Blood in the urine of a child is an immediate reason to see a doctor. Reasons for the development of microhematuria and a list of necessary examinations Reactive hematuria in children

The discovery of bloody discharge in a child’s urine will alert any parent. Therefore, at the first signs of hematuria, as this phenomenon is called in medical language, you should immediately contact a medical institution for advice and treatment. Hematuria in children may indicate the presence of serious pathologies of the kidneys, urinary tract, problems with hematopoiesis, and injuries to internal organs.

The appearance of hematuria in children is influenced by many factors:

Infectious processes in the urinary system;
Crystalluria;
Exchange nephropathy;
Metabolic nephropathies;
Overdose of drugs, herbs, dietary supplements, homeopathic remedies;
Congenital anomalies of the kidneys, bladder (hydronephrosis, polycystic disease, spongy kidney, urethral valve and others);
Injuries;
Foreign body in the urethra;
Vascular abnormalities;
Disorders in the circulatory system (coagulopathy, hemophilia and others);
Post-infectious glomerulonephritis;
Iq nephropathy;
Hereditary diseases;
Tumors (carcinoma, Wilms tumor, etc.)
Tuberculosis;
Cystic disease;
Collagenoses;
Urethroprostatitis (prostatitis also occurs at a young age).

Considering the variety of diseases that affect the appearance of red blood cells in a child’s blood, it is necessary to conduct a full comprehensive examination by a pediatrician, nephrologist, or urologist.
In addition to laboratory tests, the diagnosis of hematuria is carried out using the following methods:

Ultrasound of each part of the urinary system;
Computer tomography of the pelvic and abdominal organs;
X-ray studies;
Cystoscopy;
Excretory urography.

A modern urological clinic, as a rule, can provide a full range of services for conducting a comprehensive examination and further treatment of the genitourinary system not only for adult patients, but also for children of any age.

According to the severity of hematuria, there are two types:

Microscopic. The presence of blood in the urine can only be detected under a microscope.
Macroscopic. An excess of red blood cells in the urine causes a change in its normal color to pink, red-brown. The indicator of urine saturation with red blood cells can range from 10 red blood cells in the field of view (minor hematuria) to more than 50 (severe).

There are a number of medications, foods, dyes, pigments that do not give reason to talk about the presence of red blood cells in the urine, but contribute to a change in its color. These are blueberries, beets, bile pigments, phenolphthalein, lead, nitrogen dyes, ibuprofen, methyldopa, chloroquinine and others.

Children, as well as adults, can experience quite serious diseases associated with the normalization of kidney function, accompanied by pain in the abdomen, increased body temperature, frequent urination and other symptoms. Microhematuria is considered to be one of these ailments.

Etymology of the disease

Microhematuria is usually called a disease that appears in children due to the appearance of bacteria in the child’s body. Pseudomonas aeruginosa. This pathology is considered to be extremely severe among medical workers, since it is very difficult to cure.

Recent years have been marked by a high increase in renal pathology among children. The kidneys are the most important organ; they ensure the constancy of homeostasis in the human body.

Microhematuria is considered a type of disease such as hematuria– the presence of an increased number of red blood cells in the urine. Microhematuria is also considered to be the severity of hematuria.

Reasons for appearance

If this diagnosis has been detected in a child, it should be borne in mind that a small patient may have an early tumor or even pre-tumor disease of the bladder. In this case, the child will need to undergo a cystoscopy in the future - the doctor will examine the inner surface of the child’s bladder using a catheter.
Most often, microhematuria occurs against the background of certain renal diseases, diseases of the bladder and urethra (dysuria, cystitis, Alport syndrome, and so on).
One of the most common causes of a disease such as microhematuria in children is the occurrence of diffuse or focal nephritis in the child’s body.
Microhematuria can be caused by various infectious diseases.

