Isolated asymptomatic macroscopic hematuria is usually due to benign processes such as hypercalcuria and IgA nephropathy [4,19,24-26]. Imaging has a role to exclude nephrolithiasis, underlying urologic abnormalities, and rarely renal or bladder tumors. Voiding Urosonography While voiding urosonography is usually not indicated in the evaluation of isolated macroscopic hematuria, and there is a paucity of literature to support its use, it is likely that voiding urosonography also can be used to assess for causes of hematuria that may be detected by VCUG. CT CT is generally not indicated as a first-line test for isolated macroscopic hematuria. However, contrast-enhanced CT has a role in evaluation of renal mass diagnosed by US, and it may be considered in children with recurrent macroscopic hematuria with negative US and extensive clinical workup in the rare setting of suspected left renal vein obstruction (ie, nutcracker syndrome) [33]. Unenhanced CT may also be used to evaluate for suspected asymptomatic nephrolithiasis as a cause of hematuria in the setting of a negative US. IVU Because the incidence of upper urinary tract urothelial neoplasia is extremely rare in children, IVU is not indicated in the initial evaluation of isolated macroscopic hematuria [14,34]. MRI MR is generally not indicated as the first-line test for isolated macroscopic hematuria. In the cases of suspected renal mass or nutcracker syndrome, MRI may be of value for further diagnosis [25,27-29,33,35-41]. Arteriography/Venography Arteriography and venography have no role in the initial evaluation of isolated macroscopic hematuria. Radiography Radiography (KUB) is generally not appropriate in the initial evaluation of isolated nonpainful, nontraumatic isolated macroscopic hematuria. Radiography may have a limited role for detecting suspected asymptomatic nephrolithiasis as a cause of hematuria. Variant 4: Child. Painful hematuria (nontraumatic). Suspected urolithiasis. Initial imaging.
Hematuria Child. Isolated asymptomatic macroscopic hematuria is usually due to benign processes such as hypercalcuria and IgA nephropathy [4,19,24-26]. Imaging has a role to exclude nephrolithiasis, underlying urologic abnormalities, and rarely renal or bladder tumors. Voiding Urosonography While voiding urosonography is usually not indicated in the evaluation of isolated macroscopic hematuria, and there is a paucity of literature to support its use, it is likely that voiding urosonography also can be used to assess for causes of hematuria that may be detected by VCUG. CT CT is generally not indicated as a first-line test for isolated macroscopic hematuria. However, contrast-enhanced CT has a role in evaluation of renal mass diagnosed by US, and it may be considered in children with recurrent macroscopic hematuria with negative US and extensive clinical workup in the rare setting of suspected left renal vein obstruction (ie, nutcracker syndrome) [33]. Unenhanced CT may also be used to evaluate for suspected asymptomatic nephrolithiasis as a cause of hematuria in the setting of a negative US. IVU Because the incidence of upper urinary tract urothelial neoplasia is extremely rare in children, IVU is not indicated in the initial evaluation of isolated macroscopic hematuria [14,34]. MRI MR is generally not indicated as the first-line test for isolated macroscopic hematuria. In the cases of suspected renal mass or nutcracker syndrome, MRI may be of value for further diagnosis [25,27-29,33,35-41]. Arteriography/Venography Arteriography and venography have no role in the initial evaluation of isolated macroscopic hematuria. Radiography Radiography (KUB) is generally not appropriate in the initial evaluation of isolated nonpainful, nontraumatic isolated macroscopic hematuria. Radiography may have a limited role for detecting suspected asymptomatic nephrolithiasis as a cause of hematuria. Variant 4: Child. Painful hematuria (nontraumatic). Suspected urolithiasis. Initial imaging.