Skip to Main Content


Hematuria is a common sign of urinary tract disease but also occurs in otherwise healthy children.1,2 Hematuria can present as either discolored red, brown, or tea-colored urine (eFig. 467.1), or it can present as yellow urine with a positive dipstick for blood. Clues to the diagnosis may be obtained from a history focused on whether the hematuria is painless, intermittent, or persistent, or microscopic or gross. A family history of hematuria or renal disease is important. Brown or tea-colored urine is common in glomerulonephritis, whereas red or obviously bloody urine suggests postglomerular bleeding. Glomerulonephritis is commonly associated with other abnormalities of the urine such as proteinuria and cellular casts as well as hypertension, edema, and reduced renal function. Table 468-1 provides a simple mnemonic for the causes of hematuria throughout the urinary tract. A diagnostic approach and differential diagnosis for discolored urine and microscopic hematuria are shown in Figure 468-1.

Table Graphic Jump Location
Table 468-1. A Mnemonic for the Causes of Hematuria 
Figure 468-1.
Graphic Jump Location

Algorithm for the evaluation of the child with hematuria.


Microscopic hematuria, defined as the presence of a positive urine dipstick for blood and more than five RBCs/hpf on centrifuged urine, occurs in approximately 1% of school-age children on at least one urine sample. About 0.5% will continue to have hematuria on two of three samples, and a third have hematuria on three samples.1,2 Fewer than one third of patients diagnosed with hematuria demonstrate hematuria 1 year later. Only a very small number of children with microscopic hematuria had significant renal or urological disease. Microscopic hematuria can occur following vigorous exercise; thus, it is common in school-age children and in the majority of cases is benign.


Hypercalciuria, defined as more than 4 mg urinary calcium/kg per day, has been found in significant numbers of children with microscopic hematuria.3 This association is even stronger if there is a family history of stone disease or the occurrence of gross hematuria. The calcium-to-creatinine ratio can be used to screen for hypercalciuria; for children or adolescents, a urinary Ca/Cr ratio greater than 0.2 is abnormal.4


The value of urinary tract imaging in children with microscopic hematuria is controversial. The yield of routine IVP or ultrasound is low, and reported findings are frequently of little clinical significance. When microscopic hematuria persists for several months, decisions on the need for urinary tract imaging are made based on other concerns. Voiding cystourethrograms and cystoscopy are rarely helpful and are not indicated for the routine evaluation ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.