Hematuria Follow-up

Author: Sanjeev Gulati, MBBS, MD, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada); Chief Editor: Craig B Langman, MD more...

Updated: Apr 20, 2010

What would you like to print?

Further Outpatient Care
Prognosis
Patient Education
Show All

Further Outpatient Care

Patients with persistent microscopic hematuria should be monitored at 6-month to 12-month intervals for the appearance of signs or symptoms indicative of progressive renal disease. Prominent among them are proteinuria, hypertension, and a decrease in renal function.

Prognosis

The prognosis of patients with asymptomatic isolated hematuria is good. The ultimate prognosis for the various conditions associated with hematuria depends on the primary medical condition that caused the hematuria in the first place.

Patient Education

Inform children and their parents that strenuous exercise may aggravate hematuria; however, hematuria by itself should not prevent the child from participating in sports. Despite the sometimes alarming intensity or persistence of hematuria, parents must be informed that, by itself, hematuria rarely causes anemia.

For excellent patient education resources, visit eMedicine's Kidneys and Urinary System Center. Also, see eMedicine's patient education article Blood in the Urine.

Contributor Information and Disclosures

Author

Sanjeev Gulati, MBBS, MD, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada) Associate Professor, Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences; Senior Consultant in Pediatric Nephrology, Department of Nephrology and Transplant Medicine, Fortis Hospitals, India

Sanjeev Gulati, MBBS, MD, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada) is a member of the following medical societies: American Society of Pediatric Nephrology, Indian Academy of Pediatrics, International Society of Nephrology, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Deogracias Pena, MD Medical Director of Dialysis, Department of Pediatrics, Cook Children's Medical Center; Clinical Associate Professor, Texas Tech University School of Medicine

Deogracias Pena, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and American Society of Pediatric Nephrology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard Neiberger, MD, PhD Director of Pediatric Renal Stone Disease Clinic, Associate Professor, Department of Pediatrics, Division of Nephrology, University of Florida College of Medicine and Shands Hospital

Richard Neiberger, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Federation for Medical Research, American Medical Association, American Society of Nephrology, American Society of Pediatric Nephrology, Christian Medical & Dental Society, Florida Medical Association, International Society for Peritoneal Dialysis, International Society of Nephrology, National Kidney Foundation, New York Academy of Sciences, Shock Society, Sigma Xi, Southern Medical Association, Southern Society for Pediatric Research, and Southwest Pediatric Nephrology Study Group

Disclosure: The Osler Institute Honoraria Speaking and teaching

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Adrian Spitzer, MD Clinical Professor Emeritus, Department of Pediatrics, Albert Einstein College of Medicine

Adrian Spitzer, MD is a member of the following medical societies: American Academy of Pediatrics, American Federation for Medical Research, American Pediatric Society, American Society of Nephrology, American Society of Pediatric Nephrology, International Society of Nephrology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Howard Trachtman, MD Program Director, Pediatrics Research, Schneider Children's Hospital, Department of Pediatrics, Division of Nephrology, Professor, Albert Einstein College of Medicine

Howard Trachtman, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Craig B Langman, MD The Isaac A Abt, MD, Professor of Kidney Diseases, Northwestern University, The Feinberg School of Medicine; Division Head of Kidney Diseases, Children's Memorial Hospital

Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, and International Society of Nephrology

Disclosure: Merck Grant/research funds None; NIH Grant/research funds None; Raptor Pharmaceuticals, Inc Grant/research funds None; Alexion Pharmaceuticals, Inc. Grant/research funds None

