Hematuria in a child is evaluated differently than in an adult in two main respects:
- there is a lower likelihood of a malignancy (renal or bladder) causing the hematuria
- preference is given to nonionizing radiation
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Pathology
Hematuria can be considered in three main forms:
- "gross" hematuria (>1 mL of blood in the urine, red blood)
- glomerular hematuria (tea-colored urine with red blood cell casts)
- microscopic hematuria (defined as ≥3 red blood cells per HPF on 2 out of 3 urinalysis specimens 2)
Treatment and prognosis
There are many possible causes of hematuria in a child (e.g. infection (bacterial or viral), trauma, sexual abuse, bleeding diathesis, renal stones) and a good clinical history is as valuable as imaging.
The imaging strategy depends on whether the child has had trauma or not:
- trauma
- gross or microscopic hematuria: CT of the abdomen and pelvis with contrast
- blood at the meatus: retrograde urethrography
- pelvic fractures: CT cystography
If there is no history of trauma, then the imaging strategy depends on whether the hematuria is painful or not:
- painful: renal ultrasound or CT of the abdomen and pelvis without contrast, to assess for renal stones
- not painful
- gross hematuria: may not need imaging, but renal ultrasound is usually preferred over VCUG for an initial evaluation
- glomerular hematuria: may not need imaging 3
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