Hematuria (Blood in Urine)

Types of Hematuria

There are two main types of hematuria – microscopic hematuria and macroscopic or gross hematuria. In microscopic hematuria, there is an abnormal amount of red blood cells in the urine but the amount is too small to see with the naked eye. In macroscopic hematuria, the amount of blood in the urine is large enough that it can change the color of urine to pink, red or brown, and can sometimes cause clots. As little as 1 milliliter of blood in a liter of urine is enough to change the color of urine.

Causes of Blood in Urine

Hematuria can develop for many reasons, including:

• Genitourinary tumors
• Hypercalciuria (large amounts of calcium in the urine)
• Kidney or bladder disease
• Kidney or urinary tract stones
• Trauma to the urinary tract
• Ureteropelvic junction (UPJ) obstruction
• Ureterovesical junction (UVJ) obstruction
• Urinary tract infections (UTIs)
• Vascular anomalies
• Vesicoureteral reflux
• Vascular anomalies
• Vigorous exercise

Hematuria Symptoms

Often, hematuria has no symptoms unless there is enough blood to change the color of the urine. However, there may be symptoms from an underlying condition that is causing hematuria. This can include changes in urinary frequency and pain or burning when urinating.

Diagnosing Blood in Urine

To diagnose hematuria, your child’s healthcare provider may perform the following:

• Physical exam: Along with reviewing symptoms and health history.
• Urine tests: Testing the urine for levels of blood cells, protein, bacteria and other chemicals
• Blood tests: Testing for complete blood count, kidney function, levels of waste products in the blood and other issues.
• Urine cytology test: A urine sample is examined under a microscope to view cells
• Ultrasound: Using sound waves to take images of the urinary tract organs.
• Computed tomography (CT) scan: An imaging test to look at the kidneys, bladder and other organs.
• Cystoscopy: A thin flexible tube (called a cystoscope) with a camera is inserted through the urethra to look for structural issues, blockages or other potential problems. In children, this is done under anesthesia.
• Renal biopsy: In very rare cases, a small sample of kidney tissue may be removed through a needle for testing.

Blood in Urine Treatment

Treatment of hematuria depends on the cause of the blood in the urine. Following diagnostic testing, treatment may include urinary stone removal and antibiotics in the case of a UTI or other infection. Sometimes, the hematuria will go away on its own without diagnosis or treatment. Your child’s doctor may recommend following up in a few months to ensure that the hematuria has fully resolved and that no further issues persist.