Emergency Department Management of Hematuria in Children: An Updated, Evidence-Based Approach
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Publication Date: June 2025 (Volume 22, Number 6)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 06/01/2028.
Authors
Sujung Kim, MD
Fellow, Division of Emergency Medicine, Rady Children’s Hospital, University of California San Diego, San Diego, CA
Deborah R. Liu, MD
Associate Division Director, Division of Emergency Medicine, Children’s Hospital Los Angeles, Associate Professor of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA
Kathryn H. Pade, MD
Associate Professor of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, CA
Peer Reviewers
Ilene Claudius, MD
Professor; Director, Process & Quality Improvement Program, Harbor-UCLA Medical Center, Torrance, CA
Ada Earp, DO, CHSE-A, FAAP
Assistant Professor, Director of Simulation, Department of Pediatrics, University of Texas Austin Dell Medical School, Austin, TX
Abstract
Hematuria is a common finding in the pediatric population. The differential diagnosis for pediatric hematuria is wide, ranging from isolated benign causes to serious progressive renal or urologic diseases. Emergency clinicians must be able to identify high-risk features that raise suspicion for a serious underlying pathology while limiting unnecessary workup. This issue reviews key considerations in the evaluation and initial management of pediatric hematuria in the emergency department, including evidence-based recommendations on initial laboratory and imaging choices.
Case Presentations
CASE 1
A 10-year-old boy presents to the emergency department with eye swelling and cola-colored urine...
The boy reports a sore throat 2 weeks prior to presentation.
His vital signs are unremarkable, except for a blood pressure of 130/68 mm Hg. On examination, you note periorbital edema. Urinalysis is positive for protein and blood.
What workup is warranted at this time to confirm the diagnosis? What is the patient’s likely disposition?
CASE 2
A previously healthy 3-year-old girl presents to the emergency department with a chief complaint of pink urine...
A review of systems is otherwise normal. The girl’s vital signs are within normal limits, and her physical examination is unremarkable, including a genitourinary examination. Urinalysis is negative for blood.
What other questions would be helpful to confirm the diagnosis?
CASE 3
A 16-year-old adolescent girl presents to the emergency department for myalgias and pink urine…
The girl states she was at a rave last night but denies substance use.
The girl’s vital signs are unremarkable. The physical examination is significant for diffuse muscle tenderness. Her urine is positive for 2+ blood.
What other laboratory studies should be performed for this patient?
Accreditation:
EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
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