BLOOD IN THE URINE (HEMATURIA)

If your child's urine has a red, orange or brown color, it may contain blood. The medical term for this is hematuria. This can be caused by many things, including a physical injury, or inflammation or infection in the urinary tract. Hematuria also can be caused by some general medical problem, such as a defect of blood clotting, exposure to toxic materials, hereditary conditions or abnormalities of the immune system.

Sometimes there may be such small amounts of blood in the urine that you cannot see any color change, although it may be detected by a chemical test performed by the pediatrician. In some cases, the reddish color may simply be due to something your child has eaten or swallowed. Beets, blackberries, red food coloring, phenolphthalein (a chemical sometimes used in laxatives), Pyridium (a medicine used to relieve bladder pain), and the medicine rifampin all will cause the urine to turn red or orange if your child ingests them. Any time you are not sure that one of these has caused the color change, or if the color change persists for more than 24 hours without explanation, call your pediatrician.

Diagnosis of Hematuria

The pediatrician will ask you about any possible injury or foods that might have caused the change in color of the urine. He will perform a physical examination, checking particularly for any increase in blood pressure, tenderness in the kidney area, or swelling (particularly of the hands or feet or around the eyes) that might indicate urinary tract problems. The doctor also will perform tests on a sample of urine.

If no urinary infection is found, the doctor may request blood tests, X-rays or other examinations to check the functioning of your child's kidneys, bladder and immune system. If none of these reveals the cause of the hematuria, and it continues to occur, your pediatrician may refer you to a children's kidney specialist, who will perform additional tests. (Sometimes these tests will include an examination of a tiny piece of kidney tissue under the microscope. This tissue may be obtained by surgically operating, or by performing what's called a "needle biopsy.")

Treatment of Hematuria

Once your pediatrician knows what is causing the hematuria, treatment can begin. This may be as simple as rest, a change in diet, or, in some cases, special medication, such as cortisone or drugs to affect the immune system. Whatever the treatment, your child will need to return to the doctor regularly for repeat urine and blood tests and blood-pressure checks. This is necessary to make sure that she isn't developing chronic kidney disease, which can lead to kidney failure. If surgery is required to correct the hematuria, your pediatrician will refer you to a pediatric urologist who can perform such procedures.