Very concerned about my 3 year old daughter - blood in urine

[LPNtoBSNstudent, BSN, RN]

I would like to hear from anyone who has heard of something like this.

A week ago my daughter threw up. She had a couple of loose BMs. She wasn't as active and didn't have much appetite. But it wasn't anything that alarmed me at this point. Then for a few days this continued, except she didn't vomit again until Tuesday morning about 2am.

I took her to the pediatrician that day and he diagnosed her as having a little stomach virus that would go away in a few days max.

She did seem to be getting a little better, she was still a little tired, but no more vomiting and no loose BMs, but I could tell she still wasn't up to par.

Thursday morning I looked in the toilet when she went pee and there was a brown color liquid in the bottom of the toilet. I thought 'oh no, the diarrhea is back'. That night, I was getting ready to give her a bath and decided to watch her pee this time. The stream that came out was completely brown. I took her to the ER right then. They did a UA with a catheter (terrible terrible experience) and then as soon as they saw the urine in the tube they immediately thought it was a UTI. So they put in an IV right away while we waited for the results from the lab. And they also did a CBC. We were totally surprised to hear that there is no infection, no dehydration. The only thing 'off' in the UA was that there were red blood cells in the urine. (2500 RBCs). And the CBC was 'pristene'. The doctor in the ER spoke to the pediatrician that we saw a few days before. They sent us home and I was told that the doctor would call me the next day.

The same day that the urine changed I noticed that she was having a strange reaction on her skin. When she got scraped or scratched (very minor), a large what I would call a 'whelp' would form and then disappear in about an hour. This happened several times through out the day before I realized the urine was brown. One time we were walking, bare foot into the house (we have concrete steps) and she kind of 'stubbed' the side of her foot on the step. A huge red bleb formed that eventually faded a little while later. And a few other skin type things happened this day that concerned me. I told them this at the ER but they said, 'yeah, i get that all the time'. I tried to explain that this was NEW, but I don't think they knew what to think about it.

The ped called and basically asked me a lot of questions and stuff. I told him about the weird skin thing too (which continued basically thursday and friday and is better today). He wanted me to make an appointment with him in the coming week (appointment is this tuesday). And he wanted me to go to the clinic and pick up some urine collection equipment so that I could at some point over the weekend, get another UA and drop it off at the lab. So, Friday I picked up the equipment. Later that day her urine turned bright red like koolaid. I was and still am just shocked. I took that to the lab and then called the doctor at home and let him know. He called me back and said that there is NO protein in the urine and there of course are still RBCs in it, but the number had decreased significantly to 342....even thought the urine is RED now. Starting on Friday she was pretty much back to her normal self. And today she is even better. BMs are solid now, she has a good appetite, is active as usual. No more strange skin things happening. But her pee is bright red.

Obviously, I am very concerned. I have never heard of a healthy person having blood like this in their urine. The pediatrician seems to be concerned too. He has offered the following as a possible cause (although he admits he really isn't sure)...

She had the stomach virus earlier in the week. Her body is overreacting to the antibodies that her body is making against the virus, which caused an inflammatory reaction in the skin and kidney.

There are other things that I am wondering about. Why when her urine was brown were there more RBCs than now when it is bright red? And to me, brown urine means old blood but now with the red...is there active bleeding? The ped said that the kidney takes a long time to heal. He feels that whatever damage is done to the kidney, it is done, and on its way to healing...but it takes a long time.

I believe him but I am just trying to grasp why this is happening to my little girl. Also I want to know why her body would have a response to the antibodies like this, is that a common thing to happen?

There has been no trauma and there are no autoimmune diseases in our families.

