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

The standard test for diagnosing any disease is urinalysis. Let's consider one of its indicators - erythrocytes. Their rate, types, reasons for the 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 analysis of urine is a mandatory diagnostic procedure. It can be used to detect diabetes mellitus, gallstone disease, renal failure, jaundice, inflammatory and infectious processes, signs of neoplasms. [1]

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

• Transparency - normally the liquid is transparent. Cloudy urine is a sign of infectious or metabolic disorders in the body. This is the case with the accumulation of large amounts of salt.
• Color - in babies under one year old, urine may be colorless, then it acquires a straw-yellow and amber color. The color changes when taking medications, various diseases of internal organs, using coloring products. If the urine is dark, then this indicates a violation of the kidneys and biliary system. Too pale can be a sign of endocrine pathologies, for example, diabetes mellitus.
• Acidity - normal pH 5-7. In lactating infants, urine is slightly acidic. An alkaline fluid indicates dehydration, and an acidic fluid indicates diabetes. Upward deviations are characteristic of chronic renal failure, tumors of the genitourinary system. Decreased values are observed in diabetes mellitus, diarrhea, tuberculosis, dehydration. Also, acidity depends on the time of collection of biological material. 
• Smell - Normally, baby urine does not have a strong odor. It increases when meat and protein foods appear in the diet. An ammonia odor is a sign of inflammation, and a rotting odor is a sign of an increased level of ketone bodies.
• Foaminess - normally urine does not foam. Abundant and long-lasting foam is an indicator of the norm only for babies. In the first days of life, a newborn has a large amount of protein in the urine, which explains its frothiness. In older children, foam is caused by a lack of fluid in the body. If the foam is not associated with a lack of water and age-related characteristics of the body, then this can be a symptom of allergies, stress, hypothermia.
• Specific gravity - for children under two years old, the norm is from 1.002 to 1.004. If the specific gravity is less, then this indicates problems with the kidneys, which do not completely concentrate urine. Density decreases with drinking plenty of fluids and eating a lot of plant foods. An increase in density is a signal of dehydration, eating a large amount of fatty, meaty foods.
• Leukocytes are the norm for children up to 3 units, exceeding the norm is possible with cystitis or pyelonephritis. Increased values of 5-7 in boys and 8-10 in girls are a sign of inflammatory processes.
• Epithelium - Normally 0-5 cells of squamous or transitional epithelium can be found. Their values increase with pathologies of the urinary tract, urethra, ureters, urine congestion. Another possible reason for the indicator above the norm is a violation of the rules of personal hygiene.
• Protein - normally, the kidneys do not allow large protein molecules to pass through, therefore, this indicator should not be present in the analysis. The maximum allowable value is 0.036 g / l. In newborns and children who are just starting to walk, this figure can be up to 5 g / l. In this case, the violation of the norm is orthostatic proteinuria and develops due to increased physical exertion.
• Glucose - normally it is absent, the permissible value is 0.8 mmol / l. The only exceptions are newborns. Glucose in older children requires additional diagnostics, as it can be a sign of digestive disorders, diabetes mellitus, pancreatitis and other pathologies.
• Ketone bodies - normally absent. Appear with anemia, diabetes, dehydration, starvation. Chum bodies in children arise from improper nutrition, when there are no carbohydrates in the child's diet.
• Salt and bacteria - normally absent. If salts are found, then this is a sign of an unbalanced child's diet or increased physical activity. The appearance of bacteria is characteristic of bacterial infections, inflammatory lesions of the urinary system.
• Red blood cells 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 view. Increased values are observed during physical exertion. Higher rates are a sign of hematuria.

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

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. Transfusion is required in case of profuse blood loss, operations, as well as to replace the blood composition of infants with anemia.[2]

What does an increased content of red blood cells in urine mean?

An increased content of red blood cells in urine is hematuria. Normally, in a general analysis, they are not detected or the detected amount is not more than 1-2 elements in the field of view.

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

The main functions of red blood cells:

• Transport 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 lungs.

If an increased level of red blood cells is observed in the analysis of the child, then this may be due to the following factors:

• Pathology of the genitourinary system.
• Pneumonia.
• Kidney disease.
• Violations of the digestive tract.
• Tuberculosis.
• Increased physical activity.

The detected erythrocytes are divided into two groups, fresh (unchanged) and leached (altered). The latter arise during a long stay in an acidic environment and do not contain hemoglobin. They are most often diagnosed in high and low relative gravity urine. Unaltered blood cells contain hemoglobin and are found in neutral, slightly acidic, or alkaline body fluids. [3]

What does red blood cells in urine mean in a child?

