Peds0914 Hematuria .pdf

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An Evidence-Based Approach To
The Management Of Hematuria
In Children In The Emergency

September 2014
Volume 11, Number 9

Kathryn H. Pade, MD
Fellow, Division of Emergency Medicine, Children’s Hospital
Los Angeles, Los Angeles, CA
Deborah R. Liu, MD
Fellowship Director, Division of Emergency Medicine,
Children’s Hospital Los Angeles, Assistant Professor of
Pediatrics, USC Keck School of Medicine, Los Angeles, CA
Peer Reviewers

Hematuria is defined as an abnormal number of red blood cells in
urine. Even a tiny amount of blood (1 mL in 1000 mL of urine) is sufficient to make urine appear pink or red. In the pediatric population,
the majority of etiologies are benign and often asymptomatic. However, hematuria may also be a sign of renal pathology, local infection,
or systemic disease. Hematuria can be differentiated into 2 categories:
macroscopic hematuria (visible to the naked eye) and microscopic
hematuria (> 5 red blood cells/high-powered field on urinalysis).
This review will outline the current literature regarding evaluation
and management of pediatric patients who present to the emergency
department with hematuria. Obtaining a thorough history and the appropriate diagnostic tests will be discussed in depth.

Jeffrey R. Avner, MD, FAAP
Professor of Clinical Pediatrics and Chief of Pediatric
Emergency Medicine, Albert Einstein College of Medicine,
Children’s Hospital at Montefiore, Bronx, NY
Sandip Godambe, MD, PhD
Vice President, Quality & Patient Safety, Professor of
Pediatrics and Emergency Medicine, Attending Physician,
Children’s Hospital of the King’s Daughters Health System,
Norfolk, VA
CME Objectives
Upon completion of this article, you should be able to:
Differentiate between macroscopic and microscopic
2. Recognize the most common causes of hematuria in
3. Utilize appropriate diagnostic tests for evaluation of
hematuria in the emergency department.
4. Identify patients with hematuria who require
admission to the hospital.
Prior to beginning this activity, see “Physician CME
Information” on the back page.


Ilene Claudius, MD
Associate Professor of Emergency
Adam E. Vella, MD, FAAP
Medicine, Keck School of Medicine
Associate Professor of Emergency
of the University of Southern
Medicine, Pediatrics, and Medical
California, Los Angeles, CA
Education, Director Of Pediatric
Ari Cohen, MD
Emergency Medicine, Icahn
School of Medicine at Mount Sinai, Chief of Pediatric Emergency
Medicine Services, Massachusetts
New York, NY
General Hospital; Instructor in
Associate Editor-in-Chief
Pediatrics, Harvard Medical
School, Boston, MA
Vincent J. Wang, MD, MHA
Associate Professor of Pediatrics,
Keck School of Medicine of the
University of Southern California;
Associate Division Head,
Division of Emergency Medicine,
Children's Hospital Los Angeles,
Los Angeles, CA

Editorial Board
Jeffrey R. Avner, MD, FAAP
Professor of Clinical Pediatrics
and Chief of Pediatric Emergency
Medicine, Albert Einstein College
of Medicine, Children’s Hospital at
Montefiore, Bronx, NY

Ran D. Goldman, MD
Melissa Langhan, MD, MHS
Professor, Department of Pediatrics, Associate Professor of Pediatrics,
University of British Columbia;
Fellowship Director, Pediatric
Co-Lead, Division of Translational
Emergency Medicine, Director of
Therapeutics; Research Director,
Education, Pediatric Emergency
Pediatric Emergency Medicine, BC
Medicine, Yale School of Medicine,
Children's Hospital, Vancouver, BC,
New Haven, CT
Robert Luten, MD
Alson S. Inaba, MD, FAAP
Professor, Pediatrics and
Associate Professor of Pediatrics,
Emergency Medicine, University of
University of Hawaii at Mãnoa
Florida, Jacksonville, FL
John A. Burns School of Medicine, Garth Meckler, MD, MSHS
Division Head of Pediatric
Associate Professor of Pediatrics,
Emergency Medicine, Kapiolani
University of British Columbia;
Medical Center for Women and
Division Head, Pediatric
Children, Honolulu, HI
Emergency Medicine, BC

Marianne Gausche-Hill, MD,
Professor of Clinical Medicine,
David Geffen School of Medicine
at the University of California at
Los Angeles; Vice Chair and Chief, Madeline Matar Joseph, MD, FAAP,
Division of Pediatric Emergency
Medicine, Harbor-UCLA Medical
Professor of Emergency Medicine
Center, Los Angeles, CA
and Pediatrics, Chief and Medical
Director, Pediatric Emergency
Michael J. Gerardi, MD, FAAP,
Medicine Division, University
FACEP, President-Elect
of Florida Medical School Associate Professor of Emergency
Jacksonville, Jacksonville, FL
Medicine, Icahn School of
Medicine at Mount Sinai; Director,
Pediatric Emergency Medicine,
Goryeb Children's Hospital,
Morristown Medical Center,
Morristown, NJ

Steven Bin, MD
Associate Clinical Professor,
Division of Pediatric Emergency
Medicine, UCSF Benioff Children’s Sandip Godambe, MD, PhD
Hospital, University of California,
Vice President, Quality & Patient
San Francisco, CA
Safety, Professor of Pediatrics and
Emergency Medicine, Attending
Richard M. Cantor, MD, FAAP,
Physician, Children's Hospital
of the King's Daughters Health
Professor of Emergency Medicine
System, Norfolk, VA
and Pediatrics, Director, Pediatric
Emergency Department, Medical
Director, Central New York
Poison Control Center, Golisano
Children's Hospital, Syracuse, NY

Stephanie Kennebeck, MD
Associate Professor, University
of Cincinnati Department of
Pediatrics, Cincinnati, OH

Anupam Kharbanda, MD, MS
Research Director, Associate
Fellowship Director, Department
of Pediatric Emergency Medicine,
Children's Hospitals and Clinics of
Minnesota, Minneapolis, MN
Tommy Y. Kim, MD, FAAP, FACEP
Assistant Professor of Emergency
Medicine and Pediatrics, Loma
Linda Medical Center and Children’s
Hospital, Loma Linda, CA

Children's Hospital, Vancouver,
BC, Canada
Joshua Nagler, MD
Assistant Professor of Pediatrics,
Harvard Medical School;
Fellowship Director, Division of
Emergency Medicine, Boston
Children's Hospital, Boston, MA
Steven Rogers, MD
Assistant Professor, University of
Connecticut School of Medicine,
Attending Emergency Medicine
Physician, Connecticut Children's
Medical Center, Hartford, CT
Christopher Strother, MD
Assistant Professor, Director,
Undergraduate and Emergency
Simulation, Icahn School of
Medicine at Mount Sinai, New
York, NY

AAP Sponsor
Martin I. Herman, MD, FAAP, FACEP
Professor of Pediatrics, Attending
Physician, Emergency Medicine
Department, Sacred Heart
Children’s Hospital, Pensacola, FL

International Editor
Lara Zibners, MD, FAAP
Honorary Consultant, Paediatric
Emergency Medicine, St Mary's
Hospital, Imperial College Trust;
EM representative, Steering Group
ATLS®-UK, Royal College of
Surgeons, London, England

Pharmacology Editor
James Damilini, PharmD, MS,
Clinical Pharmacy Specialist,
Emergency Medicine, St.
Joseph's Hospital and Medical
Center, Phoenix, AZ

Quality Editor
Steven Choi, MD
Medical Director of Quality,
Director of Pediatric Cardiac
Inpatient Services, The Children’s
Hospital at Montefiore, Assistant
Professor of Pediatrics, Albert
Einstein College of Medicine,
Bronx, NY

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