Classification

When conducting an examination, it is mandatory to find out the reasons that led to these problems. Depending on them, several types of hematuria are differentiated. For these purposes, there are special diagnostic methods.

So, if the problems are caused by problems with the kidneys, then they talk about renal hematuria. The postrenal form of this disease is diagnosed when the bladder or urinary tract is affected. With extrarenal hematuria, problems are not associated with kidney damage or injury.

They also distinguish between initial, final and total damage. This depends on which portion contains increased red blood cells in the urine. What this means is not difficult to figure out. With initial hematuria they will be in the first portion, with final hematuria - in the last, and with total hematuria - in all three. It is important to understand: the higher the problem area is, the later red blood cells enter the urine.

Experts say that hematuria can be obvious or hidden. In the first case, the urine will be red or brown. But there are situations when the color indicator remains normal. But at the same time, red blood cells in the urine are increased. A specialist can tell you what this means. He will also explain what can lead to hidden hematuria. Patients should understand that this condition is dangerous, and they should not delay a visit to a urologist or nephrologist.

Causes of hematuria

Various problems can lead to the appearance of an increased number of red blood cells in the urine. So, among the most common reasons are the following:

- pyelonephritis;

— calculi (stones) in the kidneys or bladder;

- glomerulonephritis;

- bacterial diseases of the urinary system;

- hemangiomas and polycystic kidney disease;

- inflammatory diseases;

- injuries in which the urinary tract or kidneys were affected;

— malignant formations;

- kidney malformations.

Only a specialist can establish an accurate diagnosis and the reason why red blood cells in the urine are elevated after a complete examination of the patient.

It is important to understand that blood cells can appear during the filtering stage of the blood or during the removal of fluid from the body.

Causes

Determining the reasons why a child has an increase in red blood cells in the urine is a difficult task, because the list of pathologies in which this is possible is very extensive. Therefore, it is so important to pay attention to studying the symptoms and any laboratory changes that accompany this condition.

The list of ailments in which hematuria is noted includes the following:

• Glomerular pathologies. Henoch-Schönlein nephritis, Ig A nephropathy, Alport syndrome, endocapillary glomerulonephritis, nephritis, in the case of systemic lupus erythematosus, thin basement membrane disease.
• Non-glomerular diseases of the excretory system. Inflammation of the pelvis, bladder, urethra, prostate gland, nephrolithiasis, nephrocalcinosis, schistosomiasis, phimosis.
• Medullary pathologies. Papillonecrosis, spongy kidney, tuberculous lesion.
• Oncological diseases. Wilms tumor and others.
• Injury to the urethra, bladder, kidneys.
• Conditions in which general intoxication of the body is observed. Sepsis, viral infectious diseases, severe intestinal infections, meningitis.
• Other pathologies: foreign bodies in the urinary tract, lumbalgic-hematuric syndrome, compression of the renal vein (Nutcracker syndrome), familial telangiectasia, coagulopathy.

In addition, red blood cells can end up in urine due to excess physical activity. But in this situation, hematuria is temporary and quickly resolves.

Red blood cell norms

To understand whether there is a problem, you need to know how many red blood cells can be excreted in the urine. Thus, when examining biological material from adult women, there should be no more than 3 red blood cells in the laboratory technician’s field of view. For men, the norm is less - they are allowed only 1 red blood cell, which is visible during microscopic examination.

For children, the appearance of 2-4 red blood cells is acceptable. If their number is greater, then further examination is necessary. The goal is to determine why there are elevated red blood cells in the urine. They can be elevated in a child for the same reasons as in adults.

Norm

The norm of red blood cells in a child’s urine during a general urinalysis is no more than 5-6 per field of view. That is, if the form states “single in the field of view or 0-1, 2-3, 3-4, 4-5 in the field of view”, there is no reason to worry, everything is within the norm.

It should be noted that the normal level of red blood cells in a child’s urine may vary depending on age. The indicators are discussed in more detail in the table:

When performing the Nechiporenko test, 1 ml of urine should not contain more than a thousand red blood cells. Acceptable values ​​for the Addis test are up to 1 million in daily urine.

Problems in children

Very often, hematuria is diagnosed in children. It can begin with viral diseases in which the temperature rises significantly, meningitis, intestinal infections, typhoid fever or toxin poisoning with the onset of sepsis. In all these situations, general intoxication of the body is observed. This causes the kidney filter openings to widen. Because of this, red blood cells can pass through them more freely.

Also in children there is so-called “marching hematuria”. It occurs after prolonged physical activity. In this case, increased red blood cells in the child’s urine can last for about a day, and then their number returns to normal.

