Asymptomatic (isolated) hematuria generally does not require treatment. In conditions associated with abnormal clinical, laboratory, or imaging studies, treatment may be necessary, as appropriate, with the primary diagnosis.
Surgical intervention may be necessary in certain anatomical abnormalities, such as ureteropelvic junction obstruction, tumor, or significant urolithiasis.
Consultations are required in patients with urinary tract anomalies and in some patients with systemic diseases (eg, bleeding disorders, collagen vascular diseases, sickle cell nephropathy).
Dietary modification is usually not indicated except for children who may have a tendency to develop hypertension or edema as a result of their primary disease process (eg, nephritis). In these patients, a low sodium diet may be helpful. In addition, a diet containing the recommended daily amount (RDA) for calcium plus a low-salt diet may be beneficial in children with hypercalciuria and hematuria.
Activities of a child with asymptomatic, isolated hematuria should not be restricted. However, these children and their parents should be informed that strenuous exercise may aggravate hematuria. Restrictions in physical activities may be indicated in children with severe hypertension or cardiovascular disease.
Hematuria is a sign and not a disease. Therapy should be directed at the process causing hematuria.
Further Outpatient Care
Patients with persistent microscopic hematuria should be monitored at 6-month to 12-month intervals for the appearance of signs or symptoms indicative of progressive renal disease. Prominent among them are proteinuria, hypertension, and a decrease in renal function.
The prognosis of patients with asymptomatic isolated hematuria is good. The ultimate prognosis for the various conditions associated with hematuria depends on the primary medical condition that caused the hematuria in the first place.
Inform children and their parents that strenuous exercise may aggravate hematuria; however, hematuria by itself should not prevent the child from participating in sports. Despite the sometimes alarming intensity or persistence of hematuria, parents must be informed that, by itself, hematuria rarely causes anemia.