Evaluation of Hematuria in Children and Adolescents
Frank G. Boineau MD
John E. Lewy MD1
1 Professor and Chairman, Dept of Pediatrics, Tulane University School of Medicine, New Orleans, LA.
Hematuria is a frequent abnormal clinical finding in the genitourinary system, second only to urinary tract infection. The pediatrician needs to have an appropriate and organized approach to the examination of children with hematuria, to identify common causes or diseases and to identify those who need a more extensive evaluation of their problem and those who need urologic evaluation. The prevalence of microscopic hematuria among school-aged children ranges from 0.4% to 2.1%. Despite this frequency, it would appear that the presence of hematuria alone is rarely indicative of serious illness.
DEFINITIONS
The literature concerning hematuria is inconsistent in the various methods used to detect it and in the differing criteria for diagnosing hematuria. The most sensitive test for detecting the presence of blood in the urine is a reagent strip impregnated with orthotolodine-peroxide and enhanced with 6-methoxyquinolone. The commonly used dipsticks (Chemstrip-Boehringer Mannheim; Multistix or Labstix, Ames Division of Miles Laboratories) are sensitive. In the presence of hemoglobin (or another oxidizing agent), a blue coloration of the strip occurs. False-negative results are unusual but have been reported in the presence of high urinary concentrations of ascorbic acid. False-positive results (also unusual) are occasionally demonstrated in heavily infected urine where bacterial peroxidase is being liberated in high quantity.
