From the Guidelines
Hematuria alone on a urine dipstick in a female toddler is unlikely to indicate clinically significant renal disease if it is isolated microscopic hematuria without proteinuria, and no imaging is initially indicated. The most common causes of hematuria in this age group include urinary tract infection (UTI), minor trauma to the urinary tract, and irritation from bubble baths or soaps 1. In rare cases, it could signal more serious conditions such as glomerulonephritis or structural abnormalities of the urinary tract. However, according to the American College of Radiology, imaging is usually not appropriate in the child initially presenting with nonpainful, nontraumatic isolated microscopic hematuria without proteinuria 1.
Key Considerations
- The clinical evaluation of children with hematuria begins with a meticulous history, including topics such as urinary tract infection, strenuous exertion, and family history of renal disease 1.
- A thorough physical examination and assessment of the child’s height and weight should be performed.
- The urine should be evaluated for proteinuria, red blood cell casts, and deformed red blood cells to determine the source of hematuria.
- If concern for chronic kidney disease exists, basic laboratory metabolic screening should include blood urea nitrogen test, serum creatinine test, and complete blood count with platelets 1.
Recommendations
- Parents should seek prompt medical attention for proper diagnosis, which typically involves a complete urinalysis, possibly urine culture, and physical examination.
- The healthcare provider may recommend additional tests based on these initial findings.
- While waiting for medical evaluation, parents should ensure the child stays well-hydrated and monitor for other symptoms like pain during urination, fever, or changes in urinary habits.
- No imaging is initially indicated for isolated microscopic hematuria without proteinuria, but ultrasound (US) of the kidneys and bladder may be appropriate if proteinuria is present or if the child presents with macroscopic hematuria 1.
From the Research
Possible Indications of Hematuria in Toddler Female
Hematuria alone on urine dip in a toddler female can indicate several possible conditions, including:
- Urinary tract infection (UTI) 2, 3, 4
- Glomerular disease, such as postinfectious glomerulonephritis 5, 4
- Thin basement membrane nephropathy 4
- Immunoglobulin A nephropathy 4
- Idiopathic hypercalciuria 4
- Urethral or bladder irritation 4
Importance of Further Evaluation
It is essential to note that hematuria can be a sign of a underlying serious condition, and further evaluation is necessary to determine the cause 5, 6, 4. A thorough history and physical examination, as well as laboratory tests and imaging studies, may be required to rule out intrinsic renal disease or other conditions 2, 4.
Considerations for Referral to Subspecialty Care
Pediatric providers should be aware of the various causes of hematuria and have a framework for referral to subspecialty care when necessary 5. The presence of UTI does not necessarily decrease the likelihood of having a urologic malignancy diagnosed, and prompt evaluation should not be delayed 3.