Causes of hematuria:
History:
- Visible vs non-visible
- Recurrent or first episode
- Timing – terminal/initial/constant
- Pain or painless
- Other symptoms, urinary symptoms
- Trauma including NAI
- Presence of clots
- Recent illness, oedema, periorbital oedema -> nephrotic syndrome
- Joint pains, rash -> vasculitis
- Recent medications or changes
- Medical history including medications
- Surgical history
- Family history of renal disease or bleeding diathesis
Examination:
- General health and development
- Blood pressure
- Abdomen – flank tenderness, masses
- Rashes, joint oedema or pains
- Genitals – BXO, injuries etc
Investigations:
- Urine microscopy and culture
- Urine dipstick for protein
- Urine protein:creatinine ratio
- Bloods – Hb, WCC, Cr, coags (+/- renal bloods C3/C4/ANA etc)
- Ultrasound
- CT, MRU as needed
Cystoscopy can often be omitted but can be performed if no clear diagnosis, or bladder abnormality on ultrasound.
Microscopic haematuria
Most cases are idiopathic or benign in children.
Importantly – check for concurrent proteinuria and family history of renal disease.
Repeat the test periodically.
If persistent microhaematuria, probably reasonable to ultrasound.
If persistent microhaematuria and proteinuria, needs renal referral and consideration of renal biopsy.
Urethrorrhagia
Bloody spotting on the underwear or drops of blood in the terminal urine after initially voiding clear.
Mean age 10 years old.
Often concomitant dysuria.
Complete resolution usually occurs within 2 years.
Consider cystoscopy to exclude stricture if symptoms persist