Hematuria means the presence of red cells (erythrocytes) in the urine. The source of red cells passing into the urinary tract may be structures within the kidney or any region of the urinary tract. The source of bleeding in children is often the glomeruli in the kidneys. If the shape of the red blood cells are intact and appear normal when examined under the microscope, the bleeding is most likely not from intra-renal structures, but from the urinary tract (ureter, urethra or bladder-urinary bladder) located lower than the kidney. If the red cells are deformed or shrunken, it suggests bleeding of intra-renal (glomerular) origin (glomerulonephritis). The presence of increased protein in the urine (proteinuria), increased urine density and hypertension (high blood pressure) along with malformed red cells and/or accompanied by elevated serum urea and creatinine strongly indicate the diagnosis of nephritis.
Hematuria, visual urine color. It may be such that redness is visible or erythrocytes can be seen under the microscope and the color of the urine does not change. Visibly, the urine is bright red, brown or cola-coloured, and when viewed through a microscope, it means that there are plenty of red cells. Microscopic hematuria means that urine appears normal in color or slightly cloudy when viewed with the eye, and has more than 5 red cells in each area when viewed under the microscope. Microscopic hematuria has been detected in 3-4% of school-age girls and 1.4% in boys, and the frequency of visible hematuria in children is below 1%.
Transient hematuria is the most common cause of microscopic hematuria in children and is often intermittent. It is due to an infection. This type of hematuria resolves spontaneously within a few days and does not require further investigation. Persistent hematuria is the presence of red cells in the urine for a period of at least 3 weeks. When investigating the causes of persistent microscopic hematuria in children, nephritis, anatomical disorders (hydronephrosis, ureteropelvic junction stenosis, polycystic kidney disease) and tumors should be taken into consideration.
Most diseases that cause visible hematuria are also the cause of persistent microscopic hematuria. In patients with visible hematuria High redness of the urine does not indicate that hematuria is severe, because even if 1 ml of blood is mixed into 1 liter of urine, a visibly red color will occur.
When evaluating a hematuric child patient, a history of recent trauma, a family history of kidney disease, presence of relatives who have had dialysis or kidney transplantation, and whether there is hearing loss in the family or in the child should be questioned.
In visible hematuria, first of all, it should be asked whether the urine color change is continuous or intermittent. Tea- or cola-colored urine suggests kidney disease (nephritis), while bright red or pink urine indicates lower urinary tract bleeding, such as from the bladder or urethra. Cloudy-looking urine suggests urinary tract infection or nephritis due to the protein, red cells and leukocytes in it. Urinary tract infections, stones in the kidney and urinary tract, hypercalciuria (excessive calcium excretion in urine), Alport syndrome and IgA nephropathy also cause hematuria.
Follow-up: Microscopic hematuria that cannot be attributed to an obvious cause and does not show any signs of disease spontaneously. may disappear and do not require biopsy. These patients are called for outpatient clinic check-ups and are followed up with direct urine examination, full urinalysis and blood pressure measurements.
Kidney biopsy is not required for microscopic hematuria alone, but if there are signs of significant and progressive kidney disease, a kidney biopsy should be performed.
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