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Haematuria - pre-referral guideline

 

Definition

  • Microscopic haematuria: The presence of >14 RBC/µl on urine microscopy.
  • Macroscopic or gross haematuria: Darkening of urine visible to the naked eye.

Initial work-up

  • Perform at least 2 consecutive urine dipsticks or urinalysis 1-2 days apart to confirm the diagnosis.
  • Check blood pressure and growth.


  • Urine Tests:
    • Urinalysis with microscopy (clean catch urine).
    • Urine culture.
    • Urine protein and creatinine ratio.
    • Urine calcium to urine creatinine ratio (N=<0.7mmol/mmol).
    • Urine dipstick on family members.


  • Serum tests:
    • Creatinine/U&Es.
    • Electrolytes.
    • Full Blood Count.
    • Serum coags if macroscopic haematuria.

When to refer

  • Family history of renal failure or deafness.
  • Microscopic haematuria in multiple family members.
  • Recurrent episodes of painless gross haematuria.


  • Urgent phone consultation or immediate referral to paediatric nephrology is strongly recommended in the presence of any of the following:
    • Constitutional symptoms like weight loss, fever, arthralgias or rash.
    • Evidence of poor growth.
    • Elevated blood pressure.
    • Presence of oedema.
    • Elevated serum creatinine and/or potassium. 
    • Presence of RBC casts upon urine microscopy.
    • Abnormal renal ultrasound.
    • Haematuria with associated proteinuria.
    • Decreased urine output.

Information needed

  • Bring to appointment:
    • Growth records
    • Copies of all laboratory tests performed
    • Copies or originals of all radiological studies with written reports

Referral form Download (Word)
Parent handout Download (pdf)

Resources

Kids Connect (RCH Primary Care Liaison)

Kids Health Info (Parent factsheets online)

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Contact information

Clinical advice

Switchboard - ask for Nephrology specialist
consultant or registrar on call:

 (03) 9345 5522

RCH Emergency Department Triage nurse:

 (03) 9345 6139


Outpatients
Booking enquiries &
appointment rescheduling (Parents)		 (03) 9345 5054
Rural doctors only (03) 9345 5072


Admission enquiries
General admission enquiries: (03) 9345 6172

ED admission enquiries:

 (03) 9345 6477

After hours/ Switchboard:

 (03) 9345 5522


Other
Seriously unwell child: (03) 9345 7007

RCH Drug info-line:

 (03) 9345 5208

References

Paediatric Handbook (2003) Renal conditions and enuresis, Chapter 32 (pp546-566); Colin Jones and Annie Moulden; Seventh Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia

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