Approach to Pediatric Hematuria
Hematuria in children is categorized as gross (visible) or microscopic (detected on dipstick). The first step is to confirm the presence of blood using microscopy to rule out false positives (e.g., myoglobinuria, hemoglobinuria, or dyes).
1. Clinical Clues: Glomerular vs. Non-Glomerular
| Feature | Glomerular (e.g., GN) | Non-Glomerular (e.g., Stones, UTI) |
|---|---|---|
| Urine Color | Cola/Tea-colored | Bright red/Pink |
| RBC Morphology | Dysmorphic RBCs, Acanthocytes | Normal (Isomorphic) |
| Associated Findings | Proteinuria, Red Cell Casts | Clots, Dysuria, Flank pain |
2. Diagnostic Workup
- Initial Steps: Urinalysis, urine microscopy, urine culture (to rule out UTI), and basic metabolic panel.
- Advanced Imaging: Renal/bladder ultrasound (RBUS) is indicated for non-glomerular suspicion to look for stones or anatomical anomalies.
- Special Testing: Consider C3/C4 levels, ASO titer, and ANA if glomerular disease is suspected.
NEET PG Hint: The presence of Red Cell Casts is pathognomonic for glomerular origin. If you see bright red urine with clots, it is never glomerular, as fibrinogen is required for clot formation and is usually absent in the glomerular filtrate.