What is microscopic hematuria with clinical symptoms?

Updated: Jan 03, 2019
  • 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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Answer

A child who presents with either symptoms of an illness or a physical abnormality and is discovered to have concurrent microscopic hematuria should be placed in this category.

Some of the clinical conditions with associated renal involvement that may be recognized by the primary physician are acute glomerulonephritis, acute interstitial nephritis, urinary tract infections, familial hematuria (both benign recurrent and progressive hereditary nephritis), Henoch-Schönlein purpura, systemic lupus erythematosus, hypertension, hypercalciuria, and urolithiasis.

Unless the patient falls into a clear category of illness that is easily identified, an early consultation with the pediatric nephrologist should be obtained, because most other illnesses require additional expertise in either delineation or management.

The child with microscopic hematuria associated with clinical symptoms may have a vast number of diseases or conditions, which makes this a difficult category for which to suggest specific evaluation.

The first step in this category is to direct the evaluation based on the symptoms or physical examination findings. The extent and thoroughness of the evaluation depends on the knowledge and experience of the physician.

The child with a complicated diagnosis or unexplained cause for the hematuria should be referred to a pediatric nephrologist or, in some cases, to an appropriate subspecialist. If a diagnosis is straightforward, the appropriate therapy or follow-up is administered.

If the child has recurrence of the symptoms and associated hematuria or if the hematuria is persistent, referral to a pediatric nephrologist is recommended.


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