Hematuria in Kids (Blood in Urine)

Hematuria in Kids: What Does it Mean?

Close up of young girl looking straight ahead on playground


Hematuria is the presence of blood in the urine. There are two types:

  1. Gross hematuria: when the blood is visibly noticeable in the urine. It will look pink, red or brown and cloudy.
  2. Microscopic hematuria: when the blood can only be seen under a microscope.


So if the blood in the urine can’t be seen, how will parents know it’s there and what does it mean once it’s found? Typically when we find microscopic blood in the urine, another symptom has initially brought kids to the doctor’s office. Those symptoms are:

  • Puffiness, particularly around the eyes, hands or feet (swelling in these areas can go along with inflammation in the kidneys)
  • Pain in the abdomen, pain in scrotum, groin or penis for boys and pain the urethra or vagina for girls
  • Dehydration or low urine output
  • Symptoms of an undiagnosed urinary tract infection (UTI), which can include pain or no pain with increased frequency of urination and/or wetting accidents.
  • Injury to the back or abdomen


Some children naturally have blood in their urine and it’s not a cause for concern (but they might need to be followed for a year or so just to make sure). Other kids may have an underlying condition or family history of disease that may need to be treated.

Microscopic hematuria does not usually need to be investigated in otherwise healthy children. However, more evaluation is needed if your child has had three urine tests with microscopic hematuria over several months, or if other things are happening at the same time, such as:

  • Hematuria with protein in the urine (could indicate kidney disease)
  • Hematuria along with high blood pressure (could indicate kidney disease)
  • Hematuria along with abnormalities on an ultrasound of the kidneys (kidney stones, kidney disease, swollen kidneys or cystic kidney disease)

Gross hematuria, or visible blood in the urine, usually needs an evaluation more quickly, especially to check for high blood pressure and to be sure the kidneys are functioning normally.

It is helpful to note if the gross hematuria occurred at the time of a cold or flu, after a Strep infection or injury, or was associated with pain while urinating or other pain in the back or abdomen.

If you suspect your child has hematuria, call your pediatrician for further testing. 

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Beth Jackson, MD

About the Author: Beth Jackson, MD

Beth Jackson, MD, is a pediatric nephrologist and director of the Healthy Bladder Clinic at Cincinnati Children’s. She has a special interest in children with wetting accidents day or night and children with urinary tract infections and children with stones. On a personal note Dr. Jackson has one son who has taught her a lot about being a mother and a doctor, and he is now a young doctor himself. Dr. Jackson loves animals and nature. In addition to Miss Honey and Matilda, her dog and cat, she plays host to 17 varieties of birds at the backyard feeder, 3 squirrels, 5 chipmunks, a mallard couple, 2 deer, 1 raccoon, 1 opossum, and 1 or 2 rabbits.

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  1. shahnawaz May 16, 20:36
    My daughter is 11 mnths old she was diagnosed with vur grade 2 when she was 3 mnths n was on prophalactic antibiotics till 6 mnths during which she had only couple of incidents of uti. After which i stopped those medicines till now n she was alright with no episodes of uti for last 5 months. But after 5 mnths she again has uti plus rbcs in her urine for the first time , can it be bcoz of reflux or otherwise. And do u recommend dmsa scan to see whether kidneys are alright or ultrasound can do
    • Rachel Camper
      Rachel Camper May 21, 07:58
      Hi Shahnawaz, It is difficult to make patient-specific recommendations in this format. If you are local, please call 636-4975 option 1 and then option 1 again to see how we might be able to assist your daughter.
  2. Jonah April 22, 06:02
    Hi i just discover my baby has a blood in her undies after urine but its color pink i wanna know any solution about this thank u and Godbless
    • Rachel Camper
      Rachel Camper April 23, 17:26
      Hi Jonah, I reached out to our urology team and they mentioned that there are many possibilities that can cause this situation, including an infection. They recommend scheduling an appointment with your child's main doctor for an examination and a urine test. Hope this helps!
  3. KRenae May 21, 20:35
    My 7 year old has been treated for a UTI since last Monday, so 7 days. She says the pain and burning has resolved, however, we noticed pink tinged mucus when she went to the bathroom this evening. Is this normal or should I be concerned?
    • Rachel Camper
      Rachel Camper May 22, 10:32
      Hi KRenae, I reached out to our urology team, and they mentioned that it might be helpful to first reach out to your child's doctor to decide if it is concerning and/or if a subspecialty consultation is needed.