Elevated red blood cells in the urine of a child: what does it mean?

A standard test for diagnosing any disease is a urine test. Let's look at one of its indicators - red blood cells. Their norm, types, reasons for increase.

Urine is a biological fluid produced by the kidneys during the filtration of plasma and blood. With urine, all unnecessary substances are removed from the body, the study of which allows the doctor to make the correct diagnosis and prescribe treatment.

A general or clinical urine analysis is a mandatory diagnostic procedure. It can be used to identify diabetes mellitus, cholelithiasis, renal failure, jaundice, inflammatory and infectious processes, and signs of neoplasms. [ 1 ]

When deciphering urine analysis in children, the following indicators are considered:

• Transparency – normally the fluid is transparent. Cloudy urine is a sign of infectious or metabolic disorders in the body. This is observed when a large amount of salt accumulates.
• Color - in babies under one year old, urine may be colorless, then it becomes straw-yellow and amber. The color changes when taking medications, various diseases of internal organs, eating coloring foods. If the urine is dark, this indicates problems with the kidneys and biliary system. Too pale urine may be a sign of endocrine pathologies, for example, diabetes.
• Acidity - normally pH 5-7. In lactating infants, urine is slightly acidic. Alkaline fluid indicates dehydration, and acidic fluid indicates diabetes. Deviations towards an increase are characteristic of chronic renal failure, tumors of the genitourinary system. Reduced values are observed in diabetes mellitus, diarrhea, tuberculosis, dehydration. Acidity also depends on the time of collection of biological material.
• Smell – normally, children's urine does not have a strong smell. It intensifies when meat and protein foods appear in the diet. An ammonia smell is a sign of inflammation, and a rotting smell is a sign of increased ketone body levels.
• Foaminess – normally urine does not foam. Abundant and long-lasting foam is a normal indicator only for infants. In the first days of life, a newborn's urine contains a large amount of protein, which explains its foaminess. In older children, the cause of foam is a lack of fluid in the body. If foam is not associated with a lack of water and age-related characteristics of the body, then this may be a symptom of allergies, stress, hypothermia.
• Specific gravity - for children under two years of age, the norm is from 1.002 to 1.004. If the specific gravity is lower, this indicates problems with the kidneys, which do not fully concentrate urine. Density decreases with copious drinking and consumption of large amounts of plant foods. An increase in density is a signal of dehydration, consumption of large amounts of fatty, meaty foods.
• Leukocytes - the norm for children is up to 3 units, exceeding the norm is possible with cystitis or pyelonephritis. Increased values 5-7 in boys and 8-10 in girls are a sign of inflammatory processes.
• Epithelium - normally 0-5 cells of flat or transitional epithelium can be detected. Their values increase in case of pathologies of the urinary tract, urethra, ureters, urine stagnation. Another possible reason for the indicator being above the norm is a violation of personal hygiene rules.
• Protein – normally, kidneys do not pass large protein molecules, so this indicator should not be present in the analysis. The maximum permissible value is 0.036 g/l. In newborns and children who are just starting to walk, this indicator can be up to 5 g/l. In this case, the violation of the norm is orthostatic proteinuria and develops due to increased physical activity.
• Glucose – normally absent, the permissible value is 0.8 mmol/l. The only exception is newborns. Glucose in older children requires additional diagnostics, as it can be a sign of digestive disorders, diabetes, pancreatitis and other pathologies.
• Ketone bodies are normally absent. They appear in cases of anemia, diabetes, dehydration, and starvation. Ketone bodies in children occur due to improper nutrition, when there are no carbohydrates in the child’s diet.
• Salts and bacteria are normally absent. If salts are found, this is a sign of an unbalanced diet of the child or increased physical activity. The appearance of bacteria is typical for bacterial infections, inflammatory lesions of the urinary system.
• Erythrocytes are human blood cells (red blood cells) that transport oxygen from the lungs to all organs and tissues. Normally, there are 2-3 of them in the field of vision. Increased values are observed during physical exertion. Higher values are a sign of hematuria.