Hematuria often occurs due to diseases of the urinary organs and urinary tract. These are the same diseases that can occur in adults: pyelonephritis, glomerulonephritis, cystitis, urethritis. Rarely, the cause of increased red blood cells in a child's urine may be urolithiasis. In this case, blood cells can appear in any area, from the renal pelvis to the urethra. Cancer should not be ruled out. They occur quite rarely, but are the most dangerous pathology.

The most common cause of increased red blood cells in children is bladder or kidney injury.

Possible reasons for the presence of red blood cells in the urine of a child

In addition to the above reasons, hematuria can be caused not only by diseases, but also by physiological processes. Then the increase in the level of red blood cells is transient (temporary) in nature. Let's look at these reasons in more detail.

1. Poor nutrition (consumption of large amounts of protein, sweets, citrus fruits, GMOs, dyes leads to the deposition of salts in the kidneys).
2. Wrong lifestyle. Doctors recommend that children lead a moderately active lifestyle, which treats many diseases better than drugs. Get outside more often, monitor the total amount of sleep, and avoid stress.
3. Stress. Often, elevated red blood cells occur in children from dysfunctional families, where the child lives in constant nervous tension. It is likely that stress can cause deviations in tests.
4. Physical labor and excessive stress.

Increased stress can negatively affect the condition of the body as a whole and, in particular, test results.

1. Adolescent use of hormones, steroids, and stimulants. Experts remind that persons under the age of majority are prohibited from consuming sports nutrition, supplements, energy and alcoholic drinks.
2. Taking a test during the menstrual cycle in girls, as well as violating the rules for collecting tests.

False hematuria

Sometimes there are situations when defective blood cells are found in the urine of babies. In this case, they say that the patient has false hematuria. This condition is not a sign of kidney or other organ disease.

In this case, the urine may be colored red, which is a cause for concern. When examining the material, the laboratory technician will not see increased red blood cells in the urine, but spots of pigments that cause changes in the color of the biomaterial. This situation may arise after eating beets. The color of urine can also change when taking a number of medications. For example, a reddish tint may appear when consuming drugs belonging to the group of sulfonamides, phenolphthalein, aspirin and analgin, vitamin B12.

How to properly collect urine for analysis

Urine must be collected in the morning, in a clean container (preferably in a special container). Before collecting the analysis, you need to wash the child.

The middle portion of urine is considered the most informative, so it is advisable to collect it for analysis (first the child pees in the potty, then the container is placed and the final portion is placed back in the potty).

Author: Olga Ivanovna Sazonova, pediatrician

Consultation with a pediatric nephrologist

We recommend reading: Bacteriuria, or the appearance of bacteria in a child’s urine. Causes and consequences

Red blood cells are red blood cells, they are designed to carry oxygen, providing metabolism in the body. Blood loss provokes anemia, that is, a lack of red blood cells. If bleeding is caused by various types of wounds, stopping it is not difficult. It is much more difficult to cope with the presence of red blood cells in urine, especially if the pathology is detected in a child.

Hematuria (the appearance of red blood cells in urine) is more common in children than in adults. Pathology requires immediate consultation with a pediatrician. The causes of this phenomenon can be various negative factors, for example, infectious diseases of the excretory system. The sooner you see a doctor, the greater the chances of avoiding sharply negative consequences.

• general information
• The norm of red blood cells in the urine of a child
• Reasons for the appearance of red blood cells in urine
• Inflammatory kidney diseases
• Diseases that provoke the formation of toxins
• False hematuria
• In what cases is analysis prescribed?
• How to prepare for a urine test

general information

The glomerular apparatus of the kidneys is designed to filter the blood. The cell elements remain unchanged, the liquid goes through the next stage of processing. At the moment when urine reaches the required concentration, it enters the bladder through the ureters through the pelvis. Any failure at these stages can lead to blood entering the child’s urine.

The opening of the kidney filter does not exceed a diameter of 8 nanometers; the size of a red blood cell is always larger than this mark. There are two factors that cause blood to leak into the urine: a decrease in the size of red blood cells or an increase in the opening of the kidney filter.

Depending on the number of red blood cells in urine, experts divide hematuria into two types:

• microhematuria. The red blood cell count does not exceed 20, the color of urine does not change;
• macrohematuria. A huge amount of red blood cells is found in the urine of a small patient, which cannot be counted. Urine takes on a purplish tint; laboratory tests may indicate: “red blood cells throughout the entire field of view.”

Learn about the causes of spongy kidney development and treatment options for the abnormality.

Read about the causes of white flakes in the urine of women and the treatment of associated pathologies at this address.

