What is the role of imaging studies in the workup of hematuria?

Updated: May 10, 2020
  • Author: Sanjeev Gulati, MD, MBBS, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada); Chief Editor: Craig B Langman, MD  more...
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The following imaging studies are indicated [12] :

  • Renal and bladder ultrasonography

    • Macroscopic hematuria in the absence of significant proteinuria or RBC casts is an indication for a renal and bladder ultrasound to exclude malignancy or cystic renal disease.

    • Urinary tract anomalies, such as hydronephrosis, hydroureter, nephrocalcinosis, tumor, and urolithiasis, are readily revealed with ultrasonography. Compared with other imaging studies, sonography is rapid, noninvasive, readily available, and devoid of exposure to radiation.

    • In individuals with severe obesity, a more accurate definition of renal structures and surrounding organs can be achieved using only CT scanning.

  • Other imaging studies

    • A spiral CT scan is particularly useful in the detection of urolithiasis, Wilms tumor, and polycystic kidney disease.

    • Voiding cystourethrograms are valuable in detecting urethral and bladder abnormalities that may result in hematuria (eg, cystitis).

    • Radionuclide studies can be helpful in the evaluation of obstructing calculi.

    • Intravenous urography rarely contributes additional information in the evaluation of hematuria and may unnecessarily expose the child to ionizing radiation.

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