On a side note, I've mentioned before. My husband is in Iraq now. He should be home in about 1-2 months. I don't really have anyone to bounce ideas off right now. I am supposed to start my very last semester in a bachelor of nursing program this monday. I am at a loss. I am of course concerned about my daughter but I have to face the fact that I need to go to class! I am off on Tuesday of this week because this is the first week, but by next week I will be busy every day. I am wondering if I need to drop because I just can't be missing a lot of class. I did pay my tuition this week and I could get it back if I had to drop (which I would HATE HATE HATE to do) But would hate it more if my little girl wasn't being cared for. I will say that I talked to the doc about this and he said that there is no reason that she can't go to the daycare. And like I said he seems to think (hope) this is going to resolve on its own. I just can't see, first of all, that I can leave her with the daycare while she has this terrible bloody urine. And secondly, I highly doubt that they would feel comfortable watching her.

I will take any and all input I can get from you guys. If anyone has heard of something like this please respond or pm me....or if you have any advice on what I should do next, either medically or scholastically! by the way, I did email a few of the faculty at my school just now, so they would know what was going on.

I know this was long, I appreciate you reading this far... thank you!!!

[kids]

The first thing that comes to mind is glomerulonephritis.

I'll see what kind of links I can find and come back.

[kids]

What you discribe does sound like her immune system is reacting to the viral infection. Don't hesitate to call her ped back and have him explain it again. Some questions to ask are:

(1) does this have a specific name (have him spell it if needed).

(2) how long will it last?

(3) when should I become concerned?

(4) what are the potential long term consequences?

(5) will it happen again?

(6) should she be seen by a pediatric nephrologist?

If is glomerulonephritis this link gives a great discription: http://www.mayoclinic.com/invoke.cfm?id=AN00629.

At this point do NOT google the term (really). There are many types, most of them sound really frightening and are NOT appplicable.

Please, let us know how it turns out.

I am also going to move this into the Pediatric forum with a redirect (which leaves a link to it in General Nursing). Hopefully you will get more input from other Peds nurses.

[leslie :-D]

gosh, i'm sorry this is happening to your dtr.

did they check her creatinine level and a sed rate?

the only reason i can think of offhand on why her rbc's were up is because of the old blood (brown) and the rbc's decreased after she passed it.

and yes, an ab/ag reaction does respond through a wide array of different systems. there are also blood tests that can specifically help in diagnosing these responses, which i am hoping her pediatrician will follow through with on tuesday.

if i can think of anything, i'll certainly let you know.

best wishes,

leslie

[leslie :-D]

ok, i just found a very appropriate link describing many of your dtr's s/s:

http://www.fpnotebook.com/URO134.htm

much luck to you and let me know.

leslie

[wonderbee, BSN, RN]

I agree with the posters. If it was me, I'd seek out a pediatric immunologist or nephrologist referral. The welts you refer to are signs of an allergic response. Blood from the capillaries leaks out into the tissues and other structures causing welts and could conceivably be responsible for the blood in the urine.

When my daughter was a young teen, she used to fall asleep a lot. Her sleep habits were terrible. The pediatrician passed it off as being a puberty thing but I thought it was something more. I got her to a pediatric neurologist despite her pediatrician's assurances that it was "normal". Sure enough, it was narcolepsy.

Go with your gut. Don't stop here. Advocate with the pediatrician for a better explanation for your daughter's symptoms.

[LPNtoBSNstudent, BSN, RN]

Thanks to everyone for the replies.

Right now, her urine is just as red as ever. I was so hoping that it would be better today. But she does seem to be feeling ok. I'm very nervous, I'm pretty sure I will end up taking her to the ER today, just at least to check the urine again. Good idea about the pediatric immunologist. On tuesday I will mention it to the ped.

And I will definately be having him explain it again. Good idea. and a good list of questions. I can't seem to understand it.

Thanks for the links and I will definately be looking at them further. I appreciate everyones input. I will keep you all posted.

[zacarias, ASN, RN]

Interesting symptoms...let us know when you hear something.

Also, did they do a strep test on her just to be sure? Anyway, it does sound like glomerulonephritis s/p viral infection and your doc sounds like he's doing a good job and good that he wants to monitor her closely.