There is a classification based on the morphological characteristics of red blood cells:

• unchanged red blood cells in the urine. During the examination, biconvex yellow discs are visible under a microscope, which indicates a problem with the lower parts of the excretory system (ureter, bladder, urethra);
• altered red blood cells in the urine. The pathological process is started against the background of a long stay of the red blood cell in acidic urine; the formations are colorless discs/balls. This state of affairs indicates problems in the renal glomeruli and glomeruli.

On a note! There is the concept of “untrue hematuria”; the condition implies blood loss due to the entry into the urine of a large amount of blood from the affected areas of the excretory system (bladder, renal pelvis), and genital organs.

The norm of red blood cells in the urine of a child

In the field of view of a specialist, there should normally be no more than 4 red blood cells in the urine. During a detailed examination, the cells should be changed due to natural aging (the lifespan of an erythrocyte is about 120 days). The formation of new blood cells is observed every day, blood loss does not threaten. Given the characteristics of the body, modified red blood cells can be found in urine not only every 120 days, but much more often, which is considered within normal limits.

All other indicators are considered a reason to conduct additional research and consult a doctor. Even if all red blood cells are modified, but their number exceeds 4, then we need to look for the cause of their mass death.

Reasons for the appearance of red blood cells in urine

There are several reasons for this condition in children, as well as in adults: direct diseases of the excretory system, diseases of other organs, false hematuria. Each individual disease has a specific treatment regimen.

Inflammatory kidney diseases

Most often, increased red blood cells in a baby’s urine indicate the course of inflammatory processes in the urinary tract or kidneys:

• pyelonephritis. The inflammatory process occurs in the renal pelvis and calyces of the kidneys. The pathological process is caused by various bacteria. Inflammation provokes an increase in the permeability of cell membranes, red blood cells easily penetrate into the patient’s urine;
• cystitis. Bacteria invade the walls of the bladder, increasing their permeability. Against the background of this process, blood impurities are noticeable in the child’s urine;
• glomerulonephritis. The disease is autoimmune in nature (antibodies are produced to one’s own cells). Antibodies destroy their structure, which provokes an increase in the pores of the glomerulus and promotes the leakage of red blood cells into the urine;
• urethritis. The disease is an inflammatory process in the urethra. The child complains of pain when emptying the bladder, blood impurities are visible to the naked eye, or the urine has changed its usual color to brown.

Pathologies of the excretory system that occur without an inflammatory process:

• sand or kidney stones. This pathology is very rare in young children, but if stones do form, their release may be accompanied by the appearance of hematuria;
• injuries and bruises of the kidneys. Surgery in the kidney area can cause hematuria. This category includes any mechanical damage;
• tumors. Benign or malignant formations in the organs of the excretory system compress nearby tissues, leading to hematuria.

Red blood cells in a child’s urine analysis may indicate damage to other organs; this case is called “reactive hematuria” (kidney reaction to a pathological process).

Diseases that provoke the formation of toxins

Some diseases lead to the release of waste products of bacteria and viruses into the blood. The substances have a negative effect on the child’s body, including kidney function.

Probable diseases:

• ORZ. In the process of penetration, bacteria and viruses damage the mucous membranes, causing the death of red blood cells, which are then found in the baby’s urine;
• sepsis. Pathogenic microflora, entering the bloodstream, leads to severe intoxication of the body of a small patient, the formation of hematuria;
• ailments of the gastrointestinal tract. Bacteria that cause salmonellosis, dysentery, and typhoid fever poison the child’s body, causing an increase in body temperature and the appearance of red blood cells in the urine;
• chronic foci of the inflammatory process. This category includes carious teeth, abscesses, phlegmon and other pathologies.

Some diseases are asymptomatic; increased red blood cells in the urine are the only sign of the disease. Considering this fact, regular urine testing and examination by a pediatrician are the key to the healthy development of the baby.

False hematuria

The pathology is characterized by the appearance of defective blood cells in the child’s urine (untrue hematuria). The false process has nothing to do with kidney ailments. When studying urine, what the laboratory technician sees is not red blood cells, but rather coloring pigments. This condition is observed after eating beets.

The following substances similarly color a child’s urine:

• analgin, aspirin;
• vitamin B12;
• sulfonamide group agents;
• phenolphthalein.

During puberty, girls' urine may become colored as a result of menstrual blood entering it.

In what cases is analysis prescribed?

A routine examination is recommended for the baby, which involves submitting urine and blood for analysis.

