The page below is aimed at guiding clinicians in primary care and has been written with the help of local secondary care paediatric nephrologists. Comprehensive guidance on Haematuria in Children (1) is also provided by Bristol Royal Hospital for Children and designed for use in secondary care.
Visible (macroscopic) haematuria - is where the urine is visibly discoloured. As little as 1 mL of blood per litre of urine can produce a visible change in the urine colour (2).
Non - visible (microscopic) haematuria - Regard 2 out of 3 positive reagent strip tests as confirmation of persistent invisible haematuria (3) after exclusion of a UTI. Avoid testing after vigorous exercise.
In addition, children may be symptomatic or asymptomatic and may have proteinuria or isolated haematuria without proteinuria.
Refer to the clinical guidance on Haematuria in Children (1) for a full list of causes.
Pseudohaematuria - there can also be red urine or a positive urine dip caused by conditions other than blood in the urine - see before referral section.
Haematuria should be confirmed by dipstick test and/or microscopy to rule out non haematuria causes.
Visible (macroscopic) Haematuria
If not due to UTI or vigorous exercise then consider immediate or USC referral - see red flag section below.
Non-Visible (microscopic) Haematuria (NVH)
The majority of persistent NVH is benign and resolves spontaneously.
Refer to paediatric nephrology via eRS if:
Referral is not required for:
*Monitoring in primary care
Visible (macroscopic) haematuria associated with trauma - refer to paediatric ED.
Visible (macroscopic) haematuria confirmed on dipstick test and/or microscopy where UTI or trauma has been excluded - refer to Children & Young People – USC (2WW)
Palpable abdominal mass or unexplained enlarged abdominal organ (with or without haematuria)- refer to Children & Young People – USC (2WW)
Confirm haematuria with dipstick and/or microscopy.
Non-haematuria causes of red urine include:
If no red flags then investigate and refer as appropriate:
If examination and investigations are normal then isolated asymptomatic non-visible (microscopic) haematuria can be monitored in primary care:
If indicated, then refer via eRS to paediatric nephrology.
There is no formal advice and guidance service for paediatric nephrology but discuss with on call team via BRCH switch if immediate or urgent concerns.
(1) Haematuria in Children provided by Bristol Royal Hospital for Children.
(2) Haematuria, management and investigation in Paediatrics (scot.nhs.uk)
(3) Chronic kidney disease: assessment and management | Guidance | NICE - in particular sections 1.1.17-19
(4) Henoch-Schonlein Purpura (Remedy BNSSG ICB)
Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.