Davis TK, Hmiel P. Pediatric Hematuria Remains a Clinical Dilemma. Clin Pediatr (Phila). 2015 Aug;54(9):817-30.
“Hematuria in the pediatric population is a common clinical dilemma for the clinician. The clinician should attempt to categorize it further into gross versus microscopic, symptomatic versus asymptomatic, and transient versus persistent. Gross hematuria if confirmed to be persistent, regardless of symptoms, almost always warrants further diagnostic testing. A standardized approach toward microscopic hematuria cannot be recommended. The differential diagnosis is too broad. Recommendations toward screening for asymptomatic hematuria have been dynamic, but currently, the AAP recommends against screening.4 Although it is never normal to have blood in the urine, isolated microscopic hematuria is rarely an indicator of significant kidney disease. Admittedly, this can be difficult to convey to skeptical patients and families, but invasive diagnostic procedures are unlikely to yield a treatable diagnosis or guide management. Reassurance is warranted. However, reassurance without periodic follow-up is no longer acceptable because long-term data have now identified an overall small but statistically significant risk of chronic kidney disease progression during long-term follow-up.”