The presence of BLD in urinalysis indicates the development of hematuria. In the glomerular apparatus of the kidneys, blood is filtered. The cellular constituents remain, and the fluid is further processed. As soon as the concentration of urine reaches the required level, it is excreted.

The main routes of urine excretion:

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

The opening of the kidney filter is about 8 nanometers, and the diameter of the mature erythrocyte is several times larger. Based on this, red blood cells can enter the bladder when the filter opening in the kidney tissue expands or when the size of blood cells decreases.

With true hematuria, erythrocytes appear from the affected tissues of the renal pelvis, ureters, genitals or bladder. With untrue 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 elimination.

When erythrocytes are detected in the urine sediment in a child, the general condition of the patient is assessed. The doctor asks about the presence of complaints of pain when urinating, in the lower abdomen or in the lower back. Particular attention is paid to the frequency of urge to use the toilet, the 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 erythrocytes are found in the analysis of the child's urine, then this is the norm. The lifespan of a BLD cell is 120 days. The formation of new blood cells occurs constantly, so the changed cells can appear not only once every 120 days, but much more often. All other indicators are not included in the concept of the norm. If the number of erythrocytes in the field of view is more than 4, then it is necessary to establish the reasons for their massive death.

The indicator of the norm of red blood cells in the urine of a child 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. Amburge test - less than 150 per minute.
4. Nechiporenko method - less than 1000 per ml.

Hematuria in pediatric patients is 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 liquid is reddish, turbid.

The Nechiporenko method is considered the most informative for determining the number of red blood cells. For the analysis, an average portion of urine (10 ml) is used, 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, then this indicates hematuria, that is, 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 the increase in red blood cells in the urine of a child:

• Infectious lesions of the genitourinary system.
• Tumor neoplasms of the genitourinary system.
• Kidney injury.
• High blood pressure.
• Intoxication of the body.
• Glomerulonephritis, pyelonephritis.

The norm indicators are the same for both boys and girls. During adolescence, girls may have their menstrual blood tested, so the test is not done during menstruation. Reference values of red blood cells in urine do not change as the child grows up.

Single red blood cells in the urine of a child

If single blood cells are detected in the clinical analysis of children's urine, then this is the norm. During the day, more than 3 million red blood cells are released with urine, which precipitate. In laboratory analysis, 1-3 erythrocytes or their traces are normally found.

Particular attention is paid to the type of cells identified. These are altered, that is, devoid 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 found, then this indicates the 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 carry oxygen from the lungs to the tissues. In theory, 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 of the red blood cells pass through the renal barrier or through the walls of blood vessels.

If in the clinical analysis of urine in a child 1,2,3,4 or 5 erythrocytes are detected, then this is the norm. If the number of red blood cells is much higher, then this is a reason for a comprehensive examination of the body.

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

Causes of the red blood cells in the urine of a child

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

1. Reactive states - cause general intoxication of the body and enlargement of the opening of the kidney filters.

• Viral infections with fever.
• Meningitis .
• Severe intestinal infections.
• Intoxication with sepsis.

This group includes marching hematuria, that is, a large number of red blood cells due to increased physical exertion. In most cases, the condition will return to normal within 24 hours. [7]

2. Diseases of the urinary and urinary tract.

• Urolithiasis - blood enters the urine at one of the sections of the urethra.
• Inflammation of the bladder (cystitis) .
• Glomerulonephritis - damage to the renal glomeruli. In urine, not only erythrocytes are detected, but also cylinders with blood proteins.
• Urethritis is a lesion of the mucous membrane of the urethra.
• Pyelonephritis - expansion of filtration pores due to inflammatory edema. Leukocytes are detected in the urine.

The painful condition can be caused by kidney or bladder injuries, in rare cases - cancer.

Another possible cause of the disorder is false hematuria. Non-true hematuria is detected if the red blood cells are not full-fledged red blood cells. That is, false hematuria does not apply 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 assistant. This is observed after the use of coloring products or drugs. [8]

Erythrocytes in the urine of a child with allergies

One of the reasons for the increase in the level of red blood cells, leukocytes and other blood cells 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 is elevated with food allergies. About 2-3% of adults and more than 6-8% of children under 6 years old face this problem.
• The mechanism for raising the level of red and white blood cells is associated with 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 response of the body to the action of pathogens, but mistakenly directed at the proteins of certain foods.
• With prolonged intake of an allergen into the body, immunoglobulins G enter into a reaction. This is manifested by external symptoms of a disorder: itching, rash, flatulence.

