Haematuria in children

Blood in the urine or haematuria is a nasty surprise in any circumstances, but is all the more worrying when it happens to your children. What can cause blood in the urine? Should we be concerned? What can the doctor do about it? Expert paediatric urologist Mr Andrew Robb has the answers.

What causes blood in the urine?

Blood in the urine can be caused by many conditions. 

In adults, blood in the urine is a ‘red flag’ symptom that needs to be investigated in case it is caused by cancer. The causes in children are different and, as a result, the investigations in children are different.

Blood in the urine may be seen (this is called frank or gross haematuria) or it can be invisible to the naked eye (this is called microscopic haematuria). In many cases, people do not know that they have microscopic haematuria and it can go away by itself.

The causes of blood in the urine include:

• Urinary tract infections (UTIs)
• Conditions affecting the kidneys (glomerulonephritis, IgA nephropathy, glomerulosclerosis)
• Trauma
• Stones (these can be anywhere from the kidneys down to the bladder)
• Abnormal development of the renal tract
• Problems with blood clotting
• Inflammation of the bladder
• Inflammation of the urethra (pee tube) – this condition is known as urethritis.
• Irritation to the pee tube opening
• Exercise
• Rarely, it can be a sign of cancer in a child.

Some of these conditions only occur in boys, such as inflammation of the pee tube.

Is this always something to be concerned about?

Blood in the urine is a symptom. If you find blood in the urine, it is important to get seen by a doctor, so that the cause can be diagnosed. Moreover, it is important to get things like cancer ruled out. It should not be ignored.

What happens when you go to the doctor about blood in the urine?

When you take your child to see a doctor about blood in the urine they should take a full history and examine them.

As part of the examination, the doctor should check your child’s blood pressure. If you have a son, it is important that your doctor also examines his genitalia (penis) to look for any problems with the foreskin or the urethral meatus (the opening of the pee tube on the glans of the penis).

A sample of urine is also needed. This will be tested to confirm that there is blood in the urine, check for the presence of protein in the urine, and to check for evidence of waterworks infections.

There are other things that can mimic blood in the urine (including ingesting too much beetroot, taking some drugs, or the blood coming from menstruation rather than from the waterworks). It is important to confirm that your child truly has blood in the urine so as not to investigate them unnecessarily.

A sample of blood will also be taken, to ensure that the kidneys are working normally and to check to see if there are any bleeding problems.

The doctor may also recommend an ultrasound scan of the kidneys. This is the same type of scan as pregnant mums-to-be have.

Depending on the results of the tests, the doctor may ask for more investigations or may refer you to a specialist nephrologist (kidney doctor) or urologist (surgeon who specialises in waterworks).

There are certain things that raise concern, which flag up that referral to a specialist is needed. These include:

• Abnormal renal function on blood testing
• Protein in the urine when it is tested
• Signs of the body having too much fluid on board
• High blood pressure
• Persistent frank/macroscopic haematuria with no cause found after baseline investigations

Your doctor may also refer you to a specialist to treat any cause that is found, e.g. a urologist to treat kidney stones.

Visit Mr Robb’s profile to book an appointment.