Symptoms of the disease

In children, microhematuria may be accompanied by the following symptoms:

Increased blood pressure (extremely rare).
Swelling of the face and individual parts of the body.
Frequent urge to urinate (most often painful).
Painful sensations in the abdominal area.

Diagnosis of the disease

The presence of microhematuria in a child is detected when in his urine, examined using microscopic examination, specialists find more than 2 to 3 red blood cells in a single field of view.

If parents notice that their child begins to frequently ask to go to the potty, they will need to immediately attend an appointment with a pediatrician, who, in turn, will first direct them to undergo basic tests - urine and blood. Parents should also pay close attention to the presence of false urges to go to the toilet in children.

If microhematuria is suspected, the attending physician may refer the child to a urologist or nephrologist. This specialist, in turn, will advise parents to have their child’s urine tested for bacterial culture, based on the results of which the disease is reliably determined.

For each child, a nephrologist or urologist will prescribe his own individual treatment, which is determined only on the basis of studying the differential diagnosis. This diagnosis is made by specialists only on the basis of an initial examination; further additional studies, as a rule, are not prescribed.

The primary examination includes not only urine and blood tests, urine culture, but also this list should include:

Determination of APTT (activated partial thromboplastin time).
Determination of PT (thrombosis time).
Taking a skin test with purified tuberculin.
Microscopy of urine sediment.
Ultrasound of the kidneys and bladder.
Cystoscopy.

Treatment of the disease

If the bacterial culture test gives a clinical picture such as the presence of Pseudomonas aeruginosa in the child’s urine, he will be prescribed a course of antibiotic therapy. One of the most effective drugs is considered to be Ceftriaxone. After using this antibiotic, the urge to urinate in children will appear less frequently. Children may also be prescribed antibiotics such as Ceftazidime, Trovofloxacin, Imipenem, and so on.

Moms and dads should never forget that the use of antibiotics can cause increased sensitivity in children to taking any drugs, so you should not search for such drugs on your own. The drug should be prescribed only by the doctor treating the child.

A child suffering from microhematuria must follow a strict diet (parents take care of this); he should not consume:

A huge amount of fried food.
Smoked products.
Salty foods.
Chemical food additives and vitamins.

Disease prevention

Children who have been diagnosed with microhematuria for the first time will have to undergo general blood and urine tests again after completing the course of treatment recommended by the doctor. Once every six months, parents and their children will have to visit a nephrologist or urologist.

Treatment of microhematuria with folk remedies

When eliminating this kind of illness in children, alternative medicine, which has a name - folk, is also not left aside. She offers her effective methods of actively reducing the level of red blood cells in children's urine.

Do not forget that the doctor should also know about taking folk remedies. It is allowed in the treatment of microhematuria in children to take decoctions of such medicinal herbs as nettle and yarrow. No less effective means in the fight against this disease are also considered decoctions prepared from rose hips, or juniper, blackberry root and evading peony.

Hematuria refers to the presence of red blood cells in the urine. Does this always indicate pathology? Can erythrocyturia be observed normally? If yes, in what quantity and how often? There is no clear answer to these questions. Many consider the presence of single red blood cells in the morning portion of urine collected after an appropriate toilet to be a normal variant. At the same time, children who even occasionally have single erythrocytes in the general urine test require observation and a certain examination algorithm for often several months.

Considering hematuria as a manifestation of an isolated urinary syndrome (UIS), it is necessary to take into account both the degree of its severity and the possibility of its combination with other changes in the analysis of urine and, above all, with proteinuria.

According to the degree of severity, macro- and microhematuria are distinguished. With gross hematuria, urine acquires a reddish-brown color (the color of "meat slops"). With microhematuria, the color of the urine is not changed, but when examined under a microscope, the degree of hematuria varies. It is advisable to isolate severe hematuria (more than 50 erythrocytes per field of view), moderate (30-50 per visual field) and insignificant (up to 10-15 per visual field).