Red blood cells (BLD) are the most numerous cellular component of blood. They contain hemoglobin, which binds oxygen in the lungs and carries it to the tissues. Red blood cells are responsible for the normal supply of oxygen to the tissues.

Red blood cells are produced by the bone marrow. Their lifespan is 120 days. Every second, the body loses more than 3 million red blood cells, so their production never stops. According to statistics, red blood cells are transfused much more often than other blood components. Transfusions are required for heavy blood loss, operations, and to replace the blood composition of infants with anemia. [ 2 ]

What does increased red blood cells in urine mean?

Increased content of red blood cells in urine is hematuria. Normally, they are not detected during a general analysis or the detected quantity is no more than 1-2 elements in the field of view.

Erythrocytes are highly specialized anuclear blood cells. They have the shape of a biconvex disc. Due to this shape, their surface is increased for gas diffusion and plasticity increases.

The main functions of red blood cells:

• Transfer of oxygen from the lungs to the tissues and from the tissues to the lungs.
• Transfer of amino acids on its surface.
• Regulation of blood viscosity.
• Transport of fluid from tissues to the lungs.

If a child's test shows elevated levels of red blood cells, this may be due to the following factors:

• Pathologies of the genitourinary system.
• Pneumonia.
• Kidney disease.
• Disorders of the gastrointestinal tract.
• Tuberculosis.
• Increased physical activity.

The detected erythrocytes are divided into two groups: fresh (unchanged) and leached (changed). The latter arise from prolonged exposure to an acidic environment and do not contain hemoglobin. They are most often diagnosed in urine with high and low relative density. Unchanged blood cells contain hemoglobin and are found in neutral, slightly acidic or alkaline biological fluid. [ 3 ]

What does it mean if there are red blood cells in a child's urine?

The presence of BLD in the urine test indicates the development of hematuria. In the glomerular apparatus of the kidneys, blood is filtered. The cellular components remain, and the liquid undergoes further processing. As soon as the concentration of urine reaches the required level, it is excreted.

The main routes of urine excretion are:

• Renal pelvis.
• Ureters.
• Urethra.
• Bladder.

The opening of the renal filter is about 8 nanometers, and the diameter of a mature red blood cell is several times larger. Based on this, red blood cells can penetrate into the bladder when the opening of the filter in the renal tissue is widened or when the size of the blood elements is reduced.

In true hematuria, red blood cells appear from the affected tissues of the renal pelvis, ureters, genitals, or bladder. In false hematuria, only blood impurities penetrate into normal urine. That is, red blood cells can appear in the fluid at the time of blood filtration or at any stage of its excretion.

If red blood cells are detected in the urine sediment of a child, the general condition of the patient is assessed. The doctor asks about complaints of pain during urination, in the lower abdomen or in the lower back. Particular attention is paid to the frequency of urges to go to the toilet, a change in the excreted fluid to a brown color and other pathological symptoms. [ 4 ]

The norm of red blood cells in the urine of a child

If 2-4 red blood cells are found in a child's urine test, this is normal. The lifespan of a BLD cell is 120 days. The formation of new blood cells occurs constantly, so altered cells can appear not only once every 120 days, but much more often. All other indicators are not included in the concept of normal. If the number of red blood cells in the field of view is more than 4, then it is necessary to establish the reasons for their massive death.

The normal level of red blood cells in a child's urine depends on the method of studying the biological fluid:

1. Urine microscopy - less than 3 cells per field of view.
2. Kakovsky-Addis method – less than 1 million in 24 urine.
3. Amburger test - less than 150 in minute volume.
4. Nechiporenko’s method – less than 1000 per ml.

Hematuria in pediatric patients can be of varying severity. The degree of bleeding is determined by the sediment of centrifuged urine in the analysis:

• Microhematuria – 3-15 cells, no visual changes in urine.
• Average – 15-40, no visual changes.
• Macrohematuria – 40-100, the fluid is reddish, cloudy.