There are a number of indications for unscheduled diagnosis of the child’s body condition:

• the child’s complaints of pain and cramps during emptying of the bladder;
• frequent urination, change in urine color;
• pain in the abdomen or lower back;
• infants cannot talk about their problems, the baby’s behavior changes: against the backdrop of constant discomfort, the baby becomes restless.

Learn about the signs of chronic cystitis in women, as well as treatment options for the disease.

Treatment methods for bladder cancer in men with folk remedies are described on this page.

Go to the address and read about what ketone bodies in urine mean and the reasons for abnormal readings.

How to prepare for a urine test

A positive test for red blood cells horrifies parents and worries doctors. False results are misleading; correct collection of biomaterial will help to avoid incidents.

Recommendations:

• Perform urine collection in the morning immediately after waking up, at this moment the urine is most concentrated;
• you cannot take urine for analysis after physical activity;
• before collecting material for research, thoroughly clean the external genitalia to avoid the ingress of red blood cells and leukocytes;
• The most informative portion is considered to be the middle one. It can be collected only from children over 4 years old, to whom it can be explained that during urination the first portion of urine must be passed by replacing the jar without interrupting the process;
• Use special containers purchased from pharmacy chains as a container for urine. The use of mayonnaise jars is strictly prohibited;
• on the eve of urine collection, it is not recommended to give the baby a variety of medicinal products or food that can color the urine;
• It is worth considering that after surgery in the area of ​​the excretory system, urine analysis may not correspond to reality.

The more attentive parents are to collecting urine from their child, the more accurate the result will be and the more correct the diagnosis.

All deviations in urine values ​​can be divided into several groups depending on the number of red blood cells (macrohematuria, microhematuria). A detailed picture is shown by urine analysis according to Nechiporenko: in 1 ml of urine no more than 1000 red blood cells, 2000 leukocytes, 10 cylinders should be detected. Any deviations from the norm are considered a pathology and require attention from a physician.

Red blood cells may be present in a baby’s urine, but their number should not exceed 4. Other cases indicate the course of inflammatory processes in the kidneys, excretory system, and other organs. Take care of your baby’s health and take your baby to see a doctor regularly.

Next video. Children's doctor Komarovsky about deciphering urine analysis, about the norm and the reasons for deviations of red blood cells in the urine of a child:

Changes in a child’s tests are always alarming, especially if blood cells are suddenly detected in the urine. Why can red blood cells get into a baby's urine? Let's figure it out.

What is this?

Red blood cells are called red blood cells, responsible for transporting gases in the blood - oxygen from the lungs to all organs and carbon dioxide back to the lungs from the tissues.

In healthy children, these cells may pass into the urine only in very small quantities, so identifying more than normal red blood cells in a blood sample (a sign called hematuria) is important for diagnosing a wide range of diseases.

Red blood cells may be in the child’s urine, but their value must correspond to the norm. Types
Red blood cells can enter the urine in different forms:

1. Unchanged. Such cells are detected in urine with slightly acidic, alkaline and neutral reactions. They often indicate blood entering the urine from the bladder, ureters or urethra.
2. Changed. They may be colorless (without hemoglobin), enlarged or wrinkled. Such cells are detected in acidic urine and are a sign of blood entering through the kidneys.

Norm

The norms of detected red blood cells in the urine are determined by the study that was performed on the child. Most often, children are prescribed a clinical urine test, and other tests are needed only to clarify the presence of hematuria.

Types of deviations

Depending on the number of red blood cells entering the urine, the deviation from the norm is called:

1. Macrohematuria - if blood in the urine is visually noticeable (the color of the urine changes), and red blood cells under a microscope fill the entire field of view (it is impossible to count them).
2. Microhematuria - the color of urine is not changed, but the analysis revealed up to 20 red blood cells in the field of view of the microscope.

If you know the norm of red blood cells in the urine, you can draw a conclusion about the state of the child’s body. Causes of elevated red blood cells

All reasons for the detection of hematuria in a urine test are divided into two main groups - those caused by diseases of the excretory system and those caused by diseases of other organs.

Kidney and urinary tract diseases

Red blood cells can enter the urine when:

• Glomerulonephritis;
• Urolithiasis;
• Urethritis;
• Pyelonephritis;
• Cystitis;
• Tumor processes;
• Injuries to the organs of the excretory system;
• Kidney tuberculosis.

An increased number of red blood cells in urine can be caused by serious health problems, so additional examinations should be carried out. Other diseases

With general intoxication, blood cells may be excreted in the urine in greater quantities than normal. This condition is called reactive hematuria. It can be when:

• Purulent diseases of bones and soft tissues.
• ARVI and influenza.
• Meningitis.
• Typhoid fever.
• Intestinal infections caused by bacteria.
• Sepsis.