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

Increased red blood cells in the urine of a child

If a child has an increased number of red blood cells in a general urine test, then this condition is called hematuria. With a large number of red blood cells, urine has a red or brown color. A similar condition occurs in such situations:

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

Hematuria develops due to a decrease in the number of platelets or with 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 capillary permeability. If the pathological process takes place in the bladder, then the blood cells have a normal shape. With pathology in the kidneys, the blood cells are changed. [11]

Injuries, injuries and stretching of the kidney cause an active increase in red blood cells in the urine. A similar situation is observed with urates / oxalates in the renal pelvis. In this case, blood enters the urine due to mechanical damage to the mucous membranes. In the case of a tumor process, the pressure of the neoplasm on the surrounding vessels occurs, which entails a change and thinning of their walls. [12]

Changed red blood cells in the urine of a child

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

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

For a more detailed study of blood cells, an analysis is performed with a phase contrast microscope. It allows you to consider altered erythrocytes with outgrowths of the cell wall (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 can be caused by renal (renal) or extrarenal (extrarenal) causes. The first 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, bladder.

Fresh blood cells enter the body fluid excreted by the kidneys from damaged blood vessels or from opened internal bleeding. In any case, even a slight presence of unchanged erythrocytes in the urine requires further diagnosis. For these purposes, ultrasound of the organs of the genitourinary system, MRI, X-ray and a set of other studies are performed. [13]

Dysmorphic erythrocytes in the urine of a child

Altered red blood cells are found in urine when the renal filter becomes more permeable and the filtration process is impaired. Dysmorphic erythrocytes are not detected under normal conditions, therefore, they should be absent from the analysis in a child. [14]

Leached cells lose their hemoglobin, shape and structure, and are accompanied by increased protein levels. The presence of such red blood cells most often indicates a violation of the genitourinary system.

The painful condition is characteristic of 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. [15]

Protein and red blood cells in the urine of a child

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

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

• Premature up to 4 weeks - 90-84 mg / l.
• Full-term 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 old - 45-391 mg / l.

As the baby grows up, the rate of protein in the urine decreases, and the rate of daily excretion increases. There are the following main reasons for the increase in the level of erythrocytes and protein (proteinuria) in the analysis of urine in children of different ages:

1. Newborns - for 85-90% of babies, a temporary increase in these values is the norm. 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 within 1-2 weeks after birth, the amount of protein and red blood cells returns to normal. [16]

Pathological causes of poor tests:

• Hypothermia or dehydration of the body.
• Frightfulness 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 body's excretory system becomes unclear. Pathological elevation of protein and red blood cells is observed in babies who have a family history of cases of urolithiasis, pyelonephritis, glomerulonephritis. [17]

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

Reasons for violation:

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

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

In older children, protein in the urine against the background of increased erythrocytes 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 bad tests, a comprehensive examination of the body is carried out. In this case, it is not the increased protein and red blood cells that are treated, but the disorder that caused the abnormalities. [18]

Protein, erythrocytes and leukocytes in the urine of a child

Leukocytes are always determined in urine analysis. Their norm for children 0-6 in the field of vision, similar characteristics have red blood cells and proteins. If these indicators exceed the permissible values, then 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 disease.
• Infection, inflammation of the external genital organs.
• Dermatitis and allergic reactions.

Most often, increased protein, erythrocytes and leukocytes in the urine of a child appear against the background of an inflammatory process. That is why counting leukocytes in urinary sediment is an effective method for diagnosing urinary infections. Excessive white blood cell counts or pyuria are urine pus. [19]

Very often, increased leukocytes and other indicators are associated with improper sampling 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 repeated analysis is carried out. [20], [21]

If during a second examination the main indicators exceed the norm, 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 draws up a treatment plan for the child. [22]

Temperature and red blood cells in the urine of a child

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

The main causes of fever and red blood cells in the urine of a child:

• Overheat.
• Teething.
• Urinary tract infections.
• ARVI.
• Allergic reactions.
• Vaccination reactions.
• Disorders in the work of the kidneys.

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

There are 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 the components of urine, urea. It also protects the urinary system from infectious pathogens. If too much mucus is produced, the urine becomes cloudy and may contain mucus particles or sediment. [23]

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

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

If, in addition to increased mucus and erythrocytes, the analysis revealed a large number of leukocytes and epithelium, then this is a clear sign of inflammation of the urinary system. In acute inflammation, bacteria can be found. Large amounts of salt and mucus are laboratory symptoms of dysmetabolic nephropathy. The presence of protein indicates kidney disease. [24]

But more often than not, the presence of mucus indicates an improper collection of the body fluid sample. This is possible in case of violation of the sterility of the container for collecting urine, violation of the child's intimate hygiene or taking certain medications. If, against the background of poor analyzes, other pathological symptoms are observed, then a comprehensive examination of the body is required.

