Can a 6-year-old child with a viral infection have leukocytes (white blood cells), hematuria (blood in urine), and proteinuria (excess protein in urine)?

From the Guidelines

Yes, a 6-year-old child with a viral infection can have leukocytes, blood, and protein in their urine, which is known as viral-associated nephritis or post-infectious glomerulonephritis. This condition occurs when the immune response to a viral infection affects the kidneys. Common viral infections that can cause this include adenovirus, influenza, Epstein-Barr virus, and enteroviruses. The presence of these elements in urine typically indicates inflammation in the kidneys, where white blood cells (leukocytes) are responding to the infection, small blood vessels may be damaged allowing red blood cells to leak into urine, and protein passes through inflamed kidney filters.

According to the American College of Radiology Appropriateness Criteria 1, urinary tract infection (UTI) is common in young children and may cause pyelonephritis and renal scarring. However, in children older than 2 months with first episode of uncomplicated UTI, there is no clear benefit of prophylactic antibiotic. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios.

The clinical evaluation of children with any form of hematuria begins with a meticulous history, as stated in the acr appropriateness criteria for hematuria-child 1. Topics covered in the history commonly include urinary tract infection, strenuous exertion, tropical exposure, recent strep throat, recent trauma, menstruation, bleeding tendency, bloody diarrhea, joint pains, rash, flank pain, frequency, and dysuria. Searching for occult forms of trauma, foreign body insertion, family history of sickle cell disease or hemophilia, stone disease, hearing loss, familial renal disease, and hypertension should be undertaken.

Treatment focuses on managing the underlying viral infection with rest, adequate hydration, and fever control with acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours), as suggested by general medical practice. Parents should monitor the child's urine output, fever patterns, and overall condition. If symptoms worsen, particularly if the child develops facial swelling, decreased urination, or dark urine, immediate medical attention is necessary as more serious kidney involvement may require additional treatment.

Some key points to consider in the management of a child with viral infection and urinary symptoms include:

• Monitoring urine output and overall condition
• Controlling fever with acetaminophen or ibuprofen
• Providing adequate hydration
• Watching for signs of worsening kidney involvement, such as facial swelling, decreased urination, or dark urine
• Considering the need for further evaluation or treatment if symptoms persist or worsen, as recommended by the American College of Radiology Appropriateness Criteria 1 and the acr appropriateness criteria for hematuria-child 1.

From the Research

Presence of Leukocytes, Blood, and Protein in a Child with a Viral Infection

• The presence of leukocytes, blood, and protein in the urine of a child with a viral infection can be indicative of a urinary tract infection (UTI) 2, 3.
• Studies have shown that automated urinalysis can be used to detect leukocytes and bacteria in the urine, with a sensitivity of 80.4% and specificity of 82.8% for leukocyte esterase 2.
• However, the diagnosis of viral lower UTIs is based on molecular techniques, and real-time polymerase chain reaction is often the method of choice 3.
• Blood C-reactive protein levels can also be used to differentiate between upper and lower UTIs, with significantly raised levels in upper UTIs 4.
• Other biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) and interleukins (IL) have been shown to be promising in diagnosing and differentiating UTIs 5.
• Urinalysis can be a valuable tool in the initial evaluation of UTIs, with pyuria being the best determinate of bacteriuria requiring therapy 6.

Specific Findings in Children

• There is limited information available on the specific findings in children with viral infections and UTIs.
• However, studies have shown that urinary NGAL and interleukins can be used to improve the sensitivity and specificity of laboratory diagnosis of UTIs in the pediatric population 5.
• Automated urinalysis can also be used in children to detect leukocytes and bacteria in the urine, with a high sensitivity and specificity 2.