Peeing Red

The other night my pager buzzed as I pulled back the covers to settle into bed. A child in the emergency department was whizzing blood.

Gross hematuria, urine that appears bloody to the naked eye, has coloration ranging from cherry KoolAid to Coca Cola. A number of substances can color urine; the presence of actual blood must be confirmed by finding red blood cells on microscopic examination. The dipstick test may show “blood” but it detects hemoglobin (from red blood cells) and myoglobin (from muscle breakdown), both of which may darken the urine color.

Approximately 1 out of every 1000 outpatient visits to a pediatric primary care physician is due to bloody urine. About 80% of cases occur in males, and 30-40% of the time no diagnosis can be made. Since the condition almost always resolves without long-term consequences, this presents less of a problem than you might think.

Thorough history and physical examination should be directed toward trauma, familial problems, and evidence of disorders that cause inflammation in the kidney (nephritis). Other evidence of nephritis includes high blood pressure, an abnormal glomerular filtration rate (estimated by a blood test, the serum creatinine), or significant proteinuria (>100 mg/dL by dipstick). An ultrasound or other study is sufficient to diagnose stones, tumors, or other anatomic problems that can cause bloody urine. Urine studies for calcium and other stone-forming disorders may also be indicated.

If your child pees blood, please don’t ignore it- s/he does need a thorough medical evaluation; however, don’t panic! While hematuria may be scary for patient and parent, it is rarely a serious long-term medical condition. 

Photo courtesy of PhotoXpress.