Best Approach to a Child with Gross Hematuria 2025

1. Definition and Initial Evaluation

• Gross hematuria refers to visibly red or brown urine caused by blood.
• First step: Confirm hematuria by dipstick or microscopic examination to differentiate from pigmenturia (e.g., myoglobin, hemoglobin).

1. Clinical History

• Timing: Initial (urethral), terminal (bladder), or throughout voiding (glomerular).
• Associated symptoms: Dysuria, edema, hypertension, abdominal/flank pain, trauma history, recent infections, or strenuous exercise.
• Medication and family history: Consider anticoagulants, NSAIDs, or inherited kidney diseases (e.g., Alport syndrome).

1. Physical Examination

• Check for systemic signs: fever, rash, arthritis, hypertension, edema.
• Abdominal or flank masses (e.g., Wilms tumor).
• Skin findings suggestive of systemic diseases (e.g., purpura in HSP).

1. Laboratory Investigations

• Urine analysis: Microscopic RBCs, dysmorphic RBCs (glomerular), or casts.
• Serum studies: Creatinine, electrolytes, complement levels (C3, C4).
• Other tests: ASO titer, ANA, hepatitis serologies, or imaging (renal ultrasound, CT).

1. Etiological Classification

• Glomerular causes: Post-infectious GN, IgA nephropathy, Alport syndrome, lupus nephritis.
• Non-glomerular causes: UTI, stones, trauma, tumor, or bleeding disorders.

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