Your doctor will talk to you and your child about their symptoms and examine your child. They will ask what medicines your child takes and check their blood pressure to find out whether it is in a healthy range.
Haematuria is diagnosed by a urine test. Your doctor may arrange this if your child has symptoms of haematuria, such as red or dark brown urine. Or your child may have a urine test for another reason, such as a routine health check, which then picks up the haematuria.
Urine tests
You, or a nurse, will need to collect some of your child’s urine in a small, clean container for a urine test. A dipstick will be dipped into the urine – this is a strip with chemical pads that change colour depending on what substances are in the urine. This can show whether there is blood in the urine.
If the first urine test shows there is blood in your child’s urine, your doctor may arrange for more urine tests to help find out whether the haematuria is persistent (there every time the urine is tested). Microscopic haematuria is usually only investigated if it is always there.
The urine samples may also be sent to a laboratory for more accurate tests.
Testing urine at home
You may need to test your child’s urine at home to find out whether the haematuria goes away or comes back. You will need to collect a sample of your child’s urine each morning and test it with a dipstick. Your child’s doctor or nurse will give you some equipment and show you what to do.
Urine test for infections
Because haematuria can happen with urinary tract infections (UTIs), your child’s urine may need to be tested to find out whether there is an infection. The test is called a urine culture.
Further tests
Your child may need more tests, especially if they have:
- macroscopic haematuria (visible blood in the urine)
- proteinuria (protein in the urine).
Blood tests
A small amount of blood may be taken from a vein, with a needle and syringe, for a blood test. A special numbing gel or cream can be used to help your child stop feeling any pain.
Blood tests will look for a cause of the haematuria, as well as check your child's kidney function. If there is a family history of blood in the urine, doctors may look for changes in the genes that are known to cause leaky kidney filters.
Imaging tests
Some children need imaging tests (scans). These use special scanners to get images (pictures) of the inside of their body. These include:
- Ultrasound scan – looks at the shape and size of kidneys and other parts of the urinary system. A small handheld device is moved around your child’s skin and uses sound waves to create an image on a screen.
- Computerised tomography (CT) scan – a type of X-ray that can detect stones in the kidneys or bladder.
If your child’s doctors think that the haematuria is from the bladder rather than the kidneys, a cystoscopy may be carried out. This procedure is usually done under general anaesthetic by a urology surgeon. A flexible tube with a camera on the end is placed in the urethra, the tube that carries urine from the bladder to the outside of the body. The camera takes pictures of the urethra and bladder to look for any bleeding.
Kidney biopsy
Some children need a kidney biopsy. A tiny piece of one kidney is removed from the body with a needle. This is examined under special microscopes. It can take a few weeks to get the results.
Testing other family members
A few kidney conditions that cause haematuria are genetic, which means that they can be passed down by one or both parents and may affect other people in the family. These include Alport syndrome and thin basement membrane nephropathy. Depending on the test results, your doctor may want to test other members of the family.
Referral
Your child may be referred to a paediatrician, a children’s doctor, usually based in a hospital, a paediatric nephrologist, a doctor who treats children with kidney problems, and/or a urologist, a surgeon that specialises in kidney and bladder operations. This may happen:
- if your child has macroscopic haematuria or persistent haematuria (that does not go away) and no urinary tract infection
- if your child also has proteinuria
- if blood tests show that they have reduced kidney function
Treatment
For many children, haematuria will go away with time without treatment. They may need to go back to the doctor for follow up and to check whether the haematuria comes back.
Some children will need to be monitored or treated, especially if the haematuria does not go away or if there are signs of kidney damage.
If your child has hypertension (high blood pressure), this will need to be controlled. They may need to change what they eat and drink and may need to take medicines to reduce their blood pressure.
Questions to ask the doctor or nurse
- What treatment will my child need?
- How will the treatment help my child?
- What are the side-effects of the treatment?
- How can I help my child prepare for procedures and treatments?
- If the first treatment does not work in my child, what happens next?
- How will I know if we need to go back to the hospital or see the doctor?
Long-term effects and follow-up
Your healthcare team will speak with you and your family about any long-term effects your child might have with haematuria.
Children with microscopic haematuria (that cannot be seen) and that goes away after repeat urine tests, will usually have no long-term problems.
Children with persistent haematuria (blood in the urine every time it is tested) will need to be monitored. They will need to visit their doctor every 6-12 months until the haematuria has gone away, to have:
- urine tests – to check for blood, protein and other substances in their urine
- their blood pressure measured.
It is important that your child keeps all the appointments for these tests, to help prevent long-term damage to his or her kidneys.
Impact on your child and family
Children who have haematuria can usually do the things that other children their age do. Often no treatment is required and they should be able to continue going to school or nursery. They can play with other children and stay active.
Further information
If your child’s haematuria is due to a more serious kidney problem, your doctor or nurse will give you more information. If you have any concerns or need additional support, speak with your doctor or nurse.