References

Tu WH, Shortliffe LD. Evaluation of asymptomatic, atraumatic hematuria in children and adults. Nat Rev Urol. Apr 2010;7(4):189-94. [Medline].
Higashihara E, Nishiyama T, Horie S, et al. Hematuria: definition and screening test methods. Int J Urol. Apr 2008;15(4):281-4. [Medline].
Quigley R. Evaluation of hematuria and proteinuria: how should a pediatrician proceed?. Curr Opin Pediatr. Apr 2008;20(2):140-4. [Medline].
Diven SC, Travis LB. A practical primary care approach to hematuria in children. Pediatr Nephrol. Jan 2000;14(1):65-72. [Medline].
Dodge WF, West EF, Smith EH, Bruce Harvey 3rd. Proteinuria and hematuria in schoolchildren: epidemiology and early natural history. J Pediatr. Feb 1976;88(2):327-47. [Medline].
Crompton CH, Ward PB, Hewitt IK. The use of urinary red cell morphology to determine the source of hematuria in children. Clin Nephrol. Jan 1993;39(1):44-9. [Medline].
Cruz CC, Spitzer A. When you find protein or blood in the urine. Contemp Pediatr. 1998;15:89-109.
D'Amico G. The commonest glomerulonephritis in the world: IgA nephropathy. Q J Med. Sep 1987;64(245):709-27. [Medline].
Emancipator SN, Gallo GR, Lamm ME. IgA nephropathy: perspectives on pathogenesis and classification. Clin Nephrol. Oct 1985;24(4):161-79. [Medline].
Feld LG, Stapleton FB, Duffy L. Renal biopsy in children with asymptomatic hematuria or proteinuria: survey of pediatric nephrologists. Pediatr Nephrol. Aug 1993;7(4):441-3. [Medline].
Feld LG, Waz WR, Perez LM, Joseph DB. Hematuria. An integrated medical and surgical approach. Pediatr Clin North Am. Oct 1997;44(5):1191-210. [Medline].
Kalia A, Travis LB, Brouhard BH. The association of idiopathic hypercalciuria and asymptomatic gross hematuria in children. J Pediatr. Nov 1981;99(5):716-9. [Medline].
Kincaid-Smith P, Fairley K. The investigation of hematuria. Semin Nephrol. May 2005;25(3):127-35. [Medline].
Krieger I, Sargent DA. A postural sign in the sensory deprivation syndrome in infants. J Pediatr. Mar 1967;70(3):332-9. [Medline].
Meyers KE. Evaluation of hematuria in children. Urol Clin North Am. Aug 2004;31(3):559-73, x. [Medline].
Roy S 3rd. Hematuria. Pediatr Rev. Jun 1998;19(6):209-12; quiz 213. [Medline].
Sargent JD, Stukel TA, Kresel J, Klein RZ. Normal values for random urinary calcium to creatinine ratios in infancy. J Pediatr. Sep 1993;123(3):393-7. [Medline].
Seigel M, Lee ML. Hematuria. Semin Arthritis Rheum. 1974;3:1.
Ward JF, Kaplan GW, Mevorach R, et al. Refined microscopic urinalysis for red blood cell morphology in the evaluation of asymptomatic microscopic hematuria in a pediatric population. J Urol. Oct 1998;160(4):1492-5. [Medline].
Yadin O. Hematuria in children. Pediatr Ann. Sep 1994;23(9):474-8, 481-5. [Medline].

Approach to hematuria.

Nonglomerular hematuria.

Glomerular hematuria.

Microscopy of urinary sediment. Typical appearance in non-glomerular hematuria: RBCs are uniform in size and shape but show two populations of cells because a small number have lost their hemoglobin pigment.

Microscopy of urinary sediment. Typical appearance of RBCs in glomerular hematuria: RBCs are small and vary in size, shape, and hemoglobin content.

Microscopy of urinary sediment. A cast containing numerous erythrocytes, indicating glomerulonephritis.

Table. Histologic Findings

Table. Histologic Findings

Condition	Histology	History	Laboratory Data
Systemic lupus erythematosus	Mild glomerulitis, proliferative changes, immune complex deposition, crescents, immunoglobulin deposition	Hematuria, proteinuria, hypertension, joint pains, rashes	Abnormal C3, C4, ANA, and dsDNA levels; anemia; thrombocytopenia
IgA nephropathy	IgA deposition in the mesangium, glomerular sclerosis, proliferative changes, crescents in severe cases	Gross, intermittent, painless hematuria	No specific changes, although increased serum IgA levels observed in some patients
Henoch-Schönlein purpura	Same as IgA nephropathy	Purpura, joint pains, abdominal pain, hematuria	No specific laboratory data
Alport syndrome	Some thinning of basement membranes, "basket weave" changes in the glomerular basement membrane on electron microscopy	Sensorineural hearing loss, corneal abnormalities, hematuria, renal failure	No specific changes
Thin basement membrane disease	Average glomerular basement membranes reported to be 100-200 nm in children in this condition	Persistent microscopic or gross hematuria, significant family history	No specific changes
Mesangiocapillary glomerulonephritis	Glomerular lobulations, thickening of the mesangial matrix and glomerular basement membranes, crescents	Hematuria, proteinuria, hypertension	C3 levels possibly abnormal

View Table List