Hematuria should also be distinguished by duration. It can be short-term (for example, during the passage of a stone), have an intermittent course, as is the case with Berger's disease, one of the variants of IgA nephropathy, and also be characterized by a persistent, persistent course, maintaining varying degrees of severity over many months and even years ( various variants of glomerulonephritis, hereditary nephritis, some types of kidney dysplasia). It can be asymptomatic (with a number of congenital and hereditary kidney diseases) or accompanied by dysuria or pain syndrome (with renal colic).

Depending on the site of origin, hematuria can be renal or extrarenal. The presence of so-called "altered" erythrocytes in the urine sediment does not always indicate their renal origin, because their morphology often depends on the osmolality of the urine and the duration of stay in it until the moment of sediment microscopy. At the same time, “unchanged” erythrocytes in the urine can be of renal origin (for example, with gross hematuria due to rupture of the basement membrane in some forms of glomerulonephritis or with hemorrhagic fever with kidney damage and the occurrence of thrombohemorrhagic syndrome; as well as with kidney tuberculosis, with Wilms tumor ). In turn, renal hematuria is divided into glomerular and tubular. For glomerular hematuria, the appearance of erythrocyte cylinders in the urine sediment is typical, but this is observed only in 30% of glomerular hematuria. The renal nature of hematuria can be more reliably established using phase-contrast microscopy of urinary sediment.

The mechanism of occurrence of renal hematuria. To this day, there is no common understanding of the pathogenesis of renal hematuria. It goes without saying that red blood cells can enter the urinary space of the kidney only from the capillary bed, and hematuria in renal pathology is traditionally associated with damage to the glomerular capillaries. In microhematuria, red blood cells pass through anatomical pores in the basement membrane due to its increased permeability. Macrohematuria is caused rather by necrosis of glomerular loops. The cause of hematuria may be thinning of the basement membrane with disruption of the structure of type IV collagen and a decrease in the laminin content in its dense layer, which is characteristic of hereditary nephritis.

It is considered more likely that the main site of penetration of red blood cells through the capillary wall is the glomerulus. This is facilitated by the increased intracapillary hydrostatic pressure present in the glomerulus, under the influence of which the red blood cells, changing their configuration, pass through the existing pores. Permeability to erythrocytes increases when the integrity of the basement membrane is disrupted, which occurs with immunoinflammatory damage to the capillary wall. Some authors do not exclude a violation of the morphofunctional properties of erythrocytes, in particular, a decrease in their charge, in the occurrence of hematuria. However, there is no correlation between the severity of changes in the glomeruli and the degree of hematuria. This fact, as well as the often absence of severe hematuria in nephrotic syndrome, when the structure of the basal membrane is sharply disrupted, has given rise to a number of authors to express a different point of view on the mechanism of hematuria, namely, the main place of release of red blood cells is the peritubular capillaries. These capillaries, unlike glomerular capillaries, do not have an epithelial layer and are in very close contact with the tubular epithelium; in this case, significant changes of a dystrophic nature are often found both in the endothelial cells of the capillaries and in the epithelium of the tubules.

Despite the existing uncertainty about the nature of renal hematuria in nephropathies, it is nevertheless important to know the place of its origin - the glomerulus or tubule. Dysmorphism of erythrocytes, detected by phase-contrast microscopy, makes it possible to distinguish renal hematuria from extrarenal, but does not allow to differentiate glomerular erythrocyturia from peritubular. Tubular or peritubular hematuria may be indicated by the appearance in the urine of plasma low molecular weight proteins, which are usually completely reabsorbed in the proximal tubule. These proteins include beta2-microglobulin (beta2-MG). If, during hematuria, beta2-MG is detected in the urine in an amount exceeding 100 mg in the absence or less amount of albumin in it, then such hematuria should be regarded as tubular. Other markers of tubular hematuria may include retinol binding protein and alpha1 microglobulin. Determination of the latter is preferable, since beta2-MG is easily destroyed in very acidic urine.

