Hematuria and Hypercalciuria
also see
Vin-rose urine


Differential of Hematuria without proteinuria

Differential of hematuria with proteinuria

Familial causes of hematuria:polycystic kidney disease, thin basement membrane disease, sickle cell disease or trait, Alport syndrome, hypercalciuria with family history of nephrolithiasis

Workup of persistent hematuria

Lower tract:

Upper tract:

Discussion of some conditions in the differential dx

- Hypercalciuria

- Benign familial hematuria (BFH) should be considered in any child who has hematuria. Therefore, family members should have their urine tested for blood. In general, BFH is considered a diagnosis of exclusion.

- Any form of renal cystic disease may cause RBCs to appear in the urine. However, multicystic kidney dysplasia (MKD) is a rare cause of hematuria in infants. This congenital malformation almost always is unilateral and most frequently is detected on routine ultrasonographic screening during pregnancy. Ultrasonography will reveal multiple cysts scattered throughout the renal parenchyma, with marked echogenicity of the parenchyma, indicating nonspecific renal dysplasia. A renal scan will distinguish between hydronephrosis and MKD. There is no treatment for MKD.
- The most common renal tumor of childhood is Wilms tumor. In general, affected children will have a large abdominal mass that often is detected initially by a parent. There may be abdominal pain if the mass extends throughout the abdomen. However, Wilms tumor is an unusual cause of RBCs in the urine in children.

- The complete urinalysis required to evaluate urine for the presence of RBCs offers other potentially diagnostic indices, including the presence of protein, white blood cells (WBCs), and nitrites. Protein in the urine may indicate renal  disease, and in conjunction with RBCs suggests renal parenchymal injury. The presence of many WBCs, RBCs, and  nitrites in the urine is highly suggestive of a urinary tract infection.

Alon US, Berenbom A. Idiopathic hypercalciuria of childhood: 4- to
11-year outcome. Pediatr Nephrol. 2000;14:1011-1015
Coe FL, Parks JH, Moore ES. Familial idiopathic hypercalciuria. N Engl J
Med. 1979;300:337-340
Stapleton FB, Noe HN, Roy C III, Jerkins G. Hypercalciuria in children
with urolithiasis. Am J Dis Child. 1982;136:675-678