Pediatric Hematuria (Blood in Urine)

Hematuria is the medical term for the presence of blood in the urine, and parents may often be very concerned or alarmed by its appearance. However, parents will be happy to know that while it is rarely considered normal (outside of menstruation), most causes of blood in the urine are harmless and easily treated. However, significant trauma may require urgent or emergent evaluation by a doctor, so do not delay care – bring the child to the emergency room immediately. Further, blood in the urine after significant exercise/activity suggests rhabdomyolysis, which can cause kidney failure.

Importantly, parents should schedule a consultation with their trusted pediatric urologist to diagnose the problem, treat any pain or discomfort their child may have, and eliminate the root cause of hematuria. On the rare occasion that hematuria is caused by malignancy, early diagnosis and treatment are crucial for the best outcomes.

The Types of Hematuria

  • Hematuria can be considered gross/macroscopic, meaning it is visible to the naked eye within the urine, turning it pink, red, or brown depending on the quantity and where the bleeding originates. Note that the amount of blood in the urine does not need to be significant to tint the urine pink.
  • Microscopic hematuria, on the other hand, is detectable only under a microscope. It can be caused by trauma or various conditions affecting the kidneys, ureters, bladder, or urethra. This form of hematuria is detected during a urinalysis and is typically found during routine check-ups.

The Causes of Hematuria

Hematuria is very common, and the causes of this condition vary. There are far too many possible causes to list in this article; however, in addition to trauma to the urinary tract, excessive exercise, and menstruation, situations that parents can often pinpoint, some common causes of hematuria include:

Symptoms

  • Pink-colored urine typically means a small amount of blood in the urine.
  • Red-colored urine typically means the blood is fresh, likely originating in the lower urinary tract.
  • Brown-colored urine that suggests blood has spent time in the bladder.
  • Painful urination (dysuria)
  • Abdominal or back pain
  • Frequent urination (urinary frequency)
  • Fever or chills (if an infection is present)

Diagnosis

The diagnosis of hematuria in your child begins with a medical history, including recent trauma, and physical examination by your pediatric urologist. Urine tests (urinalysis with microscopy and urine culture) and blood tests may be ordered. Once your doctor has determined where the blood may be coming from, imaging studies (ultrasound or CT scan) may be ordered to look for abnormalities in the urinary tract. A cystoscopy (a minimally invasive non-surgical procedure that uses a video scope) may be recommended to visualize the urinary tract and find the source of the blood, although less commonly performed in children.

Treatment

Treatment for pediatric hematuria will depend on what is causing the bleeding. Following the exam and any testing ordered by your urologist, several conservative and surgical treatment options might be recommended.

Conservative Management

  • Regular follow-up and monitoring for children with minimal or no symptoms
  • Increased fluid intake to help flush out the urinary system
  • Antibiotics will be prescribed for urinary tract infections
  • Bowel and bladder dysfunction management

Procedural and Surgical Intervention

  • Procedures to remove kidney stones
  • Surgery to fix structural abnormalities in the urinary tract
  • Gross hematuria with a history of trauma to the abdomen may require emergent surgical evaluation and treatment.
  • Pelvic floor physical therapy for significant pelvic floor dysfunction

Follow-Up

Regular follow-ups are essential for your doctor to monitor for symptoms and prevent the recurrence of hematuria. Early diagnosis and treatment of conditions that cause hematuria are necessary for the best outcome for your child. Be sure to follow your pediatric urologist’s instructions on managing hematuria and preventing it in the future.