Your child’s doctor can diagnose (identify) haematuria with a urine test. If your child has symptoms of haematuria, such as red or dark brown urine, your doctor may arrange a urine test. Or, your child may have a urine test for another reason, such as a routine health check.
Your child’s doctor may talk to you or your child about his or her symptoms and any medicines that he or she takes, and examine your child. Your doctor or nurse will check your child’s blood pressure to find out whether it is in a healthy range.
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 shows whether there is blood in the urine. If the first urine test shows blood in your child’s urine, your doctor may arrange for more urine tests. This can help find out whether the haematuria is persistent, which means that there is blood in the urine every time it is tested.
The 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 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 he or she has:
- 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. Special gel or cream can be used to help your child stop feeling any pain.
Imaging tests
Some children need imaging tests (scans). These use special scanners that get images (pictures) of the inside of their body. The most common test is an ultrasound scan, but occasionally other imaging tests are used. If your child needs one or more of these tests, your doctor will talk to you about the procedures, any risks and how to help your child prepare for them.
- 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.
- Chest X-ray – for children with breathing problems, this test checks for any fluid (liquid) around the lungs. Your child sits or lies still for a few seconds while a machine takes X-ray images.
- MRI – uses powerful magnets and radio waves to build up a very detailed picture of parts of the urinary system. Sometimes a special dye is injected into the vein to show parts of the body more clearly. Your child lies on a bed which passes through a large machine with a tunnel.
- Cystoscopy – 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. This test is usually done under general anaesthetic.
- Intravenous urogram – an abdominal X-ray test to look for kidney stones. Your child sits or lies still for a few seconds while a machine takes X-ray images. A special dye is injected into a vein. This dye shows up on the X-ray so that the kidneys, ureters and bladder can be more clearly seen. This test is rarely used.
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. Special medicines are used so your child does not feel any pain or can sleep through the procedure. It can take a few weeks to get the results.
Testing other family members
A few kidney conditions that cause haematuria are hereditary, 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, or a paediatric nephrologist, a doctor who treats children with kidney problems. 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.
After your doctor has found out that your child has haematuria and what is causing it, he or she will decide whether your child needs treatment.
When treatment is needed
Some children do not need any treatment for haematuria. They may need to go back to the doctor for follow up and to check whether the haematuria comes back.
Your child may need treatment or to be monitored for:
- persistent haematuria – where the haematuria does not go away
- kidney damage, if it is suspected.
It is important that your child follows the treatment plan outlined by your doctor.
Controlling blood pressure
Some children with haematuria have high blood pressure (hypertension). Their blood pressure will need to be controlled so it is in a healthy range.
If your child has hypertension, he or she may need to change what he or she eats and drinks. Some children need to take medicines.
Changes to eating and drinking
Your child may need to make temporary changes to what he or she eats – for example, less salt and less of certain foods. Your child may also need to drink less fluid, such as water, squash and soft drinks.
Your doctor, nurse or a renal dietitian, a professional who advises what your child should eat and drink during different stages of their kidney condition, will help you and your child make these changes.
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) that goes away after repeat urine tests will 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.
Some children may need to change their diet and take one or more medicines.
Further information
This can be a stressful time for your child and the whole family, including other children. 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.