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Hematuria

What is hematuria?

Hematuria is blood in the urine. This can be gross or seen by the eye. It may also be microscopic or only seen by a microscope.

What are the causes?

There are multiple causes of hematuria.  The most common include: post strep glomerulonephritis, urinary tract infection, trauma, kidney stones, idiopathic urethrorraghia, or benign familial hematuria.  Other causes include: meatal stenosis, idiopathic hypercalciuria, Alports syndrome, Henoch- scholein purpura, IgA nephropathy, bleeding disorders or strenuous exercise.

What does the workup involve?

The workup may involve a combination of radiology studies and/or bloodworm.  Radiology studies may include: ultrasound of kidneys and bladder or spiral CAT scan if suspicion of stone. Blood work may include: complete blood count, chemistry panel, ASO titer for strept, C3C4 complement, urinalysis, urine culture, urine for calcium/creatinine ratio and possibly straining the urine to look for a stone.

What type of information is important to note?

Is the urine at the end of the stream in the toilet? This may be suggestive of idiopathic urethrorraghia.  Is there spotting of blood in the underwear?  This may suggest meatal stenosis (a narrowing of the opening of the penis) or idiopathic urethrorrahagia. Is there any flank or abdominal pain?  This may be suggestive of a stone.  Have there been any recent colds, viruses, sore throats or strep infections? You may have blood in the urine up to 6 months status post a strept infection.  Has there been any recent trauma or rashes? Is there a family history of hematuria?

What is idiopathic urethrorraghia?

This condition is seen in primarily prepubertal males. It is benign and self-limited. It is associated with seasonal changes and is episodic in nature.  Urine cultures are usually negative.  The cause is unknown but thought to be an infectious or viral agent.  The main symptoms include blood noted at the end of the urinary stream or blood spotting in the underwear. The workup includes a urinalysis, possible urine culture and ultrasound of the kidneys and bladder.

What if there are kidney stones?

The evaluation for kidney stones includes the above suggestions.  Depending on the size and area where the stone is located will determine the treatment plan. This may involve a workup also to evaluate why the child may have formed the stone.

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December 2005