Haematuria

  • Haematuria is the presence of red blood cells in the urine. The presence of 10 or more RBCs per high-power field is abnormal.

    Urinary dipsticks are very sensitive and can be positive at <5 RBCs per high-power field.

    Red or brown urine does not always indicate haematuria (haemoglobinuria, myoglobinuria, medication, and food).

    Urate crystals are commonly present in the urine of newborn babies. They can produce a red discolouration of the nappy ("brick dust" appearance) which is sometimes mistaken for blood.

    Blood in the urine may come from sources other than the urinary tract (eg vaginal haemorrhage, rectal fissure).

    Common causes for microhaematuria include in association with viral infections, UTI, Trauma, HSP.

    If you find microscopic haematuria in the setting of an acute febrile illness, exclude UTI by urine culture and arrange for the urine to be tested again after the acute illness has passed.

    Common causes for macroscopic haematuria include the above. It is more likely to come from the bladder or urethra.

    Symptomless or "Benign Haematuria" in children without growth failure, hypertension, oedema, proteinuria, urinary casts or renal impairment is a frequent finding.

    In the emergency department it is important in evaluating a child with haematuria to identify serious, treatable and progressive conditions.

    Many children with isolated microscopic haematuria require no immediate investigation and simply need to be checked to see if the problem persists. This should be arranged with the general practitioner or through outpatient clinic if the family do not have a GP.

    Haematuria flowchart pic
    Larger view of flowchart