Hematuria Treatment & Management

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

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Medical Care
Surgical Care
Consultations
Diet
Activity
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Medical Care

Asymptomatic (isolated) hematuria generally does not require treatment. In conditions associated with abnormal clinical, laboratory, or imaging studies, treatment may be necessary, as appropriate, with the primary diagnosis.

Surgical Care

Surgical intervention may be necessary in certain anatomical abnormalities, such as ureteropelvic junction obstruction, tumor, or significant urolithiasis.

Consultations

Consultations are required in patients with urinary tract anomalies and in some patients with systemic diseases (eg, bleeding disorders, collagen vascular diseases, sickle cell nephropathy).

Diet

Dietary modification is usually not indicated except for children who may have a tendency to develop hypertension or edema as a result of their primary disease process (eg, nephritis). In these patients, a low sodium diet may be helpful. In addition, a diet containing the recommended daily amount (RDA) for calcium plus a low-salt diet may be beneficial in children with hypercalciuria and hematuria.

Activity

Activities of a child with asymptomatic, isolated hematuria should not be restricted. However, these children and their parents should be informed that strenuous exercise may aggravate hematuria. Restrictions in physical activities may be indicated in children with severe hypertension or cardiovascular disease.

Proceed to Medication

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

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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

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