Haematuria in Children

Haematuria in Children

Differential Diagnosis

• Glomerular Causes

  • IgA nephropathy: Episodic haematuria often following an upper respiratory tract infection

  • Post-streptococcal glomerulonephritis: Cola-coloured urine with oedema and hypertension following a Group A streptococcal infection

  • Henoch-Schönlein purpura: Palpable purpura, arthralgia, abdominal pain with associated glomerular involvement

  • Alport syndrome: Progressive haematuria with sensorineural hearing loss, ocular anomalies, and a positive family history

  • Thin basement membrane disease: Persistent microscopic haematuria with a familial pattern

• Non-Glomerular Causes

  • Renal calculi: Flank pain, dysuria, haematuria, and hypercalciuria

  • Urinary tract infection: Dysuria, frequency, fever confirmed with urine microscopy, culture, and sensitivity

  • Hypercalciuria: Asymptomatic haematuria with familial predisposition

  • Wilms tumour: Painless haematuria with an abdominal mass, typically in children under 5 years

• Systemic Causes

  • Immune thrombocytopaenia: Associated with purpura, easy bruising, and low platelet count

  • Systemic lupus erythematosus: Haematuria accompanied by proteinuria, rash, joint pain, and fever

  • Haemolytic uraemic syndrome: Anaemia, thrombocytopaenia, and renal impairment following a diarrhoeal illness (commonly E. coli)

• Traumatic/Structural Causes

  • Non-accidental injury: Unexplained trauma with associated bruising

  • Exercise or blunt abdominal trauma: Can cause transient haematuria

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Investigations

• Urinalysis: To assess for haematuria, proteinuria, red cell casts, and signs of infection

• Urine culture: Essential for diagnosing urinary tract infections

• Blood tests: Full blood count, renal function tests, serum complement levels (C3, C4), and antistreptolysin O titres as indicated

• Imaging

  • Ultrasound of kidneys and bladder: To detect anatomical abnormalities, masses, or calculi

  • CT or MRI: Considered when renal calculi or tumours are suspected

• Renal biopsy: Indicated in cases with persistent haematuria, significant proteinuria, or when glomerular disease such as IgA nephropathy or Alport syndrome is suspected

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Management

• Tailored to the underlying cause

  • Infection-related causes (e.g. post-streptococcal glomerulonephritis): Supportive care with blood pressure control and appropriate antibiotics

  • Glomerulonephritis (e.g. IgA nephropathy): Consider immunosuppressive therapy in severe cases

  • Renal calculi: Manage pain, ensure adequate hydration, and consider surgical intervention if indicated

  • Systemic conditions (e.g. HUS, SLE): Provide supportive care and manage systemic complications

  • Wilms tumour: Prompt referral to oncology for potential surgical resection, chemotherapy, and/or radiotherapy

• General management for non-glomerular causes:

  • Treat urinary tract infections with appropriate antibiotics

  • Address hypercalciuria with dietary modifications and monitoring

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Complications

• Untreated glomerular disease may progress to chronic kidney disease

• Systemic complications in conditions such as HUS and SLE may affect multiple organ systems

• Delayed diagnosis in cases like Wilms tumour can lead to metastasis and poorer outcomes

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Prognosis

• Varies widely based on the underlying cause

  • Many children recover fully with appropriate treatment (e.g. post-streptococcal glomerulonephritis, HSP)

  • Genetic conditions such as Alport syndrome and thin basement membrane disease may have a progressive course leading to chronic renal insufficiency

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Notes

• Family history is crucial, especially for genetic conditions such as Alport syndrome and thin basement membrane disease

• Early detection and management are essential to prevent long-term complications

• Persistent microscopic haematuria should be monitored with periodic reassessment

• Consider non-accidental injury in cases with unexplained trauma or bruising and ensure appropriate safeguarding measures are in place