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Blood in a child's urine (hematuria)

If your child's urine is red, pink or brown: is it really blood, possible causes, which tests are needed and when to seek urgent care.

Written by: Dr. Parviz Hajiyev, pediatric urologist.

Quick answers

Is it urgent?
Yes, if there is pain, fever, swelling or little urine.
Is all red urine blood?
No. Foods, medicines and crystals can also color urine.
Most common causes
Infection, stones, excess calcium, kidney inflammation.
First step
Urine test and kidney ultrasound.

Is the urine really bloody?

Red or brown urine does not always mean blood. These can also change the color:

  • foods: beets, blackberries, food dyes,
  • some medicines (for example, rifampin),
  • uric acid crystals in infants (a brick-colored stain in the diaper),
  • myoglobin after muscle injury.

That is why the first step is a urine test: it shows whether there really are red blood cells in the urine.

Types

  • Gross hematuria: blood is visible, and the urine is pink, red or brown.
  • Microscopic hematuria: the urine looks normal, and blood is found only on testing.

Possible causes

Blood coming from the urinary tract (urine is usually red, sometimes with clots):

  • urinary tract infection or hemorrhagic cystitis,
  • kidney stones or too much calcium in the urine (hypercalciuria),
  • injury, especially after a minor blow to a kidney with hydronephrosis,
  • meatal stenosis after circumcision (a drop or two of blood in the underwear),
  • urethrorrhagia: in adolescent boys, a few drops of blood at the end of urination or in the underwear, which often goes away on its own,
  • rarely, tumors and vascular anomalies.

Blood coming from the kidney’s filtering units (urine is often “cola” or tea colored):

  • post-infectious glomerulonephritis (1–3 weeks after a sore throat),
  • IgA nephropathy (1–2 days after a cold),
  • inherited kidney diseases and other nephrological causes.

Evaluation

  • urine test, repeated when needed,
  • urine culture,
  • urine protein and calcium/creatinine ratio,
  • blood pressure,
  • kidney and bladder ultrasound,
  • if the blood is suspected to come from the kidney, blood tests and a consultation with a pediatric nephrologist.

Treatment depends on the cause. In some cases, especially when there is only microscopic hematuria, no cause is found and the child is simply followed.

When to seek urgent care

If any of the following is present, do not wait for a routine appointment: call the doctor or go to the nearest emergency department.

  • Blood in the urine together with swelling of the face and legs, less urine
  • Severe flank or abdominal pain
  • Fever and pain when urinating
  • Bloody urine after a blow to the abdomen or back
  • Blood clots, being unable to urinate

Note for pediatricians and family doctors

Hematuria accompanied by edema, hypertension, proteinuria or oliguria suggests glomerular disease and requires nephrology evaluation; “cola-colored” urine and red cell casts point to a glomerular source. Macroscopic hematuria 1–2 days after an upper respiratory infection is typical of IgA nephropathy, and 1–3 weeks after, of post-streptococcal glomerulonephritis. Hematuria with an abdominal mass requires urgent ultrasound to evaluate for Wilms tumor.

What happens at the visit?

  1. Questions about urine color, whether the blood appears at the start or end of urination, pain, recent infections and injuries.
  2. Blood pressure is measured; swelling and the abdomen are examined.
  3. Urine test and, when needed, urine calcium/creatinine ratio and blood tests.
  4. Kidney and bladder ultrasound.
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Frequently asked questions

There is a pinkish-orange stain in my baby's diaper. Is it blood?

In the first days of life, a brick-colored stain in the diaper is often uric acid crystals and is harmless. It goes away with adequate feeding. In baby girls, a small amount of bloody vaginal discharge in the first week can also occur for hormonal reasons.

Microscopic blood was found on a test, but the urine looks normal. Should we worry?

A small number of red blood cells on a single test is common. The test is usually repeated a few weeks later. If it persists, it is evaluated together with protein, blood pressure and family history.

Related topics

Sources

  • Viteri B, Reid-Adam J. Hematuria and proteinuria in children. Pediatr Rev, 2018.
  • EAU Guidelines on Paediatric Urology, 2025.

This page is for education. Decisions about your child’s treatment are made together with the doctor after an examination.

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