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Evaluation of asymptomatic, atraumatic hematuria in children and adults

Nature Reviews Urology volume 7, pages 189–194 (2010)Cite this article

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Abstract

Asymptomatic, atraumatic hematuria is a worrisome clinical sign for a patient that usually prompts a visit to a urologist. Hematuria is classified as microscopic versus gross; the evaluation for gross hematuria differs from that for microscopic hematuria, and the most important differentiating factor is the patient's age. The major causes of hematuria differ between children and adults, and the evaluation should reflect this. Renal disease is more common in children and malignancy more common in adults. The application and utility of laboratory tests, radiological studies, and cystoscopy are well established in adults but are more variable in children. Follow-up of hematuria after a negative evaluation is becoming more limited in adults but should be routine for children.

Key Points

  • The evaluation of children and adults with hematuria differs because renal disease is a more common etiology in children and malignancy is more common in adults

  • Although screening urinalysis is not routinely performed in adults except for pregnant women, screening urinalysis in children should occur at 5 years of age and at sexually active adolescence

  • Along with dipstick urinalysis, microscopic analysis of urinary sediment from a centrifuged sample should be performed to confirm the presence of red blood cells and assess for abnormal morphology

  • Unlike for adults with hematuria, cystoscopy is rarely indicated in the evaluation of children with hematuria

  • After an initial negative evaluation, follow-up for children with hematuria should be annual with repeat urinalysis and blood pressure measurement; follow-up for adults is becoming less routine

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Figure 1: Evaluation of hematuria.

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Authors and Affiliations

  1. Department of Urology, S287, 300 Pasteur Drive, Stanford, 94305-5118, CA, USA

    William H. Tu & Linda D. Shortliffe

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  1. William H. Tu
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Correspondence to William H. Tu.

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Competing interests

L. D. Shortliffe declares that she is a stock-holder/director of Vivus. W. H Tu declares no competing interests.

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Tu, W., Shortliffe, L. Evaluation of asymptomatic, atraumatic hematuria in children and adults. Nat Rev Urol 7, 189–194 (2010). https://doi.org/10.1038/nrurol.2010.27

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