Dr Andy Raffles
What is Haematuria?
Haematuria is a medical term which describes the presence of blood in the urine.
Haematuria can originate from anywhere along the system in the body responsible for producing urine - called the urinary tract. This includes the 2 kidneys (usually), ureter (tube that goes from the kidney to the bladder), the bladder itself where urine is stored, or from the urethra (tube that drains urine from the bladder to the outside of the body).
Haematuria in children is often of little significance with a good outlook but can be very distressing for children and their parents.
There are two main types of Haematuria:
Microscopic Haematuria is when red blood cells are detected on a sensitive stick test, and can only be seen with a microscope urine dip sticks. This type is usually detected on the simple but comprehensive urine test, that is often performed in the paediatrician’s office during well-child visits.
Gross Haematuria indicates that there are enough blood cells present to change the colour of the urine. The visible presence of blood in the urine can range in colour from bright red to dark brown.
What are the Causes?
Urinary tract infection (UTI): When the bladder lining is disrupted or irritated by bacteria or a virus, it can become inflamed. The inflammation can cause red blood cells to leak into the urine
Kidney stones: Kidney stones may bring not only pain, nausea and vomiting, but also haematuria as the stone travels through the urinary tract
Blockage in the urinary tract: ureteral pelvic junction obstructions (UPJO) or ureteral vesicle junction obstructions (UVJO) may present with gross haematuria, especially after a trauma
Kidney diseases, including post streptococcal glomerulonephritis (APSGN). Haematuria may develop a few weeks after having a streptococcal infection (such as strep throat or impetigo). Blood in the urine can also be caused by other types of glomerulonephritis or kidney diseases, and this may take a kidney specialist – nephrologist - many months to diagnose a specific cause. Not unusually causes of haematuria run in families
Strenuous exercise: haematuria may be present after vigorous exercise is seen in many very active children
Benign familial haematuria: An inherited family trait that is benign (Causes no Harm) and lifelong
Testing and diagnosis
The tests to determine what is causing the haematuria will depend on whether your child has gross or microscopic haematuria. The first step is typically an ultrasound of the kidney and the bladder. Based on those results, a specialist may ask for additional studies such as a CT scan with and without contrast, functional nuclear scans, or an MRI. In most instances, the cause of the haematuria is benign, and the clinical symptoms will resolve on their own.
Very uncommonly, haematuria indicates significant urologic or kidney disease. In these instances, our team will work with you and your child to determine what additional medical or surgery intervention is needed, including blood tests and evaluation by Urology and/or Nephrology