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Urology/Similar case to Maranda's son

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Question
My son is 4 yrs. 4 months and have been dropping fresh blood at the end of his pee.  Specifically seen him Sunday night, Tuesday night and tonight Thursday before bedtime.  He had 99.1, 99.2 slight fever Tuesday and yesterday morning.  Tonight at dinner time he has 99.3temp.  We took him to an urgent care clinic last Monday.  Dipstick was done and doc confirmed blood in urine and diagnosis was Hematuria.  Culture was submitted for lab tests.  Doc wanted to prescribe antibiotc but I asked if we can hold off giving my son any.  Took him to his pedia Tuesday.  Pedia called us Wednesday and said culture results were negative.  I told her about the fever and blood drops and she asked us to come in the afternoon and took another urine and blood for testing.  This morning, blood results indicated healthy kidney, and according to ped nothing abnormal from the blood results.  She is thinking its a viral infection. She did not prescribe anything and instead asked for us to come back to do anoter urine test in two weeks.  My husband finding out about this cancelled my son's appointment tomorrow  with a urologist.  I'm going ahead and rescheduling an appointment with the uro.  My son is allergic to wheat, soy, nut, milk, egg, seafood, and shelfish.  He also was diagnosed with acid reflux and currently taking Omeprazole.  In addition, his upper endoscopy 6 months ago showed esophagic hernia before the stomach.  He also has asthma symptoms and has been on a 3 month Nebulizer treatment with once per day dose of Budesonide.  What would be your advise?  Thank you very much for your time. Sincerely, Julia.

Answer
Dan,  there are many possible causes for blood in the urine (hematuria).  The origin of the bleeding can come from the upper (kidneys or ureters) or lower (bladder, prostate, urethra) urinary tract.  Blood seen only under the microscope (microscopic hematuria) is usually of a benign nature whereas gross hematuria is potentially more serious. With gross hematuria, it is important to note the relationship of the bleeding to the urinary stream.  If at the beginning of urination (initial hematuria), the source of the blood is almost always in the urinary canal (urethra).  If at the end of urination (terminal hematuria) as in your son's case, the source is usually the urethra and/or bladder neck.    Bleeding throughout the entire stream (total hematuria) is due to bleeding that is initiated in the urinary bladder or upper urinary tract (kidneys and/or ureters).  Although red discoloration of the urine is usually due to blood, it may also occur from the excretion of some pigments in the foods we eat.  The most common are from beets, rhubarb, & blackberries.  Certain medications & chronic toxicity from lead or mercury may produce red urine as well.  However, red discoloration due to pigments would be of the total (and not terminal) variety.

Some of the common causes of hematuria include infection, tumors, stones, and trauma (injury).  In order to look for the cause, it is necessary to consult a urologist.  In the case of a child, a pediatric urologist is recommended as child sometimes have unique causes of bleeding.  A history, physical examination, urine cytology, and other laboratory tests are done.  Visualization of the kidneys and bladder with ultrasound are recommended.  Other imaging studies (ie IVP,  CT or MRI) may be necessary depending on the findings on ultrasound.  Examination of the lower urinary tract with a cystoscope (under anesthesia) also may well prove necessary to determine the source of the bleeding.

In summary, your child should see a pediatric urologist in consultation.  Good luck.

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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