Haematuria in children
BMJ 2024; 387 doi: https://doi.org/10.1136/bmj-2022-072501 (Published 25 November 2024) Cite this as: BMJ 2024;387:e072501
- Alok Godse, consultant paediatric surgeon and urologist1,
- Yincent Tse, consultant paediatric nephrologist2,
- Abosede Kokumo, general practitioner3,
- Christian Harkensee, consultant in paediatric immunology and infectious diseases4
- 1Department of Paediatric Surgery, Great North Children’s Hospital, Newcastle upon Tyne, UK
- 2Department of Paediatric Nephrology, Great North Children’s Hospital, Newcastle upon Tyne, UK
- 3Second Street Surgery, Bensham, Gateshead, UK
- 4Department of Paediatrics, Dumfries and Galloway Royal Infirmary, Dumfries, DG2 8RX, UK
- Correspondence to: C Harkensee c.harkensee{at}gmx.net
What you need to know
Visible haematuria in children can be caused by many individually rare conditions; a small number of investigations can help to identify those which require urgent action
Isolated non-visible haematuria is common and usually transient; the yield from investigations is very low
Ongoing symptomatic visible haematuria should be referred urgently for hospital investigation. Non-visible haematuria with proteinuria should also be referred
A 12 year old boy presented with a history of recurrent frank haematuria. He reported three or four episodes in the past three months, with each episode quickly fading after a couple of days. On detailed questioning, he revealed that, during each episode, he experienced transient mild dysuria, urinary frequency, urgency, and central abdominal discomfort. Abdominal examination revealed no tenderness, his foreskin was retractable, and no meatal inflammation or excoriation was visible. In clinic his urine looked clear yellow with no visible blood. Urine dipstick revealed 3+of blood.
What is haematuria?
Visible haematuria (macroscopic) is visible bloody discoloration of urine. With easy availability of urine dipstick tests, the incidental discovery of persistent (defined as more than 6 months) non-visible haematuria (microscopic haematuria or NVH) may also occur. Visible haematuria is rare, and its incidence is unknown, whereas non-visible haematuria has been found in up to 5% of school children on mass screening in Asian schools,12 with up to 0.5% persisting three to six months later.
Unlike in adults, underlying malignancy as a cause of haematuria in children is extremely rare (<0.1%).345 Although the underlying cause cannot be determined by whether the haematuria is visible or non-visible, isolated non-visible haematuria is most commonly idiopathic, whereas visible haematuria may stem from the kidney (such as IgA nephropathy or autoimmune disease) or the urinary tract (such as posterior urethritis, urinary tract stones, balanitis, or urinary tract infection46). It would, …
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