Children's Hospital Colorado

Hematuria

What is hematuria?

Hematuria means blood in the urine. The bleeding can occur anywhere along the urinary tract, including in the kidneys, bladder, tubes (ureters) running from the kidneys to the bladder or the tube (urethra) that lets urine out of the bladder.

The kidneys manufacture the urine and the rest of the urinary tract (ureters, bladder and urethra) is called the collecting system. In most cases, you cannot see the blood with the naked eye, so very often your doctor will order an analysis of the urine (urinalysis) and that test indicates the possibility of blood in the urine.

If the blood is thought to be coming from the kidney, your doctor can get advice from a pediatric nephrologist, a kidney specialist for kids. If the blood is thought to be coming from the collecting system of the urinary tract, a pediatric urologist (kidney-related surgeon) should be consulted.

What causes hematuria?

The cause of hematuria might be physical trauma to the kidneys, tubes or bladder; a kidney stone being passed; or an infection of either the kidney or the bladder.

Diseases affecting the kidney and causing hematuria usually affect the kidney filters (glomeruli). These filters are actually blood vessels that clean the blood running through them.

The filters know what needs to stay in the blood and what needs to exit the blood through urine. Blood normally does not go into urine, except for a very, very tiny allowable amount of red blood cells. Unacceptable amounts of blood getting into the urine might mean the filters are "sick." A pediatric nephrologist can help find out if your child’s kidneys require medicine or not.

What are the signs and symptoms of hematuria?

There are generally no signs or symptoms related to hematuria, unless the cause is a bladder infection or related to a kidney stone. If the kidneys are the source of the condition and there is significant kidney disease present, your child’s blood pressure will be higher than normal because the kidneys help regulate blood pressure.

What tests are used to diagnose hematuria?

Hematuria is diagnosed by a urinalysis, a test that determines if there is blood found in the urine. In most doctors’ offices, a testing strip is used to check the urine for possible blood and that test strip or dipstick can indicate the possibility of blood in the urine, even though you can’t see it. However, a positive strip test needs to be verified by analysis of the urine under a microscope, because the strips are capable of giving false positives.

Once hematuria is verified, blood tests are done to make sure the kidneys are working well. Finding more than blood (for example, protein) in the urine is another sign of hematuria.

In complicated cases, children with hematuria may be referred to a pediatric nephrologist, who will order other special tests to determine the cause, especially if the disease involves more that the kidneys:

  • Sometimes a kidney specialist may recommend an ultrasound of the kidneys just to make sure they look normal. This isn’t always necessary, but is very helpful if the doctor believes the blood is from the urinary collecting system, and not the kidneys.
  • If the nephrologist feels it is necessary to look at the filters themselves, a tiny piece of kidney needs to be removed with a needle and looked at with a microscope. This procedure is called a renal (kidney) biopsy.

How is hematuria treated?

Not all kidney diseases are treatable. If it seems like the kidneys are being hurt by the hematuria, a nephrologist has the experience and knowledge to try medicines that may help. If your child has kidney disease, only time will tell how the kidneys respond to treatment. Your child’s nephrologists will discuss all options with you.

Why choose Children’s Hospital Colorado for your child’s hematuria treatment?

The Kidney Center at Children’s Hospital Colorado is ranked by U.S. News & World Report as one of the best hospitals in the nation for the treatment of pediatric kidney disorders. Our renowned pediatric nephrologists were also recently featured in 5280 magazine’s Top Docs and the Best Doctors in America® database. At the Children’s Colorado, we are proud to be at the forefront of research and teaching efforts to improve the treatments for various kidney conditions.


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