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Asymptomatic Microscopic Hematuria

  1. 5% of school aged children on single test but < 1% on repeated testing
  2. usually found on routine screening
  3. 5-10 RBCs per hpf of centrifuged urine; dipsticks are very sensitive
  4. but have a high false positive rate
  5. benign recurrent hematuria in 2/3 of cases
    • sporadic or familial
    • no associated proteinuria


Gross Hematuria

o upper urinary tract source

• cola/tea-coloured urine, casts, proteinuria, dysmorphic RBC's,associated symptoms (i.e. edema, azotemia, HTN)

o lower urinary tract source

• bright red urine, initial and terminal stream hematuria, clots, normal RBC morphology, < 2+ proteinuria, no casts

o very large renal bleeding can look like a lower urinary tract bleed




  1. definition: qualitative: 1+ on dilute, 2+ on concentrated urine (specific gravity>1.015); quantitative: 4mg/kg/h on timed urine (>40 mg/kg/hr is nephrotic range)
  2. transient: due to fever, dehydration, exercise, seizures, stress
  3. persistent
    • orthostatic (more common in adolescents)
    • increased plasma protein concentration
    • glomerular (e.g. nephrotic syndrome, glomerulonephritis)
    • tubulointerstitial (e.g. Fanconi's syndrome, ATN)
    • structural abnormalities of urinary tract (e.g. hydronephrosis)
HEMATURIA and PROTEINURIA (Pediatrics ) HEMATURIA and PROTEINURIA (Pediatrics ) Reviewed by Radiology Madeeasy on October 04, 2010 Rating: 5
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