The Nechiporenko method is considered the most informative for determining the number of red blood cells. The analysis uses an average portion of urine (10 ml), collected in the morning after sleep and sent to the laboratory within an hour after collection. [ 5 ]

If the number of red blood cells is more than 4, this indicates hematuria, i.e. bleeding in the urinary system. A similar condition is observed with urethritis, cystitis, trauma and tumor lesions of the kidneys, urolithiasis, nephritis.

The main reasons for an increase in red blood cells in a child’s urine:

• Infectious lesions of the genitourinary system.
• Tumors of the genitourinary system.
• Kidney injuries.
• High blood pressure.
• Intoxication of the body.
• Glomerulonephritis, pyelonephritis.

The normal values are the same for both boys and girls. In adolescence, menstrual blood may be included in the analysis for girls, so the test is not performed during menstruation. The reference values for red blood cells in urine do not change as the child grows older.

Single red blood cells in the urine of a child

If single blood cells are detected in a clinical analysis of a child's urine, this is normal. Over 3 million formed elements of red blood are excreted with urine per day, which precipitate. In a laboratory analysis, 1-3 erythrocytes or traces of them are normally detected.

Particular attention is paid to the type of cells detected. These are altered, i.e. deprived of hemoglobin, leached or unchanged red blood cells. The latter contain hemoglobin and can be caused by various lesions of the urinary tract.

If traces of red blood cells are detected, this indicates normal functioning of the kidneys and urinary system, the absence of internal bleeding and other pathologies that require a comprehensive examination of the body.

Red blood cells are red blood cells that deliver oxygen from the lungs to the tissues. Theoretically, they should not be present in the fluid excreted by the kidneys, but in practice, a small number of cells are present in the urine. This is due to the fact that some red blood cells pass through the kidney barrier or through the walls of blood vessels.

If a clinical urine test reveals 1,2,3,4 or 5 red blood cells in a child, this is normal. If the number of red blood cells is much higher, this is a reason for a comprehensive examination of the body.

In most cases, hematuria indicates inflammation, infections and other pathological processes in the body. If the test results are poor, a retake is indicated, as there may have been violations during fluid collection. [ 6 ]

Causes red blood cells in a baby's urine.

According to the research conducted, there are two types of reasons for the appearance of an increased number of red blood cells in the urine of a child and an adult.

1. Reactive conditions – cause general intoxication of the body and dilation of the renal filter openings.

• Viral infections with elevated body temperature.
• Meningitis.
• Severe forms of intestinal infections.
• Intoxication in sepsis.

This group includes march hematuria, i.e. a large number of red blood cells due to increased physical activity. In most cases, the condition normalizes within 24 hours. [ 7 ]

2. Diseases of the urinary and urinary tract.

• Urolithiasis - blood gets into the urine in one of the areas of the urethra.
• Inflammation of the bladder (cystitis).
• Glomerulonephritis is a lesion of the renal glomeruli. Not only red blood cells but also cylinders with blood proteins are detected in the urine.
• Urethritis is a lesion of the mucous membrane of the urethra.
• Pyelonephritis is an expansion of the filtration pores due to edema of an inflammatory nature. Leukocytes are detected in the urine.

The painful condition can be caused by injuries to the kidneys or bladder, and in rare cases, by cancer.

Another possible cause of the disorder is false hematuria. False hematuria is detected when the erythrocytes are not full-fledged red blood cells. That is, false hematuria does not relate to pathologies of the kidneys or the body as a whole. In this case, fragmented spots of coloring pigments fall into the field of view of the laboratory technician. This is observed after the use of coloring products or medications. [ 8 ]

Red blood cells in urine in a child with allergies

One of the reasons for the increased level of red blood cells, white blood cells and other formed elements of the blood in the urine is allergic reactions or intoxication of the body. [ 9 ]

• Allergy is an acute reaction of the body to the action of certain substances. Most often, BLD increases with food allergies. About 2-3% of adults and more than 6-8% of children under 6 years of age face this problem.
• The mechanism for increasing the level of red and white blood cells is related to the immune response to allergens. Blood cells produce immunoglobulins that interact with food proteins. As a result, a reaction occurs that is similar to the body's response to pathogens, but mistakenly directed at proteins in certain foods.
• When an allergen enters the body over a long period of time, immunoglobulins G react. This manifests itself in external symptoms of the disorder: itchy skin, rash, flatulence.

