What is asymptomatic microscopic (isolated) 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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Asymptomatic microscopic hematuria is common in unselected populations of children. The discovery of hematuria alone in an asymptomatic child is merely an indication for repeat testing on one or more occasions.

The Galveston County epidemiology study found that, of children who had 3 consecutive urine samples that demonstrated hematuria, only 37% had hematuria 1 year later. [16] Thus, the cause for the asymptomatic hematuria had apparently resolved in 63% of the children over the course of a single year. Significant renal disease was almost nonexistent in patients in whom hematuria was the only abnormality found.

In cases involving the development of proteinuria or pyuria, the condition of isolated asymptomatic hematuria is no longer observed, and other studies should be performed. If the microscopic hematuria persists unchanged for more than 1-2 years, a few additional studies may be indicated.

One possible entity responsible for such an asymptomatic persistence of hematuria is idiopathic hypercalciuria or hyperuricosuria.

Familial or hereditary hematuria, whether benign, nonprogressive (ie, "thin basement membrane disease"), or progressive (ie, Alport syndrome or one of its variants), is another condition in which, early in the course, hematuria may be found in the absence of proteinuria.

IgA nephropathy may also present with microhematuria.

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