Definition

• Microscopic haematuria: The presence of >14 RBC/µl on urine microscopy.
• Macroscopic or gross haematuria: Darkening of urine visible to the naked eye.

Initial work-up

• Perform at least 2 consecutive urine dipsticks or urinalysis 1-2 days apart to confirm the diagnosis.
• Check blood pressure and growth.

• Urine Tests:
  • Urinalysis with microscopy (clean catch urine).
  • Urine culture.
  • Urine protein and creatinine ratio.
  • Urine calcium to urine creatinine ratio (N=<0.7mmol/mmol).
  • Urine dipstick on family members.

• Serum tests:
  • Creatinine/U&Es.
  • Electrolytes.
  • Full Blood Count.
  • Serum coags if macroscopic haematuria.

When to refer

• Family history of renal failure or deafness.
• Microscopic haematuria in multiple family members.
• Recurrent episodes of painless gross haematuria.

• Urgent phone consultation or immediate referralto paediatric nephrology is strongly recommended in the presence of any of the following:
  • Constitutional symptoms like weight loss, fever, arthralgias or rash.
  • Evidence of poor growth.
  • Elevated blood pressure.
  • Presence of oedema.
  • Elevated serum creatinine and/or potassium.
  • Presence of RBC casts upon urine microscopy.
  • Abnormal renal ultrasound.
  • Haematuria with associated proteinuria.
  • Decreased urine output.

Information needed

• Bring to appointment:
  • Growth records
  • Copies of all laboratory tests performed
  • Copies or originals of all radiological studies with written reports

Resources

Kids Connect (RCH Primary Care Liaison)

Kids Health Info (Parent factsheets online)

Contact information

References

Paediatric Handbook (2009) Renal conditions and enuresis, Chapter 32 (pp546-566); Colin Jones and Annie Moulden; Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia