All cases of red urine are not due to hematuria.
Ask – History of fever, dysuria, rash, joint pain etc. If asymptomatic ask history of ingestion of beet-root, food colouring agents at a party, candies etc.
Look: For rash, edema, hypertension, renal angle tenderness etc.
Confirm: Presence of RBCs in urine with urine microscopy in a freshly voided urine specimen. Presence of >5 RBCs per HPF is significant in centrifuged specimen.
Evaluate:
- Urine for culture, colony count and sensitivity. If positive treat for UTI
- Renal function tests, albumin, spot urine protein creatinine ratio. Refer to Pediatric nephrologist if acute glomerulonephritis is suspected.
- Ultrasound KUB. Refer to Pediatric Nephrologist/Urologist if Nephrolithiasis.
- Spot urine calcium creatinine ratio, 24 hr urine calcium for hypercalciuria
Wait and watch: If above evaluation is non-contributory and child is otherwise asymptomatic.
Pediatric Practice... Pearls for your Pediatric Office Practice 