Differential Diagnosis for Painless Hematuria in a Child
Single Most Likely Diagnosis
- Hypercalciuria or Nephrolithiasis is less likely due to no calcium in urine micro, but
- Urinary Tract Infection (UTI): Although the urinalysis is normal, UTIs can sometimes present with hematuria as the only symptom, especially in children. A urine culture should be considered to rule out UTI.
Other Likely Diagnoses
- Glomerulonephritis: This condition can cause hematuria and may not always present with other symptoms or abnormal lab results initially. It's an important consideration in pediatric patients.
- Nephrocalcinosis or Medullary Sponge Kidney: Although calcium is not present in the urine micro, these conditions could still be considered, especially if there's a family history or other suggestive factors.
Do Not Miss Diagnoses
- Wilms Tumor or Other Renal Tumors: Although rare, these conditions are critical to diagnose early. A normal CT scan reduces the likelihood but does not entirely rule out these diagnoses, especially if the scan quality is not optimal or if the tumor is very small.
- Trauma: Even if not immediately apparent, internal trauma could cause hematuria without other obvious symptoms. A thorough history is essential.
- Sickle Cell Disease or Trait: If the child has sickle cell disease or trait, this could lead to hematuria due to sickling in the kidney.
Rare Diagnoses
- Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidneys, ears, and eyes. It's rare but should be considered in cases of unexplained hematuria, especially with a family history of kidney disease or hearing loss.
- Goodpasture Syndrome: An autoimmune disease that can cause hematuria, though it's more commonly associated with adults and those with lung hemorrhage.
- Nutcracker Phenomenon: A rare condition where the left renal vein is compressed, potentially causing hematuria. It's more commonly diagnosed in adolescents and young adults.