Hematuria (Blood in the urine)


Hematuria is defined as blood in the urine; it may be classified as microscopic (discovered on routine screening of urine in children with no symptoms) or gross (visible to the naked eye). Gross hematuria in children is less common than microscopic and occurs in only about 13 of every 10,000 children. Most hematuria does not represent an underlying disease and resolves on its own.

Patients can be seen by Texas Children's experts in Urology.

Causes & Risk Factors

The more common causes of hematuria include urinary tract infection or cystitis, and hypercalciuria. Blood can come from any level of the urinary tract from the kidneys to the urethra. Renal causes of hematuria include, but are not limited to, poststreptococcal glomerulonephritis, Alport syndrome, and thin basement membrane nephropathy.

Drugs like rifampin and ibuprofen and foods like beets and blackberries can produce red-appearing urine without being true hematuria.

Symptoms & Types

Hematuria is categorized as either gross or microscopic.

Microscopic hematuria is defined as greater than 5 RBCs (red blood cells) per high power field on microscopic examination of the urine. Hematuria cannot be diagnosed by dipstick evakuation (where a thin, plastic stick with strips of chemicals on it is placed in the urine to detect abnormalities) alone, microscopic confirmation is necessary. 

Gross hematuria will appear bright red, brown, or cola-colored. Glomerular (renal) causes of hematuria are often described as cola-colored, while non-glomerular causes will likely appear red. A few red drops at the end of a normal colored urine stream (post-void hematuria) indicate a source in the urethra, such as benign urethrorrhagia.

Children typically do not have any other symptoms, unless the hematuria is associated with a urinary tract infection, in which case burning with urination and urinary frequency may be present.

Diagnosis & Tests

Microscopic hematuria is often isolated and resolves on its own. If it persists at least 6 months, or there is gross hematuria, the child should be further evaluated by a urologist. This will involve a history and physical examination, urinalysis with microscopic examination, and possible urine culture. Other laboratory tests such as complete blood count, electrolytes, blood urea nitrogen, calcium and creatinine may be done.

A renal ultrasound will assess structural causes of the hematuria, such as renal stones or masses. If the renal ultrasound is normal, and/or urinalysis also shows protein in the urine, the child will be referred to pediatric nephrology for further work-up of possible renal causes.

Treatment & Care

Management involves treatment of the underlying cause, if one is found. Commonly, hematuria is benign and self limited, and will resolve on its own.

References & Sources

Baskin, Laurence and Barry Kogan, John Duckett. Handbook of Pediatric Urology. Philadelphia: Lippincott-Raven; 1997.

Renal functional development and diseases in children. Campbell-Walsh Urology.  Wein, Kavoussi, Novick, Partin, Peters. 10th edition, vol. 1. 3004-3006.