Is the hematuria visible or microscopic?

Isolated microscopic hematuria is a fairly common problem and may not be as serious as gross hematuria.

How often has the hematuria been noted?

Persistent hematuria is more likely to be significant than a single occurrence.

Has the patient or family ever noticed the urine to coke, tea, or rust colored? Has the urine ever appeared bright red?

Blood in the urine that appears dark is usually glomerular in origin and has been de-oxygenated in the renal tubule e.g. acute post-infectious glomerulonephritis. Bright red blood can be from the renal pelvis, ureter or bladder. However, glomerular blood may be bright red if the urine flow is rapid, e.g. IgA nephropathy.

Has your child eaten beats, foods with red dye, etc.?

Certain foods and food colorings can turn the urine dark and be mistaken for blood. This should be considered particularly when the hematuria is gross, intermittent, and accompanied by negative urines in between episodes.

Is the hematuria visible?  Is it associated with any symptoms of a respiratory tract infection, sore throat, or skin infection?

The hematuria of IgA nephropathy often immediately follows symptoms of a URI. Acute post-infectious glomerulonephritis usually occurs within two weeks of the onset of a strep throat and longer if associated with impetigo.

Has blood been visible in the urine of an African-American child? Has the child been tested for Sickle cell disease?

Sickling in the pelvis may cause gross, intermittent hematuria. This is especially seen in patients with Sickle trait and can be very perfuse resulting in hemodynamic changes. Patients with Sickle cell disease will often infarct the renal medulla and thus not bleed. Patients with Sickle cell disease may develop nephritis and present with hematuria and proteinuria.

Has there been gross blood in the stools?

Bloody diarrhea followed by hematuria and decreased urine output can be hemolytic uremic syndrome.

Have there been other systemic symptoms associated with the hematuria?

The association of hematuria, abdominal pain, joint pain, and a petechial rash involving the lower extremities, buttock, and extensor surfaces of the arms is likely Henoch-Schönlein purpura. The association of hematuria, joint pain, a butterfly rash on the face, and fever is likely lupus erythematosis.

Has blood been visible in the urine? Have clots been noted?

Clots would suggest a non-glomerular source.

Has blood been visible in the urine? Has the blood been noted throughout the stream or only at the beginning or dripping out after voiding?

Bleeding from the penile urethra could appear as hematuria at the beginning of the stream. Bleeding from the bladder neck or prostatic urethra could present as blood after voiding. Blood might be noted in the underwear after voiding under these circumstances.

Is there any pain on voiding?

Burning or dysuria with hematuria could represent a urinary tract infection. Flank pain radiating from the back into the pelvis could represent a renal stone.

Does the child have a high salt or a high calcium intake? Does the child take an excessive amount of supplemental vitamins?

A high sodium intake increases calcium losses in the urine. A high calcium intake would also increase the calcium losses in the urine. Excessive vitamin D intake could produce hypercalcemia and increased calcium losses in the urine.

Has the child ever been noted to have an elevated blood pressure?

Hypertension is often in children a sign of significant renal pathology. One would also want to ask when the child’s last blood pressure was taken.

Has any other practitioner evaluated your child for hematuria, and if so, what tests were done?

Sometimes an existing evaluation is available so some steps may be saved.