Haematuria in Children: Advice for Referrers

RHC for Health Professionals
NHS GGC

Microscopic haematuria is a relatively common finding in children during acute febrile illnesses, urinary tract infections or in association with local inflammation (such as balanitis or vulvovaginitis). If this resolves once recovered, it does not require onwards referral. However, if persistent, it can be a sign of underlying kidney disease and warrants further investigation.

Who to refer

Indications for routine referral via SCI gateway:      

  • Persistent microscopic haematuria - isolated 1+ or more dipstick haematuria on three or more occasions over at least 6 months
  • Taken when child is otherwise well - without symptoms of urinary tract infection or febrile illness
  • Ensure not exercised for at least 6 hours before sample provided

Red Flag Indications for acute (same-day) discussion, via Consultant Connect

  • Persistent macroscopic haematuria (for 3 or more days)
  • Abdominal mass or abdominal pain
  • Peripheral oedema
  • Persistent significant proteinuria with urine PCR >200 (nephrotic range)
  • Oliguria
  • Acute onset headache

Who not to refer

  • Child or young person with isolated episode of microscopic haematuria particularly if noted at time of intercurrent illness
  • Child with macroscopic haematuria associated with urinary tract infection that resolves with treatment of the urinary tract infection

Appropriate referral specialty

  • General Paediatrics – isolated microscopic haematuria without deranged renal function, proteinuria, hypertension or concerns regarding systemic inflammatory disease
  • Paediatric Nephrology – microscopic haematuria with deranged renal function, known underlying renal disease, proteinuria, hypertension or significant co-morbidity

Please include the following points from history in the referral letter

  • What symptoms does the child have if any?
  • Family history of kidney disease or early onset hearing loss
  • Personal history of inflammatory or auto-immune disease
  • Association with viral illnesses, urinary tract infection
  • Does the child have vulvovaginitis or balanitis?

Please include the following points from the clinical examination in the referral letter

  • Are there any findings on clinical examination?
  • Any findings on abdominal examination. Specifically Is the child otherwise well and thriving?
  • Any other findings on urinalysis?
  • Measure blood pressure if possible, and appropriate sized cuff available
  • Weight and height of child

Investigations before onwards referral

  • Urine protein: creatinine ratio
  • Urine calcium: creatinine ratio
  • Urine culture
  • If the child is of an age where it is possible in primary care, please could you send bloods for FBC/U+E/LFT/Bone profile/Mg, and include results in the referral

Suggestions for management whilst waiting for outpatient appointment

  • Ensure urine culture sent and treat if positive - if haematuria resolves following UTI treatment, referral for haematuria not necessary
  • Treat vulvovaginitis and constipation if present
  • Urine dipstick of immediate family members (benign familial microscopic haematuria)

Useful resources for parents

Information about haematuria can be found here:
https://www.infokid.org.uk/conditions/haematuria/

Parent information about vulvovaginitis can be found here:
NHSGGC vulvovaginitis in children parent information leaflet

 

Useful resources for Health Professionals

NHSGGC paediatric guidelines for investigation and management of haematuria are available for reference at: Haematuria, management and investigation in Paediatrics

NHSGGC guidance on diagnosis, management and follow up for children with UTI can be found here: Urinary tract infection (UTI) : Diagnosis, treatment and management - RHC Glasgow

Editorial Information

Last reviewed: 25/11/2024

Next review date: 30/11/2029

Author(s): Dr Peter Schulga, Paediatric Nephrology GRID trainee; Dr Allison Mckie, Medical Paediatric Consultant.

Approved By: Medical Paediatrics