Hematuria in children can be caused by a wide range of conditions, ranging from benign causes to serious systemic disorders. A systematic approach is essential to identify the underlying cause.
Differential Diagnosis
1. Non-Glomerular Causes
- Urinary Tract Infections (UTI)
- Most common cause in young children.
- Symptoms: Dysuria, fever, abdominal pain.
- Diagnostic test: Urine culture.
- Trauma
- Blunt abdominal trauma or urethral injury.
- History of injury or vigorous activity.
- Urolithiasis
- Associated with flank pain or irritability in younger children.
- Imaging: Ultrasound or CT scan.
- Hypercalciuria
- Can be idiopathic or secondary to metabolic disorders.
- Structural Abnormalities
- Vesicoureteral reflux, posterior urethral valves, or ureteropelvic junction obstruction.
- Imaging: Voiding cystourethrogram (VCUG).
2. Glomerular Causes
- Post-Streptococcal Glomerulonephritis (PSGN)
- Recent history of a sore throat or skin infection.
- Features: Tea-colored urine, edema, hypertension.
- Investigations: ASO titers, complement levels (low C3).
- IgA Nephropathy (Berger’s Disease)
- Episodic hematuria, often after an upper respiratory infection.
- Henoch-Schönlein Purpura (HSP)
- Purpuric rash, abdominal pain, arthralgia.
- Associated with IgA deposition in the kidneys.
- Alport Syndrome
- Family history of hearing loss and renal disease.
- X-linked inheritance.
3. Miscellaneous Causes
- Coagulopathies
- Bleeding disorders (e.g., hemophilia).
- Check coagulation profile.
- Medications/Toxins
- NSAIDs, cyclophosphamide.
- Lead or arsenic poisoning.
- Tumors
- Wilms’ tumor or rhabdomyosarcoma.
- Abdominal mass might be palpable.
Management Approach
- History and Examination
- Focus on onset, associated symptoms, recent illnesses, trauma, or family history.
- Laboratory Investigations
- Urine Dipstick: Differentiates between hematuria and hemoglobinuria.
- Urinalysis: RBC morphology (dysmorphic RBCs suggest glomerular cause).
- Urine Culture: Rule out UTI.
- Serum Studies: BUN, creatinine, complement levels, ASO titer.
- Imaging
- Renal ultrasound: Structural abnormalities.
- VCUG: If vesicoureteral reflux is suspected.
- CT scan: For suspected stones or trauma.
- Specific Management
- Infections: Antibiotics for UTI, supportive care for PSGN.
- Trauma: Urological consultation if severe.
- Stones: Increase hydration, dietary modification, or surgical intervention if necessary.
- Glomerular Causes: Supportive care, manage hypertension, nephrology referral.
