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Isolated haematuria – isomorphic — RACP Paediatrics MCQ

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ModerateNephrologyIsolated haematuria – isomorphicRACP Paediatrics

A 7-year-old has persistent microscopic haematuria (1+ blood on 3 dipsticks over 6 months). Urine microscopy shows isomorphic red cells. There are no casts. Protein is negative. BP is normal. Renal function is normal. What is the most important investigation to exclude a urological cause?

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Correct answer: E — Normal urinalysis

Persistent isolated microscopic haematuria with isomorphic (non-dysmorphic) RBCs suggests a non-glomerular (urological) source. Renal and bladder ultrasound is the first-line investigation to exclude structural causes (stones, tumours, hydronephrosis, cystic disease). If dysmorphic RBCs or casts were present, a glomerular cause would be suspected.

Reference: RCH Melbourne – 2023 – Haematuria CPG; RACP Paediatric Curriculum – Nephrology