Urology

Blood in the Urine: "Hematuria" in Infants and Children

Linda M. Dairiki Shortliffe M.D.

WHAT IS HEMATURIA?
Hematuria is blood in the urine. If it is "gross" the urine may be pink to red or rust, but if it is "microscopic" the blood may be seen under a microscope only. Blood in the urine is abnormal and may be serious, so it is important to try to find the cause. At times blood in the urine may be associated with pain, frequency, or difficulty urinating, but there is no correlation of the seriousness of the cause and whether or not there are symptoms. Bleeding without any other signs or symptoms "asymptomatic hematuria" can be just as serious as that with pain. If you see blood in your child's urine, clothes, or diaper, even once, you should have your child evaluated by a doctor even if the blood disappears. While certain foods or medicines cause red discoloration of the urine, it is usually difficult to tell that this is the reason for the discoloration unless the urine is examined by a professional.

CAUSES OF HEMATURIA?
There are many reasons for blood in the urine. Blood may come from any part of the urinary tract. The urinary tract consists of the 2 kidneys-the organs that make urine, the ureters-- the tubes that carry the urine to the bladder, the bladder that stores the urine, and the urethra--the tube that passes the urine out the body. In children kidney disease is a common cause of hematuria, but urinary infection, stones, injury (trauma) or blockage of the urinary tract or other urinary tract birth defects may also be causes. Tumors or cancers may cause blood in the urine of children in rare instances and more commonly in adults. Microscopic blood may be caused by any of these things and may also be related to increases of certain minerals in the urine. In some cases the cause of the hematuria cannot be found.

TESTS THAT MIGHT NEED TO BE DONE.
If your child has had possible blood in the urine your doctor will ask you further questions about the episode and your child's health and give the child a full physical examination. Usually the doctor will want to see if the blood is still present and look for common reasons for the blood. They may do chemical tests on the urine or examine your child with radiologic imaging techniques. These radiologic imaging techniques will show your child's urinary tract. Since small tumors are rare in children, kidney and bladder imaging studies may be done, but examination of the bladder with cystoscopy is rarely done in children whereas this is a more common procedure in adults with hematuria.

SOME POSSIBLE TESTS ARE:
Urinalysis. This is examination of a freshly urinated sample of urine. Various tests are performed on the urine and is examined under the microscope. These tests will show if blood is still present. Your doctor may also have you get a urine sample at a particular time of the day or after specific activity. Urine culture and sensitivity. The urine is tested for bacterial growth and for what antibiotics can be used to treat the bacteria if they grow. Urine cytology. The cells found in the urine are examined under a microscope for any evidence of abnormality.

Renal and Bladder Ultrasound. Using sound waves, shadow-like images of the kidneys and bladder can be made. This is particularly useful for seeing birth defects, partial blockages of the urinary tract, or stones. Voiding Cystourethrogram. A small tube is placed in the urethra (tube from which the urine passes out of the body) and a dye that can be seen on x-rays is placed into the bladder so that the lining of the inside of the bladder can be seen and examined for abnormalities.

Cystoscopy. A small telescope-like instrument that is put into the urethra and bladder to examine the lining of the urethra and bladder.

Kidney biopsy. If the kidney is thought to be the cause of the bleeding, a small sample of the kidney may be taken for microscopic examination.

TREATMENTS
The treatment of hematuria depends upon the cause. For instance if the cause is a kidney disease then treatment of the kidney disease or recovery from the disease will probably stop the bleeding and, likewise, if the cause is an infection then treatment of the infection will probably solve the bleeding problem. In other instances an abnormality may need to be repaired or stone or tumor removed.

GLOSSARY:
hematuria: blood in the urine
terminal hematuria: blood at the end of the urinary stream
initial hematuria: blood seen at the beginning of the urinary stream asymptomatic
hematuria: blood in the urine without any other signs or symptoms such as pain or burning
inflammation: redness and swelling
urinary tract: upper and lower urinary tracts--kidney, ureters, bladder, and urethra
lower urinary tract: involving the bladder, prostate, and urethra
upper urinary tract: involving the ureters, renal pelvis and kidney
urethra: tube through which one urinates
ureters: tubes connecting the kidneys and bladder to void: to urinate
cystoscopy: procedure during which a telescope-like tube in used to look at the urethra and bladder
glomerular disease: disease of the kidney
urinalysis: analysis of the urine with chemical and microscopic testing urinary tract
imaging: techniques for examining the urinary tract (usually ultrasonography, CT-computed tomography, and MRI-magnetic resonance imaging) renal and bladder ultrasonography--imaging of the kidney and bladder using sound waves voiding cystourethrogram (VCUG)--imaging of the inside of the bladder and urethra with a dye introduced through a catheter placed in the urethra
idiopathic: without known cause
urinary cytology: microscopic examination of cells in the urine for signs of cancer

Other Information:
American Foundation for Urologic Disease
1128 North Charles Street
Baltimore, MD 21201
1-800-242-3483
http://www.afud.org

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
3 Information Way
Bethesda, MD 20892-3560
301-o654-3315
http://www.niddk.nih.gov

Stanford Medicine Resources:

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