When a parent observes a color change in their child’s urine, it can be concerning. The medical term for blood in the urine is hematuria, meaning the presence of red blood cells in the urinary tract. Hematuria is classified into two types: gross hematuria, where the blood is visible and makes the urine appear pink, red, or cola-colored, and microscopic hematuria, detectable only through laboratory testing. While alarming, hematuria is common in children and often signals a temporary or easily treatable condition, though it always requires medical evaluation.
Immediate Action Steps and Triage
The first step upon noticing blood is to remain calm and assess the child for other symptoms, which helps determine the urgency of the medical visit. Note if the child is experiencing fever, chills, vomiting, or pain, especially in the abdomen, side, or while urinating. Pay close attention to the urine color, noting if it appears red, brown, or tea-colored, as this can indicate the source of the bleeding.
If the child has severe abdominal or flank pain, a high fever, is unable to pass urine, or recently sustained trauma to the back or abdomen, seek immediate emergency care. These symptoms suggest a kidney stone, severe infection, or a potentially damaging injury requiring urgent intervention. If the case is less severe, or the child seems otherwise well, contact the pediatrician promptly to schedule an urgent evaluation.
When speaking with the doctor, share information about the child’s recent activities, such as strenuous exercise or a recent throat infection, as these details can be significant clues. Also, note any new medications or if the child recently consumed foods like beets or blackberries, which can harmlessly change urine color to red.
Understanding the Potential Causes
The underlying reasons for hematuria are numerous, ranging from benign and temporary to more intricate conditions affecting the urinary system. One common cause is a urinary tract infection (UTI), where bacteria irritate the lining of the urethra, bladder, or kidneys, causing inflammation and bleeding. UTIs are often accompanied by painful or frequent urination and sometimes fever.
Temporary causes that typically resolve on their own include strenuous physical exertion, such as intense sports activity, or a simple viral illness. High levels of calcium in the urine, known as hypercalciuria, can also cause irritation and bleeding. In many instances of isolated and asymptomatic microscopic hematuria, no identifiable cause is found, a condition termed idiopathic hematuria.
More complex causes involve structural or genetic issues affecting the kidneys’ filtration system. Kidney stones cause bleeding and severe pain as these mineral masses move through the urinary tract. Inherited conditions like IgA nephropathy (IgAN), the most common inflammatory kidney disease causing hematuria in children, or Alport syndrome, directly affect the kidney’s filtering units (glomeruli). Trauma to the urinary tract must also be ruled out.
How Doctors Diagnose Hematuria
Diagnosis begins with a thorough physical examination and detailed review of the child’s medical history and symptoms. The initial and most informative test is a urinalysis, which screens the urine sample for blood using a test strip. If the dipstick test is positive, the sample is examined under a microscope to confirm the presence of red blood cells and distinguish between gross and microscopic hematuria.
The urinalysis also checks for components like protein or cellular casts, which, if present with blood, suggest a problem originating in the kidney’s filtering units (glomeruli). A separate urine culture is performed to check for a bacterial infection, confirming a UTI as the source. The doctor may also test the urine for calcium levels, as high concentrations are a common cause of bleeding.
If initial tests are inconclusive or suggest a deeper problem, further diagnostic tools are used. Blood tests, such as a complete blood count (CBC) and serum creatinine, help assess overall kidney function and check for anemia or systemic infection. Imaging studies, most commonly a renal and bladder ultrasound, use sound waves to visualize stones, cysts, tumors, or structural abnormalities. In rare cases, a kidney biopsy may be performed to obtain a tissue sample for definitive diagnosis of glomerular diseases.
Managing and Treating the Underlying Issue
The treatment approach depends entirely on the specific underlying diagnosis. For the most frequent cause, a urinary tract infection, the issue is managed with a course of antibiotics to eliminate the bacteria. The child must complete the full course of medication, and a follow-up urine test is often required to confirm the infection has resolved.
When hematuria is attributed to temporary factors like strenuous activity or dehydration, specific medical treatment may not be necessary. Recommendations center on observation, rest, and increasing fluid intake to flush the urinary system. If the cause is high calcium levels in the urine, dietary changes such as reducing salt intake and increasing water consumption are commonly advised.
If kidney stones are the source of bleeding, small stones may pass naturally with hydration. Larger or obstructing stones may require procedures, including lithotripsy, which uses shock waves to break the stone into smaller fragments, or surgical removal. For chronic kidney conditions, such as glomerulonephritis, management may involve specific medications, including steroids, to reduce inflammation and slow disease progression.