Approach to Persistent Microscopic Hematuria in Children

Abstract

Persistent isolated microscopic hematuria is relatively common in pediatric practice, affecting around 0.25% of children. Isolated microscopic hematuria can be caused by a myriad of potentially benign or serious causes, including urologic issues; kidney stones; glomerular diseases, including disorders of the glomerular basement membrane; hematologic abnormalities; and others. The challenge for the pediatrician or pediatric nephrologist is to distinguish children with potentially progressive forms of kidney disease versus other causes while minimizing cost and inconvenience for the child and family. This manuscript will review the multiple potential causes of microscopic hematuria and provide a framework for the initial evaluation and monitoring of such patients.

Keywords: Alport syndrome; IgA nephropathy; IgA vasculitis; glomerular and tubulointerstitial diseases; hematuria; hypercalciuria; pediatric nephrology.

Figure 1.

Urine microscopy of hematuria from a glomerular source demonstrates red blood cell casts and dysmorphic red blood cells. (Left panel) Image shows a red blood cell cast. (Right panel) Image shows deformed red blood cells (arrows). Both findings are consistent with a glomerular source for hematuria.

Figure 2.

Algorithm for evaluation of a child with microscopic hematuria. ANA, antinuclear antibody; ASO, antistreptolysin O antibody; Ca, calcium; Cr, creatinine; C3GN, complement factor 3 glomerulopathy; dsDNA, antidouble-stranded DNA antibody; hpf, high-powered field; PTH, parathyroid hormone; RBC, red blood cell.