When parents notice a pink, red, or brown discoloration in their child’s urine, they are seeing hematuria, the presence of blood. Hematuria occurs when red blood cells leak into the urinary tract from the kidneys, ureters, bladder, or urethra. It is common in childhood and often not an indication of a serious illness. Nevertheless, because hematuria can signal issues ranging from minor irritation to significant conditions, it always requires prompt evaluation by a healthcare professional.
Immediate Steps and When to Call 911
The first step is to remain calm and assess the child’s overall condition, noting specific details about the change in urine color and any accompanying symptoms. Observe if the color is bright red, pink, dark brown, or tea-colored, and if the child is passing blood clots. It is also important to note the timing of the discoloration—does it occur only at the start of urination, at the end, or throughout the stream?
Parents should also check for other concerning signs, such as fever, vomiting, or pain, especially in the abdomen, side, or back. Note if the child is urinating normally or if they are experiencing a reduced output or inability to pass urine. Providing these specific details helps the doctor determine the cause of the bleeding.
Certain signs necessitate immediate emergency medical attention; parents should call 911 or go to the nearest emergency room. Urgent symptoms include severe, sudden flank pain (which may suggest a kidney stone), high fever, signs of fluid overload like significant swelling (edema) in the face or legs, or the inability to urinate (anuria). Immediate evaluation is also required if the child recently experienced significant trauma to the abdomen or back.
Identifying the Source and Type of Hematuria
Hematuria is categorized into two types based on detection. Gross hematuria is visible to the naked eye, causing the urine to look pink, red, or tea-colored. Microscopic hematuria is not visible but is detected only through laboratory analysis, typically during a routine urine test.
The color of the urine can provide a clue about the source of the bleeding. Bright red or pink urine often suggests bleeding from the lower urinary tract, such as the bladder or urethra. Darker, brownish, or cola-colored urine can indicate bleeding originating higher up, specifically from the kidney’s filtering units (glomeruli).
Not all red or discolored urine is true hematuria; this is called pseudo-hematuria. This occurs when the urine changes color due to certain foods, medications, or dyes. Eating beets, blackberries, or rhubarb can temporarily turn the urine pink or red, mimicking blood.
Common Reasons for Blood in a Child’s Urine
One frequent cause of hematuria is a Urinary Tract Infection (UTI) in the bladder or kidneys. The bacteria irritate and inflame the urinary tract lining, causing small amounts of blood to leak into the urine. Symptoms of a UTI often accompany hematuria, including pain or burning during urination, a frequent or urgent need to urinate, and sometimes a fever.
Another common cause is hypercalciuria, involving abnormally high levels of calcium excreted in the urine. This excess calcium can form crystals that irritate the kidney and bladder lining, leading to hematuria even without forming a full kidney stone.
Strenuous physical activity, particularly long-distance running, can cause transient hematuria. The repetitive impact or temporary changes in blood flow during intense exercise can cause minor trauma to the bladder or kidneys, resulting in blood that resolves with rest. Minor trauma, such as a fall, can cause a bruised kidney resulting in visible blood; significant trauma always requires medical evaluation.
Less common but more serious causes include kidney stones or inflammation of the kidney filters (glomerulonephritis). Glomerulonephritis is often triggered by a recent infection, like strep throat, and can cause the urine to appear dark brown or tea-colored. This condition is usually accompanied by other symptoms, such as high blood pressure or swelling.
What to Expect During Medical Evaluation and Treatment
The medical evaluation begins with a detailed history, covering the specific color of the urine, associated pain, recent illnesses, and family history of kidney problems. A physical examination assesses the child’s general appearance, checks for swelling, measures blood pressure, and palpates the abdomen for tenderness or masses.
The cornerstone of diagnosis is the urinalysis, where a fresh urine sample confirms the presence of red blood cells and checks for signs of infection or kidney damage. A microscopic examination confirms true hematuria and helps suggest the source of the bleeding. If infection is suspected, a urine culture identifies the specific bacteria.
Blood tests may be ordered to check kidney function. If initial tests are inconclusive, or if a structural issue or kidney stones are suspected, an imaging study like a renal and bladder ultrasound may be recommended. This non-invasive test uses sound waves to create pictures of the kidneys and bladder, helping to identify stones, blockages, or anomalies.
Treatment is directed at the underlying cause once identified. A urinary tract infection is treated with antibiotics. For hypercalciuria, increasing water intake and modifying the diet to reduce salt may be sufficient. In many cases of transient hematuria, such as following exercise or a viral illness, no specific treatment is necessary beyond observation and follow-up.