For a more detailed diagnosis of the disease state, in addition to a clinical urine analysis, a general blood test, determination of the amount of immunoglobulins, elimination and provocative tests are indicated. [ 10 ]

Increased red blood cells in urine in a child

If a child's general urine analysis reveals an increased number of red blood cells, this condition is called hematuria. With a large number of red blood cells, urine is red or brown. This condition occurs in the following situations:

• Diseases of the genitourinary system.
• Kidney pathologies.
• Inflammatory and infectious processes in the body.
• Disorders of the gastrointestinal tract.
• Intoxication of the body.
• Tumor neoplasms.

Hematuria develops due to a decrease in the number of platelets or a decrease in the activity of other blood clotting factors. Such changes affect the walls of blood vessels, increasing their permeability to red blood cells.

Infectious and inflammatory diseases in the body also lead to increased permeability of capillaries. If the pathological process occurs in the bladder, then the blood cells have a normal shape. In case of pathology in the kidneys, the blood cells are changed.

Trauma, damage and stretching of the kidney cause an active increase in red blood cells in the urine. Similar is observed with urates/oxalates in the renal pelvis. In this case, blood gets into the urine due to mechanical damage to the mucous membranes. In the case of a tumor process, pressure from the neoplasm on the surrounding vessels occurs, which entails a change and thinning of their walls. [ 11 ]

Altered red blood cells in the urine of a child

The appearance of red blood cells depends on the pH of urine. In a slightly acidic and slightly alkaline environment, the cells retain their appearance for a long time, and in an acidic environment, they lose hemoglobin, that is, they are leached.

Altered red blood cells in the urine of a child are characteristic of renal failure. In addition to hematuria, the analysis reveals an elevated protein level. Leached red blood cells differ from normal ones in their size, shape and hemoglobin content.

For a more detailed study of blood cells, a phase-contrast microscope analysis is performed. It allows one to examine altered erythrocytes with cell wall outgrowths (acanthocytes). Their appearance indicates a violation of glomerular filtration.

Unchanged red blood cells in the urine of a child

Single unchanged red blood cells in the urine may be caused by renal or extrarenal causes. The former appear when the mucous membranes of the urinary tract are damaged by salt crystals, as well as when the genitals are damaged.

Fresh red blood cells in the urine of a child indicate that the parameters of the cells remain the same (they do not lose hemoglobin). Unchanged blood cells can occur with the following factors:

• Injuries to the kidneys, urethra, bladder.
• Blood clotting disorder.
• Compression of the renal vein.
• High blood pressure.
• Intoxication of the body.
• Neoplasms in the kidneys, ureters, and bladder.

Fresh blood cells enter the biological fluid excreted by the kidneys from damaged blood vessels or from internal bleeding that has opened. In any case, even a slight presence of unchanged red blood cells in the urine requires further diagnostics. For these purposes, ultrasound of the genitourinary system, MRI, X-ray and a range of other studies are performed. [ 12 ]

Dysmorphic red blood cells in urine in a child

Dysmorphic red blood cells are found in urine when the permeability of the renal filter increases and the filtration process is disrupted. Dysmorphic red blood cells are not detected under normal conditions, so they should be absent from the child's analysis. [ 13 ]

The leached cells lose their hemoglobin, shape and structure, and are accompanied by an increased level of protein. The presence of such red blood cells most often indicates disorders of the genitourinary system.

The diseased condition is typical for chronic and acute inflammatory and infectious processes in the body. To establish the true cause of the deviation, a comprehensive examination of the body is carried out: ultrasound of the genitourinary system, CT, MRI, blood tests. [ 14 ]

Protein and red blood cells in the urine of a child

Protein is found in all organs and tissues, as it is necessary for normal growth and development of the body. The presence of protein in the urine is most often associated with poor kidney function, but in some cases it is normal.