The short-term appearance of red blood cells in children's urine can be caused by significant physical activity, stress, or poor diet. In teenage girls, blood may get into the urine during menstruation.

In infants

In the first week of a baby’s life, up to 7 red blood cells can be detected in his urine, since their number in the fetal blood is increased during intrauterine development, and immediately after birth they rapidly disintegrate.

In addition, hematuria in infants may appear as a consequence of colds or phimosis in boys.

In the first days of life, an increased level of red blood cells in the urine may be a variant of the norm. What should you do if the level is elevated?

If there is a slight increase in the number of red blood cells, a repeat test is required. This situation may indicate:

• Incorrect analysis collection.
• Short-term exposure to factors such as stress, physical activity, and dietary changes.
• The hidden course of diseases of the kidneys or the ways in which urine is excreted from the body.
• Sluggish inflammatory diseases of other organs.

If more than 5 red blood cells are detected in a general urine test, the child will be prescribed a biochemical and clinical blood test, additional urine tests (Kakovsky-Addis test, Nechiporenko test), ultrasound examination, and specialist consultations.

What is the treatment?

Having discovered a large number of red blood cells in a child's urine, it is important to determine what disease is causing it in order to begin the correct treatment. If a child is diagnosed with kidney disease, he may be prescribed a special diet, anti-inflammatory drugs, antibiotics and other medications. For urinary tract inflammation, treatment will also include taking antibiotics and medications that reduce inflammation.

In any case, any medications should be prescribed to the child by a doctor. This even applies to folk remedies.

To make an accurate diagnosis, it is necessary to undergo additional tests False hematuria

This is the name for a condition when the appearance of urine suggests hematuria, but in the analysis there are no red blood cells in the sample. The reason why urine turns red in this situation is pigments that can enter the child’s body with medications or food. For example, a baby may have reddish urine after taking vitamin B12, aspirin, phenolphthalein, or sulfonamide drugs.

For more information about the presence of red blood cells in the blood, watch the video of the Russian Union of Pediatricians.

Hematuria in young children is a dangerous symptom indicating a malfunction of the urinary system, internal bleeding or poor blood clotting. In a normal state of health, there are no red blood cells in the child’s urine or they are contained in small quantities. Therefore, if the color and composition of urine changes, you should quickly show the baby to the doctor for a comprehensive examination.

The need for examination

In order not to miss any congenital pathologies, it is necessary to undergo routine blood and urine tests. But in addition to these periodic studies, it is important to monitor the baby’s condition. Thus, a urine test must be taken if there are complaints of pain in the lower back or lower abdomen, frequent urination, which may be accompanied by unpleasant sensations. You should also take a referral for an examination if the child is not worried, but the urine is colored red. This, of course, may be false hematuria, but we cannot exclude the possibility that the child has increased red blood cells in the urine.

If the described problems began at night, then it is better to collect urine and take it to the laboratory. A referral from a pediatrician can be taken immediately at the clinic. This will allow you to identify emerging problems in a timely manner.

Collection of material

In a number of cases, situations arise when, despite a generally normal state of health, a urine test turns out to be quite bad. This is possible due to improper collection of this biological material.

Thus, the first morning urine, which is the most concentrated, is optimal for analysis. In addition, the child must be rested to eliminate the possibility of the so-called “marching test”, which will reveal increased red blood cells in the urine. They are elevated in children after physical activity much more often than in adults.

It is necessary to pay very close attention to the hygiene of the genital organs of both boys and girls. It is advisable to collect a medium portion of urine by placing the jar during urination.

Necessary diagnostics

It is important to understand that a general analysis can only show that there are increased red blood cells in the urine. What this means can only be figured out after a full examination and identification of the reasons for the onset of hematuria.

So, if unchanged red blood cells are visible in the urine, then most likely the problems lie in the urinary organs or tract. The cause may be cystitis, the passage of stones. In men, this may indicate a prostate tumor. If the changed red blood cells in the urine are elevated, this indicates possible kidney damage.

The so-called three-glass test method helps to identify the exact cause. Its essence is to collect the secreted liquid into three different containers during one urination. If there are increased red blood cells in the urine in the first portion, then there is a problem with the urethra. If the number of red blood cells is increased in the last container, then the bladder is damaged.

Problems with the kidneys or ureters will be indicated by the fact that all three portions show increased red blood cells in the urine. What this means can be determined with further research. Only after obtaining information about the state of red blood cells, their quantity, the presence of leukocytes, renal epithelium, bacteria, cylindrical bodies is it possible to make an accurate diagnosis.