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Primary Care Liaison

Haematuria - pre-referral guideline



    • 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 referralto 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)


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    Contact information

    Clinical advice


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

    (03) 9345 5522

    RCH Emergency Department:

    (03) 9345 6477


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    appointment rescheduling
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    After hours/ Switchboard:

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    Seriously unwell child: (03) 9345 7007

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    (03) 9345 5208


    Paediatric Handbook (2009) Renal conditions and enuresis, Chapter 32 (pp546-566); Colin Jones and Annie Moulden; Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia

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