Algorithm for gross or symptomatic microscopic hematuria in children

ASO: antistreptolysin; BUN: blood urea nitrogen; C3: complement component 3; C4: complement component 4; CBC: complete blood count; Cr: creatinine; CT: computed tomography; RBC: red blood cell.

* Manifestations such as proteinuria, RBC casts, edema, and hypertension suggest a glomerular source for the hematuria. The evaluation includes serum Cr, CBC, C3, C4, and serum albumin. Other tests to consider based on the history and physical examination include 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 kidney disease).