Approach to Persistent Microscopic Hematuria in Children

Persistent isolated microscopic hematuria is relatively common in pediatric practice, affecting around 0.25% of children. Isolated microscopic hematuria can be caused by a myriad of potentially benign or serious causes including urologic issues, kidney stones, glomerular diseases including disorders of the glomerular basement membrane, hematologic abnormalities, and others. The challenge for the pediatrician or pediatric nephrologist is to distinguish between children with potentially progressive forms of kidney disease vs other causes while minimizing cost and inconvenience for the child and family. This manuscript will review the multiple potential causes of microscopic hematuria and provide a framework for the initial evaluation and monitoring of such patients.