Pediatric Hematuria: Key Causes, Symptoms, and Treatments

A] What is Pediatric Hematuria?

Pediatric hematuria refers to blood in a child’s urine. The blood may be visible to the naked eye, making the urine appear pink, red, or brown (gross hematuria), or it could be microscopic, detectable only through lab tests. Hematuria can originate from any part of the urinary system, including the kidneys, bladder, or urethra. While sometimes benign, it’s essential to consult an expert to address this issue with the appropriate approach to hematuria in pediatrics to identify any underlying conditions and prevent further complications.

B] Common Causes of Hematuria in Children

Several potential factors can lead to blood in baby urine. Understanding these causes can help parents and caregivers respond appropriately.

1. Urinary Tract Infections [UTIs]

A common cause of pediatric hematuria is a urinary tract infection. Infections in the bladder or kidneys can cause inflammation and irritation, leading to blood leakage into the urine. Symptoms may include frequent urination, painful urination, and discomfort in the lower abdomen. UTIs can easily be treated with antibiotics, but untreated infections can lead to complications like kidney damage.

2. Kidney Stones

Kidney stones can form in children and cause blood in urine pediatric urology.  Stones form when minerals in the urine crystallize and cause blockages or irritation. Kidney stones can be extremely painful, often causing visible blood in the urine along with nausea and vomiting. Risk factors include dehydration and diets high in salt or oxalates. Treatment may range from hydration and pain management to medical procedures for larger stones.

3. Injury or Trauma

Blunt force trauma to the kidneys or bladder—often due to sports injuries or accidents—can lead to blood in urine in children. This trauma can damage the urinary organs, causing internal bleeding that manifests as hematuria. In some cases, pediatric urethral injury, a trauma to the urethra, can also occur, leading to blood in the urine. While minor injuries may heal with rest, significant trauma, including urethral injury, requires immediate medical intervention.

4. Glomerulonephritis

Glomerulonephritis is a condition involving inflammation of the kidney’s filtering units, known as glomeruli. This condition can be caused by infections, such as strep throat or immune system disorders. When the kidneys are inflamed, they may leak red blood cells into the urine, resulting in hematuria. Depending on the severity, treatments range from medications that control inflammation to managing underlying health conditions. Proper evaluation and treatment of causes of hematuria in pediatrics are critical to avoid lasting kidney damage.

5. Inherited Disorders

Certain genetic conditions, such as Alport syndrome, can affect the kidneys and lead to hematuria. Alport syndrome, for example, causes progressive kidney damage and is often accompanied by hearing or vision problems. Children with inherited disorders that impact kidney function may experience chronic hematuria, requiring long-term management by a specialist in pediatric urology.

C]  How to Recognise Symptoms of Pediatric Hematuria

Detecting pediatric hematuria depends on whether the blood is visible. In the case of gross hematuria, urine may be pink, red, or brown. However, microscopic hematuria, where blood cells are present but not visible, can only be detected through a urinalysis. Other accompanying symptoms can include pain or burning during urination, frequent urges to urinate, lower abdominal or flank pain, and sometimes fever, especially if a UTI is present.

D] Diagnosis of Hematuria in Children

Diagnosing the cause of blood in urine in pediatric urology typically involves several steps:

1. Medical History and Physical Exam

Doctors begin by taking a detailed medical history and asking about any recent illnesses, injuries, or family history of kidney problems. A physical exam may reveal signs of infection, inflammation, or injury.

2. Urine Analysis

A urinalysis is the primary diagnostic tool for detecting pediatric hematuria. It identifies blood in the urine and tests for proteins, white blood cells, and bacteria that may indicate infection or kidney issues.

3. Imaging Tests

Imaging studies such as ultrasounds, X-rays, or CT scans may be ordered to detect structural abnormalities, stones, or tumors in the urinary system. These tests help identify underlying causes, such as kidney stones or obstructions.

4. Blood Tests

Blood tests can assess kidney function and detect markers of systemic diseases, such as infections or autoimmune conditions, that may be contributing to hematuria.

E]  Treatment of Pediatric Hematuria

Hematuria treatment depends on the underlying cause. Some of the common treatments include:

1. Treating the Underlying Cause:

• For UTIs: Antibiotics are prescribed as the main medication for blood in the urine caused by infections.
• For Kidney Stones: Small stones can pass naturally with increased hydration. Larger stones might require procedures such as lithotripsy (breaking stones apart) or surgical removal.
• For Trauma: Rest and monitoring are often sufficient for minor injuries, but more severe trauma may require hospitalization and intensive care.
• For Glomerulonephritis: Treatment focuses on reducing kidney inflammation and managing any associated infections or immune system disorders.

2. Managing Pain and Discomfort

Over-the-counter medications can help alleviate pain, especially for conditions like kidney stones or UTIs, where discomfort can be significant. Managing symptoms effectively improves recovery.

3. Monitoring

In cases where causes of hematuria in pediatrics are mild and self-limiting, regular monitoring through follow-up appointments may be recommended. This practice is particularly true for conditions like benign familial hematuria, where no immediate intervention is required.