Haematuria in Children: Advice for Referrers

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

• 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

• 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

• 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?

• 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

• 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

• 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)

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

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