From the Guidelines
Management of microscopic hematuria in a 5-year-old female requires a systematic approach, starting with confirmation of the presence of microscopic hematuria with a repeat urinalysis, as transient hematuria can occur due to various factors 1.
Initial Evaluation
The initial evaluation should include a thorough history and physical examination, focusing on family history of kidney disease, recent infections, medication use, and trauma.
- Laboratory evaluation should include:
- Urine culture to rule out urinary tract infection
- Urine calcium-to-creatinine ratio to assess for hypercalciuria
- Serum creatinine to evaluate kidney function
- Additional tests may include renal ultrasound to identify structural abnormalities and complement levels if glomerulonephritis is suspected 1.
Management
Most cases of isolated microscopic hematuria in children are benign and self-limiting, often due to hypercalciuria, thin basement membrane nephropathy, or post-infectious glomerulonephritis.
- Management typically involves monitoring with repeat urinalyses every 3-6 months if no concerning features are present.
- Imaging is usually not appropriate in the child initially presenting with nonpainful, nontraumatic isolated microscopic hematuria without proteinuria 1.
- Referral to a pediatric nephrologist is recommended if hematuria persists beyond 12 months, is associated with proteinuria, hypertension, decreased kidney function, or if there's a family history of significant kidney disease.
- No specific medications are typically needed for isolated microscopic hematuria, but treatment of any underlying cause is important.
From the Research
Guidelines for Managing Microscopic Hematuria in a 5-Year-Old Female
- The evaluation of microscopic hematuria in children should include a thorough history and physical examination to determine potential causes and assess risk factors for malignancy 2.
- The differential diagnosis of hematuria with or without proteinuria is extensive, and isolated hematuria is a common problem in children and adolescents 3.
- Children with only isolated microscopic hematuria can generally be followed after baseline evaluation to rule out infection, hypercalciuria, familial hematuria, sickle cell disease, post-streptococcal glomerulonephritis (GN), and structural abnormalities (cysts, stones, obstruction, Wilms tumor) 3.
- A recommended approach for evaluating microscopic hematuria in children includes:
- Baseline evaluation to rule out infection, hypercalciuria, familial hematuria, sickle cell disease, post-streptococcal GN, and structural abnormalities 3.
- Renal ultrasound (US) scanning and cystoscopy as the initial evaluation 4.
- Re-evaluation after 3 months to assess for persistence of microhematuria 4.
- Consideration of intravenous urography (IVU) as a secondary radiographic study if microhematuria persists for 3 months after the initial workup 4.
- It is essential to note that the risk of malignancy with microscopic hematuria is lower than with gross hematuria, but it is still crucial to investigate the cause of microscopic hematuria to rule out underlying conditions 2, 5.