Haematuria in children

Renal causes:

– Pyelonephritis

– Henoch Schönlein Purpura

– Hemolytic Uremic Syndrome

– Glomerulonephritis:

– Post-Streptococcal

– Thin basement membrane

– Membranoproliferative

– IgA Nephropathy

– Alport disease

– Hypercalciuria/ stones

– Tumour (Wilms, other)

Other renal tract:

– Lower UTI

– PUJ obstruction

– bladder stones / tumour

– Local trauma / irritation

Other causes:

– Bleeding disorders

– Sickle cell disease

– Menstrution

– Vulvovaginitis/ balanitis

– Rhabdomyolysis

History:

– Ask if gross haematuria or ‘cola’coloured’ urine

– Blood at end of micturition? menses?

– Onset, duration, persisting / intermittent

– Any dysuria, frequency, hesitancy, etc

– Any loin pain? fever? riggers?

– Preceding sore throat / skin infection?

– Diarrhoea illness (HUS?), Purpuric (HSP?) rash?

– taken any medicine or food that makes urine red?

– Any trauma?

– Any underlying disease (sickle, haemophilia, etc)

– Family h/o renal or bleeding disorders?

Examination:

– Growth stunted?

– Check BP

– Rash of HSP?

– `Puffy’ eyes, feet, sacrum?

– Alopecia, malar rash, swollen joints?

– Genitalia- for local cause

– Renal angle tenderness?

– Abdominal mass?

Investigations:

Microscopic haematuria is common, consider:

– Urine microscopy look for RBCs

– Urine calcium/creatinine ratio

– Dipstick testing of the immediate family

investigate further if persistent at 6m:

– U&E, FBC and USS Renal Tract

Macroscopic haematuria, common early tests:

Urine microscopy look for RBCs

Urine culture

Urine protein/creatinine ratio

Urine calcium/creatinine ratio

– U&E, LFT, Calcium, CK

– FBC, clotting, ESR

– ASOT, Immunoglobulins

– C3, C4, dsDNA, ANCA

– Renal Tract USS

Liaise with Renal team if:

Abnormal renal function

Proteinuria 2+ or more

Fuid retention / Oliguria

Hypertension

Persistent/ macroscopic haematuria

Structural abnormalities of renal tract/ tumour

Persistent/ complicated HSP