Pediatrics in Review
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 Vol. 29 No. 10, October 2008
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Right arrow Renal Disorders

(Pediatrics in Review. 2008;29:342-348.)
© 2008 American Academy of Pediatrics

Hematuria


Susan F. Massengill, MD*
 * Director, Pediatric Nephrology, Levine Children's Hospital at Carolinas Medical Center, Charlotte, NC

The first 300 words of the full text of this article appear below.


   Objectives
 
After completing this article, readers should be able to:

  1. Define hematuria.
  2. List the common conditions associated with hematuria.
  3. Identify the important elements of the history and physical examination that suggest serious renal disease.
  4. Plan a practical and systematic approach to the evaluation of hematuria.
  5. Appreciate when consultation with a pediatric nephrologist is necessary.


   Case Study
 
An 8-year-old white girl is referred for evaluation of hematuria, proteinuria, and hypertension. She has had recurrent episodes of gross hematuria. The first was at 3 years of age and was attributed to a urinary tract infection, but a urine culture was negative. She was treated with 10 days of antibiotics, and the symptoms resolved. The second episode, at age 5 years, was attributed to acute poststreptococcal glomerulonephritis, although an antistreptolysin O (ASO) titer was normal, and complement studies were not ordered. Blood pressure at that time was 120/80 mm Hg (normal for age and height is 94/54 mm Hg). The girl was lost to follow-up and presents 3 years later with blood pressure at the 95th percentile, gross hematuria, and generalized edema. Urinalysis of tea-colored urine shows too-numerous-to-count dysmorphic red blood cells (RBCs), white blood cells, proteinuria, and RBC casts. The differential diagnosis includes immunoglobulin A nephropathy, membranoproliferative glomerulonephritis, and hereditary nephritis, although the latter condition is unusual in a female. She is admitted for additional evaluation.


   Introduction
 
Hematuria is a common finding in children and often comes to the attention of the pediatrician as a result of a routine screening urinalysis, as an incidental finding when evaluating urinary tract symptoms, or when a child has gross hematuria. Although the differential diagnosis for hematuria is extensive, most cases are isolated and benign. Generally, hematuria is a medical rather than a urologic issue. Only the rare child or adolescent who has hematuria needs initial screening radiographic imaging . . . [Full Text of this Article]






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