Evaluation of microscopic hematuria in children
- Olivia Gillion Boyer, MD, PhD
Olivia Gillion Boyer, MD, PhD
- Associate Professor of Pediatrics
- Pediatric Nephrology, Imagine Institute, Paris-Descartes University, Hôpital Necker - Enfants Malades, Paris, France
- Section Editors
- Patrick Niaudet, MD
Patrick Niaudet, MD
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Hôpital Necker-Enfants Malades, Paris, France
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
Microscopic hematuria is a common finding in children. There is a long list of causes of microscopic hematuria, most of which are benign, especially in children with isolated asymptomatic microscopic hematuria. The challenge that faces the clinician is to identify the child in whom hematuria is caused by significant underlying disease and avoid unnecessary testing in those individuals with a benign condition.
The etiology and evaluation of microscopic hematuria in children will be reviewed here. The evaluation of children with gross hematuria is discussed separately. (See "Evaluation of gross hematuria in children".)
Hematuria is defined by the presence of an increased number of red blood cells (RBCs) in the urine. Hematuria can either be visible to the naked eye (gross) or apparent only upon urinalysis (microscopic). Microscopic hematuria may be discovered as an incidental finding on an urinalysis prompted by urinary or other symptoms.
Urinary dipstick — The most common screening test for hematuria is the urinary dipstick test for blood. Dipsticks for hemoglobin are as sensitive as the urine sediment examination, but result in more false-positive tests. In comparison, false-negative dipstick tests are unusual; as a result, a negative dipstick reliably excludes abnormal hematuria.
The reagent strip that detects blood utilizes hydrogen peroxide, which catalyzes a chemical reaction between hemoglobin (or myoglobin) and the chromogen tetramethylbenzidine. Different shades of blue-green are produced according to the concentration of hemoglobin in the urine sample. These strips can detect 5 to 10 intact RBCs/microL, which roughly corresponds to a finding on microscopic examination of two to five RBCs per high-power field from the sediment of a centrifuged 10 to 15 mL urine sample.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Feld LG, Waz WR, Pérez LM, Joseph DB. Hematuria. An integrated medical and surgical approach. Pediatr Clin North Am 1997; 44:1191.
- Diven SC, Travis LB. A practical primary care approach to hematuria in children. Pediatr Nephrol 2000; 14:65.
- Fogazzi GB, Edefonti A, Garigali G, et al. Urine erythrocyte morphology in patients with microscopic haematuria caused by a glomerulopathy. Pediatr Nephrol 2008; 23:1093.
- Dodge WF, West EF, Smith EH, Bruce Harvey 3rd . Proteinuria and hematuria in schoolchildren: epidemiology and early natural history. J Pediatr 1976; 88:327.
- Vehaskari VM, Rapola J, Koskimies O, et al. Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation. J Pediatr 1979; 95:676.
- Iitaka K, Igarashi S, Sakai T. Hypocomplementaemia and membranoproliferative glomerulonephritis in school urinary screening in Japan. Pediatr Nephrol 1994; 8:420.
- Feld LG, Meyers KE, Kaplan BS, Stapleton FB. Limited evaluation of microscopic hematuria in pediatrics. Pediatrics 1998; 102:E42.
- Stapleton FB. Idiopathic hypercalciuria: association with isolated hematuria and risk for urolithiasis in children. The Southwest Pediatric Nephrology Study Group. Kidney Int 1990; 37:807.
- Stapleton FB, Roy S 3rd, Noe HN, Jerkins G. Hypercalciuria in children with hematuria. N Engl J Med 1984; 310:1345.
- Okada M, Tsuzuki K, Ito S. Diagnosis of the nutcracker phenomenon using two-dimensional ultrasonography. Clin Nephrol 1998; 49:35.
- Kim SH, Cho SW, Kim HD, et al. Nutcracker syndrome: diagnosis with Doppler US. Radiology 1996; 198:93.
- Shin JI, Park JM, Lee JS, Kim MJ. Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children with hematuria. Eur J Pediatr 2007; 166:399.
- Vianello FA, Mazzoni MB, Peeters GG, et al. Micro- and macroscopic hematuria caused by renal vein entrapment: systematic review of the literature. Pediatr Nephrol 2016; 31:175.
- Erben Y, Gloviczki P, Kalra M, et al. Treatment of nutcracker syndrome with open and endovascular interventions. J Vasc Surg Venous Lymphat Disord 2015; 3:389.
- Bergstein J, Leiser J, Andreoli S. The clinical significance of asymptomatic gross and microscopic hematuria in children. Arch Pediatr Adolesc Med 2005; 159:353.
- Stapleton FB. Asymptomatic microscopic hematuria: time to look the other way? Arch Pediatr Adolesc Med 2005; 159:398.
- Patel HP, Bissler JJ. Hematuria in children. Pediatr Clin North Am 2001; 48:1519.
- Lee YM, Baek SY, Kim JH, et al. Analysis of renal biopsies performed in children with abnormal findings in urinary mass screening. Acta Paediatr 2006; 95:849.
- Urinary dipstick
- Microscopic examination
- - Glomerular versus nonglomerular bleeding
- Persistent hematuria
- - IgA nephropathy
- - Alport syndrome
- - Thin basement membrane disease
- - Poststreptococcal glomerulonephritis
- - Hypercalciuria
- - Nephrolithiasis and nephrocalcinosis
- - Nutcracker syndrome
- Transient hematuria
- Asymptomatic isolated microscopic hematuria
- Asymptomatic microscopic hematuria and proteinuria
- Symptomatic microscopic hematuria
- - Historical clues
- - Physical examination
- - Urinalysis
- - Further evaluation
- Indications for renal biopsy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS