Hematuria in Children with Spinal Injury

Abstract

The presence of red blood cells (RBCs) in urine is hematuria, even in microscopic amounts alarms the patient and parents of the patient, and often prompts physician for many laboratory investigations. Hematuria can be red, dark or cola-colored, or brown known as macroscopic hematuria, and when it is not visible to the unaided eye, it is known as microscopic hematuria. RBCs in urine is one of the most important signs of genitourinary tract disease; however, it is almost never a cause of anemia, since few drops (1 mL) of blood can turn 1 L of urine into red-colored urine. Overall the physician should be alert enough not to overlook serious conditions like neoplasms and underlying bleeding disorder, to avoid unnecessary and often expensive laboratory studies. This article provides an approach to the evaluation and management of hematuria in children, and the detection of preventable and treatable conditions at the earliest to limit the disease progression, and an overall reduction in cost, energy, and anxiety. The patients are spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and elderly populations is presented separately. The target audience is healthcare providers who are engaged in the medical care of patients with spinal cord injury. The mandatory assessment includes medical history, physical examination, frequency-volume chart, urinalysis, blood chemistry, transabdominal ultrasonography, measurement of postvoid residual urine, uroflowmetry, and video-urodynamic study. Optional assessments include questionnaires on the quality of life, renal scintigraphy, and cystourethroscopy. The presence or absence of risk factors for renal damage and symptomatic urinary tract infection affects urinary management, as well as pharmacological treatments. Further treatment is recommended if the maximum conservative treatment fails to improve or prevent renal damage and symptomatic urinary tract infection. In addition, management of urinary incontinence should be considered individually in patients with risk factors for urinary incontinence and decreased quality of life. Keywords: Children; Kidneys, bladder, neurogenic, injuries, spinal cord, spinal cord disorders, ; RBC cast; Red blood cells; Urine, ASIA (American Spinal Injury Association)