Haematuria

Published on 23/06/2015 by admin

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Last modified 23/06/2015

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16.2 Haematuria

1 In children haematuria usually originates from the kidneys.

2 Haematuria can be caused by urinary infection, glomerular disease, tumours, congenital abnormalities and coagulopathies.

3 All paediatric haematuria should be investigated.

4 All patients with haematuria require follow-up.

Introduction

Blood in the urine (haematuria) may be visible to the naked eye (macroscopic) or be detected only on dipstick testing and/or urine microscopy (microscopic). It may be found in isolation or associated with other urine abnormalities such as proteinuria, crystals and casts. It is essential to consider urinary tract infection (UTI) as a possible cause and, if confirmed, to manage accordingly (see Chapter 16.4).

Microscopic haematuria may be defined as >10 red blood cells (RBCs) per high-power field, or >50 RBCs mL^–1 of urine (confirmed on three separate occasions).

Note that small numbers of red cells are normally excreted in urine.

Macroscopic haematuria exists when visible to the naked eye and confirmed on testing as being blood.

Haematuria can originate at any site in the urinary tract but, in contrast to adults, lower tract haematuria is relatively uncommon in children (and therefore cystoscopy is rarely indicated).

Microscopic haematuria in the setting of an acute febrile illness can be normal. UTI should be excluded by urine culture and the urine tested again after the acute illness has passed.

Asymptomatic micro-haematuria in children without other signs of renal disease (hypertension, oedema, proteinuria, urinary casts, poor growth or renal impairment) is also relatively common.

Consider idiopathic thrombocytopenic purpura (ITP), Henoch–Schönlein purpura (HSP) and coagulation disorders.

Causes of glomerular haematuria include:

• glomerulonephritis (GN) (including nephritis in multisystem disorders, e.g. systemic lupus erythematosus (SLE));

• familial nephritis (Alport’s disease);

• thin basement membrane disease (‘benign’ familial haematuria);

• IgA nephropathy;

• polycystic kidney disease.

Causes for non-glomerular haematuria include:

• idiopathic hypercalciuria;

• anatomical abnormalities;

• sickle cell disease (in relevant ethnic groups).

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