Diagnosis of hematuria in children. Diagnosis of asymptomatic hematuria presents the greatest difficulties for the doctor. However, the absence of one or another symptomatology at the moment does not exclude the presence of it in the anamnesis, such as, for example, past pain, or dysuria, or fever without catarrhal phenomena. The diagnostic process, as always, should begin with a detailed history. In table Table 3 presents the main points to which the doctor’s attention should be drawn when collecting an anamnesis. Identification of certain features of the medical history will allow the most rational examination of the patient, and analysis of the circumstances under which hematuria was detected will help to simplify it.

It is extremely important to determine the age when the debut of hematuria took place, because establishing the fact of the appearance of hematuria in early childhood allows us to consider it as a manifestation, most often, of some congenital or hereditary pathology. A carefully studied family and obstetric history will allow you to confirm this. It is important to establish whether hematuria is constant or occurs occasionally against the background of any intercurrent illness, cooling or exercise. Its severity is also of certain importance, i.e. whether it manifests itself as macro- or microhematuria. But greater significance should be attached to the accompanying proteinuria, especially when it is permanent. This always indicates a renal origin of hematuria.

When starting to examine a child with detected hematuria in a clinic, first of all, it is necessary to determine the place of its origin, that is, whether the hematuria is renal or extrarenal. Undoubtedly, if hematuria is accompanied by proteinuria, then its non-renal origin is excluded. In the absence of proteinuria, the first step in the examination should be a two-glass test (see diagram 1 on page 56). The detection of red blood cells only in the first portion indicates their external origin. In this case, examination of the external genitalia, taking smears for microscopy and latent infection, scraping for enterobiasis will help identify the inflammatory process and its cause. If signs of inflammation are detected, it is necessary to exclude its allergic nature. To do this, in addition to obtaining relevant anamnestic data, a vulvo- or urocytogram should be prescribed, which, in the presence of a predominance of lymphocytes and the detection of eosinophils, will exclude the bacterial nature of the inflammatory process. The detection of red blood cells in two portions indicates involvement of the kidneys and/or bladder in the pathological process. Bladder pathology can be suspected, in addition to relevant anamnestic data, during ultrasound examination, but only cystoscopy makes it possible to definitively verify the presence or absence of cystitis. Ultrasound examination (ultrasound) can reveal changes in the position of the shape and size of the kidneys, suggesting the possibility of cystitis, as well as a neurogenic bladder. In addition, ultrasound can detect the presence of stones. Subsequent IV urography and/or renoscintigraphy will help clarify the nature of the detected changes.

Hematuria, combined with proteinuria, as already mentioned, is of renal origin. If this pathology is detected in urine tests in early childhood, after taking an appropriate history (Table 3), it is necessary to determine whether the disease is congenital or hereditary. The proposed algorithm of actions (see diagram 2 on page 57) allows at the first stage not only to outline the differential diagnosis between congenital and hereditary kidney pathologies, but also to approach the identification of diseases such as interstitial nephritis and metabolic nephropathy, for which hematuria is one of the manifestations of this pathology.

When hematuria, combined with proteinuria, appears in preschool and school age, the hereditary or congenital nature of the disease cannot be ruled out. However, the role of acquired pathology in the form of various forms of primary or secondary glomerulonephritis, interstitial nephritis, diabetic nephropathy, and pyelonephritis is significantly increasing. After a detailed history collection, examination of this group of children should begin with the collection of 24-hour urine for protein and an orthostatic test. It is preferable to collect daily urine for protein separately during the day and at night. This makes it possible to assess the importance of physical activity on the severity of both proteinuria and hematuria. Since in children of this age group, when hematuria is combined with proteinuria, the incidence of various variants of glomerulonephritis increases, it is necessary to identify a possible connection between this pathology and hemolytic streptococcus. To do this, it is not enough to detect its presence by taking swabs from the throat; it is necessary to establish the appearance and increase in the titer of antistreptococcal antibodies (ASL-O), as well as the activation of the complementary system.

