Question Title: blood in urine of adolescent

My 14-yr old son has had some generalised pain in the lower abdominal
area above the pelvis but below the navel. He has also had some afternoon and evening lethargy
, generalised aches and pains elsewhere, and occassional loss of appetite,
especially in the morning. He says he gets relief by lying on his stomach.
When I took him in to the Dr. 2 days ago for a regular yearly physical,
small amounts of blood (occult) were found in his urine. His urine is not dark or frothy
and he does not have edema or high blood pressure. He does not participate in
contact sports, or heavy physical labor. He has had to urinate more frequently.
These symptoms have been going on for the past 10 days or so, and have not in
capacitated him so that he cannot go to school. There is a urinalysis underway,
showing no initial bacterial population.

What are some other causes that I can research for these symptoms? Should
I still consider glomerulonephritis for a cause?

---

Dear Grant,
Your son seems to be having microscopic hematuria and suprapubic abdominal pain. Even though medical causes of hematuria are common in your son's age group, presence of suprapubic pain and increased urinary frequency suggests the lower urinary tract as a source of blood in the urine. It may be a stone, some infection or other renal or non-renal abdominal pathology. He needs further evaluation.

The main aim of evaluation is to find out if the cause of bleeding is medical or urological. Medical causes (nephrological) include glomerulonephritis, infections and other renal diseases while urological causes include stones and other congenital anomalies. It is difficult to pin point the diagnosis over the Internet but standard evaluation protocol is as follows:

Physical examination including urologic and genital examination. Blood pressure measurement. Is he febrile?
Urine examination for red blood cells, white blood cells, casts, crystals, pus cells, bacteria and protein.
Urine test for dysmorphic red blood cells
Culture and sensitivity for urinary infection if pus cells or bacteria are observed in the urine
Routine blood test and renal function test
If hematuria in associated with red blood cell casts or an inappropriate degree of proteinuria, this warrants further nephrologic workup, including C3 and ASO titers.
Intravenous pyelogram (IVP) or ultrasound scan
Some times cystoscopy and additional testing is required based on the findings of above mentioned tests

Hope I have been able to provide some useful information in response to your question.

This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.

The Henry Ford Hospital Department of Urology has experience in the evaluation and treatment of problems such as you describes. They would be most interested in helping you. You can reach them through our toll-free number (1-800-653-6568). We can also arrange local accommodations through this number if this is your need.
Sincerely,
HFHS M.D.-A.T.
*keyword: Microscopic hematuria

---