The norm for protein in urine (portion, mg/l) in a child depends on his age:

• Premature babies up to 4 weeks – 90-84 mg/l.
• Full-term infants up to 4 weeks – 95-456 mg/l.
• Up to 12 months – 71-310 mg/l.
• Children 2-4 years old – 46-218 mg/l.
• Children 4-10 years old – 51-224 mg/l.
• Children under 16 years of age – 45-391 mg/l.

As the baby grows, the protein level in the urine decreases, and the daily excretion rate increases. The following main reasons for the increase in the level of red blood cells and protein (proteinuria) in the urine analysis of children of different ages are distinguished:

1. Newborns – for 85-90% of babies, a temporary increase in these values is normal. Infants have increased permeability of the glomerular epithelium and tubules. This is due to the fact that the body is just beginning to adapt to new living conditions. But already 1-2 weeks after birth, the amount of protein and red blood cells returns to normal. [ 15 ]

Pathological causes of bad test results:

• Hypothermia or dehydration.
• Fright or prolonged crying.
• Subfebrile/febrile body temperature.
• Prolonged exposure to sunlight.
• Burns.
• Allergic reactions to breast milk.

Minor deviations from the norm occur in children in the first months of breastfeeding. In such cases, the product of the excretory system of the body becomes cloudy. Pathological increase in protein and erythrocytes is observed in children who have a family history of urolithiasis, pyelonephritis, glomerulonephritis. [ 16 ]

2. Children aged 1-3 years – even before taking tests, you can notice the presence of deviations. With an elevated protein level, a child often has swelling of the eyelids and lower extremities. Hematuria is manifested by increased pallor of the skin, subfebrile body temperature, anxiety when urinating.

Reasons for violation:

• Condition after physical activity.
• Allergic reactions.
• Nervous tension, stress.
• Hypothermia.
• Dehydration.
• Long-term use of certain groups of drugs.

If traces of protein are found in urine, this is most often due to increased physical activity, overwork. In most cases, the traces are transient (passing) and do not cause concern when deciphering the test results.

In older children, protein in the urine against the background of increased red blood cells may indicate the following diseases: pyelonephritis, blood diseases, hypertension, urolithiasis, kidney injuries/bruises, glomerulonephritis, hypervitaminosis D, endocrine pathologies, malignant neoplasms of the kidneys or other internal organs, inflammatory processes.

In order to determine what caused the poor test results, a comprehensive examination of the body is carried out. In this case, it is not the elevated protein and red blood cells that are treated, but the disorder that caused the deviations from the norm. [ 17 ]

Protein, red blood cells and white blood cells in the urine of a child

Leukocytes are always determined in urine analysis. Their norm for children is 0-6 in the field of vision, red blood cells and protein have similar characteristics. If these indicators exceed the permissible values, this can be caused by various disorders and pathologies of the body:

• Diseases of the urinary tract.
• Kidney pathologies and injuries.
• Cystitis.
• Urethritis
• Pyelonephritis.
• Urolithiasis.
• Infections, inflammation of the external genitalia.
• Dermatitis and allergic reactions.

Most often, increased protein, red blood cells and white blood cells in the urine of a child appear against the background of an inflammatory process. That is why counting white blood cells in the urinary sediment is an effective method for diagnosing urinary infections. An excessively large number of white blood cells or pyuria is pus in the urine. [ 18 ]

Very often, elevated leukocytes and other indicators are associated with improper collection of material for research. This is observed with insufficient hygiene of the genitals or a non-sterile container for collecting fluid. To exclude errors and false results, a repeat analysis is carried out. [ 19 ]

If the main indicators exceed the norm during a repeated examination, then additional diagnostics of the body are prescribed: ultrasound of the kidneys and bladder, MRI, CT, cystoscopy. Based on the results of the examination, the doctor makes a treatment plan for the child. [ 20 ]

Temperature and red blood cells in urine in a child

Another common cause of abnormal BLD levels in urine analysis is elevated body temperature. It acts as a kind of irritant that affects all organs and structures.