An obligatory step in the examination of this group of patients is an ultrasound scan of the kidneys. Despite the normal ultrasound characteristics of the kidneys in the presence of isolated urinary syndrome in the form of hematuria with proteinuria, regardless of their severity, a positive orthostatic test requires intravenous urography. The latter will eliminate kidney dystopia, the presence of their immobility, and also finally resolve the issue of the absence of pathological kidney mobility. From a functional examination, it is often enough to confine ourselves to conducting a Zimnitsky test, and to clarify the condition of the tubulointerstitium - a test with Lasix. If certain abnormalities are detected by ultrasound of the kidneys, in addition to the above, it may be necessary to perform a Rehberg test, as well as renoscintigraphy.

Thus, before deciding on the need to use invasive examination methods in children with IMS, manifested in the form of hematuria, it is necessary to conduct the above basic examination on an outpatient basis. This will, on the one hand, prevent unnecessary hospitalization, and on the other, reduce the stay of children in a specialized bed if a more in-depth examination is required.

Literature

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Blood in the urine of a child or hematuria is divided into micro- and macro- (visible to the naked eye - the urine turns red). If it occurs, you should consult a doctor, as this may be a sign of a serious pathology of the urinary system.

At the slightest suspicion of a disease of the urinary system, a general urine test is prescribed. The doctor evaluates its indicators; only he can objectively evaluate the result obtained. It is handed over to a specialized institution. Normally, urine is transparent, without sediment or impurities, the color varies from straw-yellow to golden. Other indicators depend on the age of the child:

Specific gravity: 0-2 years - up to 1015, in 2-3g. – up to 1016, over 3 years – up to 1025 g/l.
Urine pH 4.5-8.
Leukocytes: in girls 0-6 in one field of view, in boys 0-3.
Epithelial cells – permissible value up to 10 units.
Erythrocytes or red blood cells: in newborns 0-7, in older children 0-3 cells in one field of view.
Mucus should be completely absent.
Protein 0-0.03 g/l.
Glucose, ketone bodies, casts, bilirubin, bacteria are absent in the normal analysis.

Deviations in indicators may indicate a disease.

To identify it, the doctor will prescribe an additional examination: general and biochemical blood tests, urine culture for flora and sensitivity to antibiotics, ultrasound of the urinary system, daily analysis according to Nechiporenko and others.

Timely diagnosis and treatment are the key to complete recovery and prevention of complications.

Causes

Changes in the color of urine (becomes red), streaks and blood clots in the diaper and potty are signs of hematuria. The main reasons are:

Kidney pathologies: glomerulonephritis.
Pathologies of the genitourinary system: , .
Kidney failure.
Colds.
The presence of sand and stones in the kidneys and bladder.
Injuries to the kidneys and urinary organs.
Benign and malignant neoplasms.
Blood clotting disorder.
The presence of sand and stones in the kidneys and bladder.
Injury to the external genitalia.
Meningitis.
Malformations of the cardiovascular system.

Non-pathological reasons:

Excessive physical activity.
Stress.
Taking certain medications.
The use of coloring vegetables, fruits (beets, carrots, etc.)

Regardless of the cause, the presence of blood in the urine requires immediate consultation with a specialist, treatment and further regular examinations.

In a newborn, the passage of red blood cells into the urine can occur for various reasons. Sometimes this is a sign of a physiological phenomenon - uric acid infarction, in which the color of urine becomes reddish due to the increased content of urates. This condition does not require treatment, but you should definitely consult a doctor to identify the causes.

Infants have very thin and fragile vessel walls, which can lead to blood in the urine.

Common causes in newborns:

Birth injury.
Constipation.
Atopic dermatitis.
Eating foods that color urine: beets, blueberries, sweets with dyes, etc.
Allergy.
Cracked nipples in mother while breastfeeding.
Increased body temperature.
Colds.

