Algorithm for gross or symptomatic microscopic hematuria in children

U/A: urinalysis; RBC: red blood cell; BUN: blood urea nitrogen; Cr: creatinine; CBC: complete blood count; C3: complement component 3; C4: complement component 4.
* Manifestations such as proteinuria, red blood cell casts, edema, and hypertension suggest a glomerular source for the hematuria. The evaluation includes serum creatinine, complete blood count, C3, C4, and serum albumin. Other tests to consider based upon the history and the physical examination include antistreptolysin (ASO) titer and/or streptozyme testing to detect poststreptococcal glomerulonephritis, and antinuclear antibody testing to detect lupus nephritis. Such patients should be referred to a pediatric nephrologist (or a clinician with expertise in the care of children with renal disease).