Hematuria: Part I: The trauma patient

Hematuria remains the hallmark of renal trauma, although its absence does not necessarily rule out renal injury. It is imperative that the physician obtain a urine sample in the case of any injury where there was trauma to the back or abdomen - no matter how mild the mechanism of the injury. Although there remains some controversy as to which children with hematuria need radiographic evaluation, there is no question that all children need a careful examination and follow-up. The following guidelines may be helpful in the evaluation of children with hematuria following blunt trauma: (1) If the child sustained minor or moderate trauma, there is no flank gain, and the urinalysis shows < 20 RBCs/hpf, careful follow-up is recommended. (2) If there have been recurrent episodes of microscopic hematuria following minor trauma, a renal ultrasound study should be obtained to rule out an underlying anatomic abnormality. (3) If the child has flank pain, hematuria ≥ 20 RBCs/hpf, microscopic hematuria and shock, or a low rib or pelvic fracture, an IVP should be obtained. A CT scan should be reserved for the child with hematuria associated with abdominal pain or if there is suspicion of an associated injury. An algorithm is shown in Figure 1.