Additional symptoms

Hematuria in children can be asymptomatic, and is sometimes accompanied by:

Pain and burning when urinating - with cystitis.
Increased body temperature.
Pain in the lower abdomen.
Painful and unpleasant sensations in the kidneys and lower back.
Edema.
Increased blood pressure.
Severe weakness and fatigue that does not go away after sufficient rest.
Young children experience a change in their usual daily routine, they become capricious, whiny, have trouble falling asleep and often wake up, and refuse to eat.

When should you not worry?

There are conditions in which the appearance of blood in the urine is normal, does not require therapy and goes away on its own:

After bladder catheterization in the next few days.
Diagnostic testing using an endoscope may also result in the appearance of blood within the next two days.
When performing lithotripsy (crushing kidney and bladder stones).
After high physical activity - important for children actively involved in sports.

If symptoms do not disappear after 5-7 days, you should see a doctor.

How to detect hematuria?

A condition in which a change in the color of urine to red and streaks of blood is visible to the naked eye is called gross hematuria. In this case, parents immediately contact a specialist. But there is also microhematuria, when the number of red blood cells in the urine is insignificant and does not affect its color. This condition can only be detected through laboratory tests. Therefore, it is important to undergo medical examinations at the prescribed time.

If changes in the TAM are detected, a number of additional studies are prescribed: urine samples according to Nechiporenko and Adiss-Kakovsky, ultrasound of the kidneys and bladder, urine culture for flora and sensitivity to antibiotics, computed tomography, MRI, cystoscopy, intravenous urography and others.

The appearance of blood in the urine at the beginning of urination may indicate problems with the urethra, and at the end - diseases of the bladder. The appearance of blood clots indicates kidney disease, but it also happens with other pathologies. The presence of protein and leukocytes also indicates organ damage.

When the color of urine changes, it is very important to remember whether the child has consumed foods that can affect the color of urine. These include: carrots, red beets, blueberries, pomegranate juice, red berries and fruits. If yes, then you should monitor your child’s drinking regime: with sufficient water consumption, the color will return to normal in the near future. Some medications can also change the color of urine; when you stop taking them, everything will return to normal.

Treatment

After collecting anamnesis, conducting a physical examination and examination, the doctor will make a diagnosis and decide on treatment tactics and give recommendations.

If the cause of hematuria is increased physical activity, drug treatment is not prescribed. It is worth changing the regime, reducing the load and within 3-5 days everything will return to normal.
If the cause of hematuria is an infectious process, complex therapy is prescribed, including the use of antibacterial drugs, taking into account the sensitivity of microorganisms.
If urolithiasis is detected, treatment is carried out in a specialized hospital with a solution to the issue of removing sand and stones, including surgical methods.
Glomerulonephritis, as a cause of hematuria, requires complex treatment, including drug therapy, diet (excluding fatty, smoked, spicy foods from the diet) and daily routine.

When treating any disease of the urinary system, attention must be paid to proper fluid intake. Your doctor will tell you how much water you need to drink per day, taking into account the child’s age and size.

Prevention

There is no primary prevention for hematuria. But, in any case, you should follow a few simple rules:

Proper hydration with sufficient water consumption.
No stress or excessive physical activity.
Compliance with the daily routine, sufficient daytime and night sleep.
Balneotherapy (sanatorium-resort).
Diet appropriate for the child's age. Exclusion from the diet of fatty, smoked, spicy foods, carbonated drinks, foods high in artificial colors and preservatives, and uncontrolled consumption of sweets is also unacceptable.

If hematuria is detected, you should strictly follow all doctor’s prescriptions and under no circumstances self-medicate, as this can lead to the development of complications and aggravation of the child’s condition. After a course of treatment, you should see a doctor once every 6-12 months for regular examinations.