. Pediatr Transplant. 2005;9(s7):48–54.

    Article  PubMed  Google Scholar 

  55. Mufson MA, Belshe RB, Horrigan TJ, Zollar LM. Cause of acute hemorrhagic cystitis in children. Am J Dis Child. 1973;126(5):605–9.

    PubMed  CAS  Google Scholar 

  56. Mulvey MA. Adhesion and entry of uropathogenic Escherichia coli. Cell Microbiol. 2002;4(5):257–71.

    Article  PubMed  CAS  Google Scholar 

  57. Semeniuk H, Church D. Evaluation of the leukocyte esterase and nitrite urine dipstick screening tests for detection of bacteriuria in women with suspected uncomplicated urinary tract infections. J Clin Microbiol. 1999;37(9):3051–2.

    PubMed  PubMed Central  CAS  Google Scholar 

  58. Meglič A, Čavić M, Hren-Vencelj H, Tršinar B, Ravnik M, Kenda R. Chlamydial infection of the urinary tract in children and adolescents with hematuria. Pediatr Nephrol. 2000;15(1–2):132–3.

    PubMed  Google Scholar 

  59. Gauthier M, Gouin S, Phan V, Gravel J. Association of malodorous urine with urinary tract infection in children aged 1 to 36 months. Pediatrics. 2012;129(5):885–90.

    Article  PubMed  Google Scholar 

  60. Brandström P, Esbjörner E, Herthelius M, Swerkersson S, Jodal U, Hansson S. The Swedish reflux trial in children: III. Urinary tract infection pattern. J Urol. 2010;184(1):286–91.

    Article  PubMed  Google Scholar 

  61. Investigators RT. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014;370(25):2367–76.

    Article  CAS  Google Scholar 

  62. Ahn S-Y, Ingulli E. Acute poststreptococcal glomerulonephritis: an update. Curr Opin Pediatr. 2008;20(2):157–62.

    Article  PubMed  Google Scholar 

  63. Eison TM, Ault BH, Jones DP, Chesney RW, Wyatt RJ. Post-streptococcal acute glomerulonephritis in children: clinical features and pathogenesis. Pediatr Nephrol. 2011;26(2):165–80.

    Article  PubMed  Google Scholar 

  64. Kanjanabuch T, Kittikowit W, Eiam-Ong S. An update on acute postinfectious glomerulonephritis worldwide. Nat Rev Nephrol. 2009;5(5):259–69.

    Article  PubMed  Google Scholar 

  65. Sjöholm AG. Complement components and complement activation in acute poststreptococcal glomerulonephritis. Int Arch Allergy Immunol. 1979;58(3):274–84.

    Article  Google Scholar 

  66. Rodriguez-Iturbe B, Musser JM. The current state of poststreptococcal glomerulonephritis. J Am Soc Nephrol. 2008;19(10):1855–64.

    Article  PubMed  Google Scholar 

  67. Zoch-Zwierz W, Wasilewska A, Biernacka A, Tomaszewska B, Winiecka W, Wierciński R, et al. The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection. Wiad Lek. 2001;54(1–2):56–63.

  68. Roy S, Murphy WM, Arant BS. Poststreptococcal crescenteric glomerulonephritis in children: comparison of quintuple therapy versus supportive care. J Pediatr. 1981;98(3):403–10.

    Article  PubMed  Google Scholar 

  69. Wong W, Morris MC, Zwi J. Outcome of severe acute post-streptococcal glomerulonephritis in New Zealand children. Pediatr Nephrol. 2009;24(5):1021–6.

    Article  PubMed  Google Scholar 

  70. Coppo R, editor. Pediatric IgA nephropathy: clinical and therapeutic perspectives. Semin Nephrol; 2008: Elsevier.

  71. Yuzawa Y, Yamamoto R, Takahashi K, Katafuchi R, Tomita M, Fujigaki Y, et al. Evidence-based clinical practice guidelines for IgA nephropathy 2014. Clin Exp Nephrol. 2016;20(4):511–35.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Tomino Y, Suzuki S, Imai H, Saito T, Kawamura T, Yorioka N, et al. Measurement of serum IgA and C3 may predict the diagnosis of patients with IgA nephropathy prior to renal biopsy. J Clin Lab Anal. 2000;14(5):220–3.

    Article  PubMed  CAS  Google Scholar 

  73. Cattran DC, Coppo R, Cook HT, Feehally J, Roberts IS, Troyanov S, et al. The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int. 2009;76(5):534–45.

    Article  PubMed  Google Scholar 

  74. • Trimarchi H, Barratt J, Cattran DC, Cook HT, Coppo R, Haas M, et al. Oxford classification of IgA nephropathy 2016: an update from the IgA nephropathy classification working group. Kidney Int. 2017;91(5):1014–21. This article adds new understanding as to the implications of histopathological characteristics in IgA nephropathy, specifially the prognostic significance of crescentic disease.

    Article  PubMed  Google Scholar 

  75. Xu K, Zhang L, Ding J, Wang S, Su B, Xiao H et al. Value of the Oxford classification of IgA nephropathy in children with Henoch–Schönlein purpura nephritis. J Nephrol. 2017:1–8.

  76. •• Cattran DC, Feehally J, Cook HT, Liu ZH, Fervenza FC, Mezzano SA, et al. Kidney disease: improving global outcomes (KDIGO) glomerulonephritis work group. KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl. 2012;2(2):139–274. This set of practice guidelines describes the evidence-based consensus guidelines for diagnostic evaluation and treatment of several forms of glomerulonephritis with additional pediatric-focused recommendations.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bradley P. Dixon MD.

Ethics declarations

Conflict of Interest

O. N. Ray Bignall II and Bradley P. Dixon declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Urology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bignall, O.R., Dixon, B.P. Management of Hematuria in Children. Curr Treat Options Peds 4, 333–349 (2018). https://doi.org/10.1007/s40746-018-0134-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40746-018-0134-z

Keywords

Navigation