Pediatric hematuria (blood in urine)

What are the signs and symptoms of pediatric hematuria (blood in urine)?

When you can see blood in the urine, it is the red blood cells causing the urine to appear red, pink or the color of rust or cola. Apart from the appearance of blood in the urine, children with hematuria usually do not have symptoms.

If your child’s hematuria is caused by a urinary tract infection (UTI), your child may complain of burning when they urinate, or of feeling the need to urinate frequently. Having pain or urinary symptoms, or not having them, has little to do with how severe your child’s hematuria might be.

How is pediatric hematuria (blood in urine) diagnosed?

If you think your child has hematuria, or blood in the urine, you should visit your child’s doctor. The doctor will examine your child and ask questions about your child’s health.

At the doctor’s office, your child will be asked to give a urine sample. The urine will be collected and a dipstick—a strip of paper treated with chemicals—will be inserted into the urine. When blood is visible in the urine or when spots on the dipstick change color, indicating the presence of red blood cells, your child’s doctor may make the diagnosis of hematuria.

Sometimes, hematuria is microscopic, or can’t be seen without the help of a microscope. The doctor may send your child’s urine sample to a lab for further testing. The test might reveal red blood cells in the urine, or white blood cells, which can mean your child has a urinary tract infection.

It’s important to find out the cause of microscopic hematuria as soon as possible, especially if your child has hypertension (high blood pressure), chronic kidney disease (CKD) or excessive protein in the urine.  

Additional test

Your child’s doctor may order additional tests to determine how your child’s kidneys are functioning and gather other important information about possible causes of hematuria.

• Urine tests - Additional urinalysis can help doctors learn the problem causing hematuria, such as infection, cancer, or kidney disease. Urine tests can also detect levels of protein, calcium and creatinine  for imbalances, which may be signs of kidney disease.

• Blood tests - Your child’s doctor may draw a sample of blood and send it to a laboratory to be analyzed for levels of creatinine, a waste product in the blood. High levels of creatinine may indicate kidney disease.

• Ultrasound - An ultrasound of the kidney or bladder can reveal or rule out a structural problem as the cause of your child’s hematuria. This test provides the doctor with information about the size and shape of the kidney and helps detect cysts, kidney stones, obstructions, lumps or other problems. A technologist moves a probe over the kidney and bladder, creating sound waves that bounce back from the organs and forming an image that can be viewed on a video screen.

• Biopsy - When findings of blood tests are abnormal, protein levels in the urine are high, or when there is a family history of kidney disease, your child’s doctor may recommend a biopsy. Your child will receive a light sedative and local anesthesia, and the doctor directs a needle into the kidneys, using ultrasound or computed tomography (CT) for guidance. A CT is a test that uses cross-sectional X-ray images to provide detailed images. The kidney tissue is examined in a laboratory to determine whether a kidney disease is causing your child’s hematuria.

Less commonly your child’s doctor might recommend:

• Intravenous pyelogram - an X-ray of the kidneys that provides information about how the kidneys drain urine

• Voiding cystourethrogram - an X-ray of the bladder and urethra—the tubes that let urine pass from the body

• Cystoscopy - a test in which a scope is passed through the urethra to view the bladder and urinary tract

What are the causes of pediatric hematuria (blood in urine)?

Babies are born with two kidneys. One of the functions of the kidneys is to filter blood from urine.

Hematuria may occur because blood leaks through the kidneys’ filters or comes from any part of the urinary tract, including the kidneys, which produce urine; the bladder, where urine is stored; the ureters, which transport urine from the kidneys to the bladder; or the urethra, the tube the urine passes through as it leaves your child’s body.

Hematuria is common in children and may result from several causes, including:

• Diseases that run in families

  • Alport syndrome

  • Polycystic kidney disease (PKD)

• Excessive amounts of minerals in the urine, such as high levels of calcium

• Injury, blockage, birth defects or other abnormal structures in the urinary tract including stones or cysts, which are sacs filled with fluid, in the kidney

• Kidney disease

• Kidney stones

• Sickle cell disease (in African-Americans)

• Tumors or cancers (rare)

• Urinary infection - In many cases, doctors can find no particular cause for hematuria.

How is pediatric hematuria (blood in urine) treated?

If your child has hematuria, or blood in the urine, they might not need treatment; sometimes the problem is mild and goes away on its own.

Sometimes, though, hematuria can be a sign of a problem in your child’s body. For this reason, your child’s doctor may want to perform tests to find out what’s causing the blood to appear in the urine.

Once your child’s doctor knows the cause, your child will receive treatment that manages the cause, which will eventually get rid of the blood in your urine and any symptoms your child might have.

For example, if your child has a urinary tract infection (UTI), the doctor might give your child antibiotics. You should make sure your child takes all of the antibiotics. Often, the doctor also will recommend that your child have a follow-up examination or urine test to make sure the infection is cured.

Other causes of hematuria may require different types of treatment. If your child’s hematuria is from a kidney stone, for example, your child will have pain and doctors will remove the kidney stone. If your child’s hematuria is from sickle cell disease, doctors will try to manage the blood disorder so that it doesn’t cause hematuria.