The main reasons for elevated temperature and red blood cells in the urine of a child:

• Overheat.
• Teething.
• Urinary tract infections.
• ARVI.
• Allergic reactions.
• Reactions to vaccination.
• Kidney dysfunction.

Hematuria and hyperthermia are observed in acute viral infections. For example, if a child has the flu or has recently had an acute respiratory viral infection, this will be reflected in the results of his tests.

There are also other conditions that provoke an increase in the number of red blood cells against the background of hyperthermia. There are bacterial infections (typhoid fever, intestinal infection) that affect the growth of red blood cells. This is observed in hemophilia, intoxication, thrombocytopenia.

Red blood cells and mucus in the urine of a child

Mucus is produced in the goblet cells of the urethra mucosa. Its main function is to protect the urinary tract from urine components, urea. It also protects the urinary system from infectious agents. If too much mucus is produced, the urine becomes cloudy and may contain mucus particles or sediment. [ 21 ]

Normally, the amount of mucus excreted in urine is quite small. If the increased level occurs against the background of high red blood cells, then this may be due to the following reasons:

• Inflammatory infectious diseases (cystitis, urethritis, etc.).
• Vulvaginitis caused by pathogenic flora.
• Dysmetabolic disorders of kidney function.
• Phimosis in boys.
• Glomerulonephritis and pyelonephritis.

If, in addition to increased mucus and erythrocytes, a large number of leukocytes and epithelium are detected in the analysis, then this is a clear sign of inflammation of the urinary system. In acute inflammation, bacteria can be detected. A large amount of salts and mucus are laboratory symptoms of dysmetabolic nephropathy. The presence of protein indicates kidney disease. [ 22 ]

But most often, the presence of mucus indicates improper collection of a biological fluid sample. This is possible if the container for collecting urine is not sterile, the child's intimate hygiene is violated, or certain medications are taken. If other pathological symptoms are observed against the background of poor analysis, a comprehensive examination of the body is required.

Salts and red blood cells in the urine of a child

Increased amounts of salt in urine analysis are quite common. In most cases, this is due to excessive consumption of certain foods (legumes, salted fish, chocolate, coffee, cocoa, citrus fruits, dairy and smoked products, strong tea).

If salts appear against the background of high red blood cells, then most often this indicates kidney disease, cystitis, urolithiasis. [ 23 ]

The type of salt compounds depends on the level of acidity of urine. In an acidic environment, the following salts are formed:

• Oxalates - increase with a large amount of oxalic acid in the child's body. Also, possible causes of deviation include severe kidney diseases, the presence of kidney stones.
• Phosphates - if there are more than the norm, then this is a sign of excess phosphorus-containing products in the diet (dairy, legumes, greens, carrots, spicy and hot dishes). More serious causes include infections in the genitourinary tract, dysfunction of the digestive tract or intestines, rickets.
• Urate - this type of salt is extremely rare, but in combination with elevated blood cells indicates such pathologies as: urolithiasis, impaired renal function, intestinal diseases. The disease is manifested by a decrease in the child's body weight against the background of loss of appetite, abdominal pain, a change in the color of urine to brick red.

The first thing to do with elevated levels of salts in the analysis is to change your diet. Particular attention should be paid to maintaining water balance. If poor analysis results are accompanied by pathological symptoms, then a comprehensive examination of the body is required to establish the root cause of the disorders.

Hemoglobin and red blood cells in the urine of a child

The presence of hemoglobin in urine is called hemoglobinuria. This condition has several mechanisms of development:

1. Red blood cells enter the urine and are destroyed, releasing hemoglobin (hemolyzed). Due to the high pH and low osmolality of urine, the formed elements of the blood are quickly leached.
2. Red blood cells enter the biological fluid through the renal filter. True hemoglobinuria is associated with intravascular hemolysis of erythrocytes.

