From the Guidelines
Hematuria in an 18-month-old child requires prompt medical evaluation by a pediatrician or pediatric urologist, with a focus on determining the underlying cause to guide appropriate treatment and prevent potential complications 1. The evaluation should include a thorough history, physical examination, and urinalysis to identify potential causes such as urinary tract infections, viral infections, trauma, or more serious conditions like kidney stones or structural abnormalities.
Key Considerations
- The child's medical history, including any recent illnesses, medications, or changes in urine color or frequency, should be carefully reviewed 1.
- A physical examination should be performed to assess for signs of infection, trauma, or other potential causes of hematuria 1.
- Urinalysis, including urine culture and blood tests, should be conducted to help determine the underlying cause of hematuria 1.
- Imaging studies, such as ultrasound, may be necessary in certain cases, such as suspected urolithiasis or renal trauma 1.
- In cases of isolated microscopic hematuria without proteinuria, no imaging may be indicated, and screening family members' urine may be useful in identifying benign familial hematuria 1.
Recommendations
- Parents should schedule an appointment with a pediatrician or pediatric urologist within 1-2 days, or seek emergency care if the child has significant bleeding, pain, or appears ill.
- While waiting for medical care, parents should ensure the child stays well-hydrated, monitor for fever or pain, and collect a urine sample if possible.
- Hematuria can range from microscopic to gross, and determining the cause is essential for appropriate treatment, so parents should never ignore blood in a child's urine as it may indicate conditions requiring prompt intervention 1.
From the Research
Evaluation of Hematuria in Children
Hematuria in an 18-month-old child can be a cause for concern, and it is essential to evaluate the condition properly. According to 2, hematuria can be classified into macroscopic or microscopic hematuria, and clinical presentation and urine microscopy can help differentiate between glomerular and non-glomerular disorders.
Causes of Hematuria
The causes of hematuria in children can be extensive, and it is crucial to identify the underlying condition. As stated in 3, hematuria occurs in approximately 1.5% of children, and the presence or absence of proteinuria is a critical differentiating feature. The study also notes that most patients with asymptomatic microscopic hematuria do not have clinically significant glomerular pathology.
Diagnostic Approach
The diagnostic approach to hematuria in children involves a step-wise evaluation. As mentioned in 4, pediatricians should be aware of screening indications and the evaluation and management of a child with hematuria and/or proteinuria. The study emphasizes the importance of understanding the common causes of proteinuria and hematuria and being able to differentiate between benign and serious causes.
Management and Referral
The management of hematuria in children depends on the underlying condition. According to 5, children with isolated microscopic hematuria can generally be followed after baseline evaluation, while those with macroscopic hematuria or a combination of hematuria and proteinuria require more extensive evaluation. The study also notes that prompt referral to a pediatric nephrologist is indicated in certain situations, such as when hematuria does not resolve within 2 weeks of onset or when there is a need for a renal biopsy.
Key Considerations
Some key considerations in the evaluation and management of hematuria in children include:
- Ensuring that a positive dipstick test is accompanied by RBCs on microscopic examination 3
- Differentiating between glomerular and non-glomerular disorders 2
- Recognizing the importance of proteinuria in the diagnostic and prognostic evaluation of hematuria 6
- Providing guidelines for additional studies if there is a change in the child's course 6