- What is the colour of the urine?
Brown (tea- or cola-): renal or glomerular cause of haematuria.
Red or pink: lower tract origin, particularly if bleeding occurs only with the onset of micturition.
Turbid: presence of cells, seen in glomerular disease or infection.
- What is the timing of the bleeding?
Onset or end of micturition: Lower tract/Urethra
Throughout: Bladder or upper renal tract
May indicate urinary tract infection (UTI)
- Are there any preceding infections?
Group A Streptococcal infection: may indicate post-infectious glomerulonephritis
Bloody Diarrhoea (E Coli O157): may indicate haemolytic uraemic syndrome (HUS)
- Is there any history of trauma?
- Is the patient menstruating?
- Does the patient have Sickle Cell Disease
May indicate pupillary necrosis
- Is there any history of fever / malaise / weight loss / alopecia / rash / joint pains? May indicate multisystem disease
- Is there a family history of …? Haematuria, Renal problems, Hearing loss
- Is there evidence of faltering growth?
This may indicate underlying chronic kidney disease
This is usually an incidental finding and is known to occur with fever, illness, vigorous exercise and cystourethritis secondary to insufficient fluid intake.
- Has there been a preceding or current febrile illness?
- What is the child’s fluid intake?
- Has the child complained of any pain – back, suprapubic or vulval?
- Have there been any episodes of gross haematuria associated with illness? (IgA Nephropathy)
Examination (for microscopic and macroscopic haematuria)
The aim of examination is to assess for any underlying renal problem that may require discussion and referral to a paediatrician. Particular attention should be paid to:
- Oedema: Extremities and around the eyes
- Abdomen: Loin pain, Masses
- Genitalia: External irritation or trauma (accidental or non accidental)
- Skin: Rashes, Purpura (HSP)
- Joints: Swelling, Pain, reduced range of movement
If possible in primary care, the following are useful to record:
- Blood Pressure
- Dipstick Urine and send for MC+S
Weight and height (plotted on an appropriate centile chart for age and gender)