Salts and red blood cells in the urine of a child

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

If salts have arisen against the background of high red blood cells, then most often this indicates kidney disease, cystitis, urolithiasis. [25]

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, the possible reasons for the deviation include severe renal diseases, the presence of calculi in the kidneys.
• Phosphates - if there are more than the norm, then this is a sign of an excess of phosphorus-containing products in the diet (dairy, legumes, herbs, carrots, spicy and spicy dishes). More serious causes include infections in the urogenital tract, dysfunction of the digestive tract or intestines, and rickets.
• Urates - this type of salt is extremely rare, but in combination with high blood cells indicates pathologies such as: urolithiasis, impaired renal function, bowel disease. The painful condition is manifested by a decrease in the child's body weight against a background of loss of appetite, abdominal pain, and a change in the color of urine to brick-red.

The first thing to do with an increased salt level in the analysis is to change the diet. Particular attention must be paid to maintaining the water balance. If poor analyzes are complemented 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 the urine is called hemoglobinuria. This condition has several development mechanisms:

1. Erythrocytes enter the urine and are destroyed, releasing hemoglobin (hemolyzed). Due to the high pH and low osmolality of urine, blood cells are rapidly leached out.
2. Red blood cells enter the body fluid through the kidney filter. True hemoglobinuria is associated with intravascular hemolysis of erythrocytes.

Normally, blood protein is not detected in urine, that is, its amount should be zero. Acceptable values are 1-5 erythrocytes per field of view. If the indicators are from 10 to 25, then this is a sign of bleeding in the urinary organs. With moderate hemoglobinuria 25-50, muscle pathologies can be observed in the field of view. High hemoglobin values - more than 50, are associated with an increase in myoglobin protein. Its increase is caused by infectious processes in the body. [26]

Unlike hematuria, with hemoglobinuria, erythrocytes 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 organs of 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 to haptoglobin and can penetrate the kidney filter into the urine.
• Severe infectious diseases (tonsillitis, scarlet fever, malaria, typhoid fever).

In some cases, signs of hemoglobinuria are visible without urinalysis. The liquid secreted by the kidneys changes its color from pink to the color of meat slops. The child may complain of back pain, fever, aches and pains in joints and muscles, general malaise. The skin becomes pale or yellow.

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 shown. In severe cases, a bone marrow biopsy is performed. Methods for treating hemoglobinuria directly depend on the etiology of the disorder. [27]

Treatment of the red blood cells in the urine of a child

Only laboratory research (microhematurgy) can show that the number of red blood cells in the urine is increased. To detail the results obtained, an additional analysis of several samples is assigned. The material is placed in three different containers and examined under a microscope:

• If in all test tubes the number of blood cells is the same, this indicates blood from the kidneys.
• If BLDs are found only in the first test tube, then this is a sign of bladder abnormalities.
• Elevated erythrocytes in the third container are 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 urine of a child? The doctor asks about changes in the diet in the last week, the presence of injuries, medication, stress, overwork. This allows you to determine if the increased BLD is caused by a physiological cause or pathological factors. [28]

If the growth of red blood cells is due to kidney disease, then the patient is given the following recommendations:

• Diet food.
• Taking medications (anti-inflammatory, antibiotics, diuretics).
• Decrease in fluid intake during the day.

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

• Antibacterial drugs.
• Special diet with a minimum amount of salt.
• Antimicrobial installations.

In any case, after 20-30 days, it is necessary to pass a second analysis.

In some cases, poor test results are due to improper preparation of the child for their delivery. For the study to be as reliable as possible, a couple of days before its conduct, vegetables, fruits and other foods that change the color of urine must be excluded from the diet. Urine is collected in a sterile container or urine bag (used for babies). Before collecting liquid, the child must be washed well. It is better to take morning urine for analysis, skipping the first portion. If evening urine is collected, then the container with the liquid should be stored in the refrigerator so that its main indicators do not change. [29]

There are several methods for examining urine and certain rules for its collection:

1. For the analysis according to Nechiporenko, an average portion of morning urine is needed. Moreover, it can be stored for no more than 1.5 hours.
2. According to Zimnitsky, the liquid is collected in 8 containers every three hours during the day. If it was not possible to collect urine within the specified period of time, then the container remains empty. The liquid is stored in the refrigerator.
3. For Sulkovich's test, morning urine is collected on an empty stomach. The liquid must be submitted for analysis within 2 hours after collection.
4. For analysis according to Robert, it is necessary to go to the toilet immediately after sleep, completely emptying the bladder. All liquid from the moment of the morning toilet is collected in a container. Before delivery, the urine is stirred and 50 ml is measured. The liquid is stored in the refrigerator.

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