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Clinical investigations from the RACP

Investigating the child with haematuria

Charles H Crompton

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Abstract

Haematuria in children is usually detected incidentally. This article describes a stepwise approach to evaluation.

Key Points

  • Dipsticks can detect as few as 5 red blood cells per µL of urine. The normal range is less than 10 cells/µL.
  • Children with haematuria should be assessed differently to adults.
  • The temporal relationship of recent infections with the haematuria should be established carefully.
  • All children with haematuria require a urine microscopic examination and culture.
  • The nature of haematuria is variable, and therefore several urine samples should be tested, at intervals of one to two weeks, to confirm initial findings. If haematuria is confirmed, further evaluation is required.
  • Macroscopic haematuria requires prompt evaluation, and a diagnosis is usually determined. Microscopic haematuria is usually transient and benign, and arriving at a firm diagnosis is often difficult.

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