Normally, blood protein is not detected in urine, i.e. its amount should be zero. Acceptable values are 1-5 red blood cells in the field of view. If the values are from 10 to 25, then this is a sign of bleeding in the urinary organs. With moderate hemoglobinuria 25-50 in the field of view, muscle pathologies can be observed. High hemoglobin values - more than 50, are associated with an increase in the protein myoglobin. Its increase is caused by infectious processes in the body. [ 24 ]

Unlike hematuria, in hemoglobinuria, red blood cells are not found in the urine sediment. The main reasons for the presence of hemoglobin and red blood cells in the urine of a child include:

• Bleeding in the urinary system.
• Inflammatory processes and neoplasms in the excretory organs.
• Hemolytic anemia due to intoxication of the body, allergic reactions, injuries, burns, infections.
• Transfusion of incompatible donor blood.
• Increased production of hemoglobin, due to which it does not have time to bind with haptoglobin and can penetrate through the kidney filter into the urine.
• Severe infectious diseases (tonsillitis, scarlet fever, malaria, typhoid fever).

In some cases, signs of hemoglobinuria are visible even without a urine test. The fluid secreted by the kidneys changes its color from pink to the color of meat slops. The child may complain of back pain, increased body temperature, aches and pains in the joints and muscles, and general malaise. The skin becomes pale or has a yellow tint.

To determine the causes of the disorder, an ultrasound of the kidneys and urinary tract is performed. If there is a suspicion of injury to the excretory organs, then an X-ray is indicated. In particularly severe cases, a bone marrow biopsy is performed. Treatment methods for hemoglobinuria directly depend on the etiology of the disorder. [ 25 ]

Treatment red blood cells in a baby's urine.

Only a laboratory test (microhematuria) can show that the urine has an increased number of red blood cells. To obtain more detailed results, an additional analysis of several samples is prescribed. The material is placed in three different containers and examined under a microscope:

• If the number of blood cells in all the test tubes is the same, this indicates blood from the kidneys.
• If BLD is detected only in the first test tube, then this is a sign of pathologies on the part of the bladder.
• Increased red blood cells in the third container indicate diseases of the urinary system.

Further actions are aimed at a comprehensive examination of the body, collecting anamnesis and studying the existing symptoms. What to do if red blood cells are found in the child's urine? The doctor asks about changes in the diet in the last week, the presence of injuries, taking medications, stress, overwork. This allows us to determine whether the increased BLD is caused by a physiological reason or pathological factors. [ 26 ]

If the increase in red blood cells is caused by kidney disease, the patient is given the following recommendations:

• Diet food.
• Taking medications (anti-inflammatory, antibiotics, diuretics).
• Reducing the amount of liquid consumed during the day.

For diseases of the urinary tract, the patient is prescribed:

• Antibacterial drugs.
• Special diet with minimal salt.
• Antimicrobial installations.

In any case, it is necessary to take a repeat test after 20-30 days.

In some cases, poor test results are due to improper preparation of the child for the test. To ensure that the test is as reliable as possible, vegetables, fruits, and other foods that change the color of urine should be excluded from the diet a couple of days before the test. Urine is collected in a sterile container or urine bag (used for infants). Before collecting the fluid, the child must be washed well. It is better to submit morning urine for analysis, skipping the first portion. If evening urine is collected, the container with the liquid should be stored in the refrigerator so that its main indicators do not change. [ 27 ]

There are several methods of urine testing and certain rules for collecting it:

1. For the Nechiporenko analysis, you need an average portion of morning urine. It can be stored for no more than 1.5 hours.
2. According to Zimnitsky, the fluid is collected in 8 containers every three hours during the day. If it is not possible to collect urine during the specified period of time, the container remains empty. The fluid is stored in the refrigerator.
3. For the Sulkovich test, morning urine is collected on an empty stomach. The fluid must be submitted for analysis within 2 hours of collection.
4. For the Roberg analysis, you need to go to the toilet immediately after waking up, completely emptying your bladder. All the liquid from the morning toilet is collected in a container. Before submitting, the urine is mixed and 50 ml is measured out. The liquid is stored in the refrigerator.

Red blood cells in a child's urine may occur against the background of an increase in other indicators. An increased number of red blood cells is a reason for a repeated analysis and a detailed examination of the baby's body.