Hematuria in Kids: What Does it Mean?

Close up of young girl looking straight ahead on playground

In short, hematuria in kids – or blood in the urine – often means that something else is going on in their bodies.

It tells us that we need to do further exploration. Rarely is hematuria in children caused by cancer, which is often first on the minds of adults with the same symptom.

It’s not very common to have visible blood in a child’s urine, nor for it to turn red and look like there’s blood in it (which can be mistaken for blood in the urine).

If there is visible blood in a child’s urine, it will look pink, red or brown and cloudy. When urine looks clear like it’s been colored, one of two things has typically happened. Either a child has been taking a drug like phenazopyridine (which turns urine a bright red-orange color and doctors will warn families about it ahead of time), or the child has eaten something that colors the urine red, like blackberries or beets (but a lot of it needs to be eaten for this to happen).

The much more common scenario is for blood in the urine to be microscopic, meaning the urine is normal color but blood shows up either under a microscope or detected by a dipstick of the urine. In fact, about 3-4% of kids will have microscopic blood in their urine at some point in their lives. If tested again, only 1% of children will still have blood in the urine and only about 0.3 % of children will have persistent microscopic hematuria.

More evaluation is needed if your child has had three urine tests with microscopic hematuria, or if other things are happening at the same time, such as the presence of red blood cell casts (indicate inflammation in the kidneys), protein with the blood, (could indicate kidney disease), crystals and high calcium (could indicate kidney stones or susceptibility to kidney stones), or squeezed red blood cells (bleeding coming from the kidneys). Other reasons to be concerned about microscopic blood in the urine would be high blood pressure or symptoms of chronic kidney disease like being tired all the time, poor growth, puffiness, or pale appearance.

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

Having hematuria can also be a sign of some conditions that run in families, such as:

  • Polycystic kidney disease, which is when the kidneys have fluid-filled cysts and can potentially cause high blood pressure and low kidney function.
  • Kidney stones, which are solid masses that form in the urine when it becomes highly concentrated with substances like calcium, oxalate, uric acid and phosphorus.
  • Benign (microscopic) familial hematuria. Some people naturally have microscopic blood in their urine and it doesn’t necessarily mean that something is wrong.
  • Hereditary nephritis, also called Alport syndrome. This is a rare condition that causes progressive hearing loss and kidney damage.

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.

The bottom line is that if your child has hematuria, it means that your doctor should explore further to determine what else, if anything, might be going on. 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. Talk with your child’s doctor about it. He or she may recommend seeing a pediatric nephrologist if your child has:

  • Hematuria with protein in the urine (could be indicative of kidney disease)
  • Hematuria along with high blood pressure (could be indicative of kidney disease)
  • Hematuria along with abnormalities on an ultrasound of the kidneys (kidney stones, kidney disease, swollen kidneys or cystic kidney disease)
  • Gross hematuria (visible blood in the urine) not associated with urinary tract infections

A referral to a pediatric urologist may be needed for kidney stones or blocked kidneys. The pediatric nephrologists and urologists should work closely together to determine the cause and treatment if needed.

If you have questions, or would like to request an appointment, please contact our Stones Center.

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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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Comments

  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.