Differential Diagnosis for Painless Haematuria in a 5-year-old Boy
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): This is a common cause of haematuria in children, and although it often presents with dysuria and frequency, it can sometimes be painless. The age and presentation of the child make this a likely initial consideration.
Other Likely Diagnoses
- Hypercalciuria: A condition where there is an excess of calcium in the urine, which can cause microscopic or gross haematuria. It's a relatively common cause of haematuria in children and can be asymptomatic aside from the haematuria.
- Nephrolithiasis (Kidney Stones): Although less common in children than adults, kidney stones can cause painless haematuria, especially if they are small and not obstructing the urinary tract.
- Glomerulonephritis: An inflammation of the glomeruli, which can be post-infectious or due to other causes. It may present with haematuria, proteinuria, and sometimes hypertension or edema.
Do Not Miss Diagnoses
- Wilms Tumor: A type of kidney cancer that is the most common renal malignancy in children. It can present with a palpable abdominal mass, hypertension, or abdominal pain, but sometimes the only symptom is painless haematuria. Early detection is crucial for treatment and prognosis.
- Trauma: Even if the child or parents do not report any history of trauma, it's essential to consider this possibility, especially if there are other signs or symptoms suggestive of injury.
- Sickle Cell Disease or Trait: In children with sickle cell disease or trait, haematuria can occur due to sickling in the kidney. This condition requires specific management and can have significant implications for the child's health.
Rare Diagnoses
- Alport Syndrome: A genetic disorder characterized by glomerulonephritis, hearing loss, and eye abnormalities. It can present with haematuria, but it's much less common than other causes.
- Vasculitis (e.g., Henoch-Schönlein Purpura): Although more commonly associated with purpura, arthritis, and abdominal pain, vasculitis can sometimes present with renal involvement and haematuria.
- Cystic Diseases of the Kidney: Such as autosomal dominant polycystic kidney disease (ADPKD), which is rare in children but can cause haematuria due to the rupture of cysts.