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

Miscellaneous and Personal Stuff I Must Share
1

This is a very long story. I have searched like crazy and since I’m a nursing student I have a lot of books that I have been through. 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)…

<hopefully, I’ll get this right>

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. <Is this what you would describe as an autoimmune response?> He says this could last for a long time (he mentioned months). He said we would need to follow this closely and for a LONG time, even after it is resolved. And that as long as she is not spilling protein into her urine and not getting anemic and is feeling ok, then he feels ok about this. He mentioned that he wants to do a blood test to check and see if she has had a strep infection in the recent past.

I am not sure if this is even plausible (body over reacting to the antibodies). It sounds like it would be but I can’t really find anything about this happening. 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 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 (the day of her appointment) 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. No, I don’t have family or people around that I know could take care of her. 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 mean, every time I see this pee, I am saying…OH MY GOD. It just amazes me and it is very scary.

I need Doper help, if anyone has any input I’ll gladly take any info I can get my hands on. I hope this isn’t too long or against the rules. I’m a newby as a poster but an older lurker.

2

I don’t have any hard medical advice to offer, but hang in there. Your pediatrician sounds like he’s got a handle on things. You’ll need to watch your little girl very closely to make sure this is a one-time weird thing. Bug the pediatrician, check with your peds nursing instructor. If you’re doing any clinical work, ask around there for opinions. I hope things go better for your daughter.

3

oh! NOT fun when you are basically alone with your daughter. Is there any possibilty of seeking informal (but informed) advice form a staff member at your nursing school? Worst they can do is say “no”, really.

Or any official telephone “talk to a nurse here” helplines?

At least you have got the paediatricians and so on keeping a close eye on things now.

I hope it’s all OK.

4

I think that I will send an email to some of my past instructors and maybe the Dean. That is a good idea. Thanks.

Any other advice?

5

Father of 6 here, been through more than I care to share right now.
Do not take no for an answer if you are not satisfied with the attention your daughter is getting. Follow your motherly instincts, if you think something is still wrong, stick to your guns and get anothert CBC with complete chems and labs.

Medical personel are used to hearing hoofbeats and thinking horses. They no better than to think zebra, except that once in a great while it is. What I’m saying is be sure they elliminate all they can, however rare.

I’m not meaning to alarm you, but I’m speaking from experence, (not the same symptoms)

Take care and keep us posted.

6

Hi Astacey , I am a nurse and a mother also so I hope I can give you some support here.

First of all, the autoimmune response your ped describes does make sense to me. This is from a personal perspective, as I have a highly responsive autoimmune system and have had these dermatologic responses frequently. Ex: if I am carrying something like a box in my arms I may end up with whelps on my forearms which eventually fade. My internist calls it dermagraphia. I have also had unusual responses to common illnesses which have been related to my overactive autoimmune system so the connection of the hematuria to the recent viral illness make sense to me. I might add that I have had a significant work-up including an endocrine consult and have no defined diagnosis such as lupus. Also none of the autoimmune responses I have had resulted in lasting sequelae.

The lowering RBC count in the face of bright red hematuria makes sense also. The original sample was most likely as you said “old blood” as well as closer to your daughter’s illness and probably less hydrated. GU blood also always looks like “so much more blood” than it often is because it it is fluid based. It is scary to see someone (esp your child) pee blood even when we know it is bloody urine. The fact that she is not spilling any protein though indicates that her kidneys are functioning well and that the RBCs are not from kidney damage but some other inflammatory or traumatic response. In the case you described the inflammatory process makes sense again.

I can understand so well the dilemma you have regarding letting her go to daycare. You described her as feeling good, active as usual and “not sick”…I was glad to see that because that is what I was planning to ask. Given this I think you could feel good about going on to school and perhaps keeping in closer contact with her daycare provider than you normally do. I think that might make both you and the provider feel better.

Maybe by Tuesday everything will have changed some and will make this decision easier to make. It is a mixed blessing being a nurse when you are also a mother. Our minds (naturally) move through all the possibilities of what could happen, what else could be wrong, what else each symptom could mean. My daughter (who is grown now) once told me that when she was a child she could never just have a headache…it was always she “might” have meningitis. But both of us survived just fine.

Good luck. I will be thinking of you. Let us know how things go for you and your daughter.

:slight_smile:

7

Well since no one has mentioned it - how about kidney stones ?

I have had many attacks in my lifetime and that brown-appearing urine sounds very familiar to what happens to me. (Sort of looks like Coke™ I would say).

The symptom I never got but I hear is quite common with kidney stones is infection, fever and so on. The only problem with my “diagnosis” (I have NO professional medical training) is that the pain (which can be phenomenal) does not seem to be present with your daughter’s condition. Still, the hemoturia and the fever suggest the possibility of a kidney stone.

I hope this has helped - even if it is to rule something out.

8

http://www.med.umich.edu/1libr/pa/pa_hematuri_hhg.htm

from the above link:

This list might help with discussing it further with her doctor, to put your mind at rest that he has considered & ruled out the other possible causes.

9

I would think she’d be in a lot of pain with kidney stones. Females don’t pass them as easily as males. (Not that males pass them with no problem.)

Keep an eye on the little one, take her to the doctor if you’re concerned, and keep us posted.

10

My first thought was kidney stones, too (as far as the blood in the urine thing).

You can have a stone and not be in the floor screaming (although the screaming thing seems to be the norm). My mom has passed some that she didn’t know about until, well, they passed. If the kid has those little grain of sand stones, it’s possible that’s what’s causing the bleeding. I don’t see where you said she had a fever, but I can tell you the throwing up thing is very common with stones.

IANAD, though.

11

Thanks to everyone for the input.

Today she is up and playing as usual. Her pee this morning is just as red as ever. I think I may take her to the ER today. They probably won’t want to deal with us because there are not any new symptoms but I don’t know what else to do, I’m just worried.

She did have a low grade fever earlier in the week during the time she had the loose stools. It never got higher than 100 degrees though, and now her temperature is normal and has been for several days. Sorry I left that out!

Last night after I posted, I emailed about 5 of my instructors with the same story. I am waiting to hear from them. Classes start tomorrow.

It really does help a lot to hear your feedback. Thank you again.

12

Don’t hesitate to take her to the ER if you are still worried – I never did :slight_smile:

I think Sam I Am had a good idea about taking the list with you to let them explain why they r/o all the other possibilities.

Good luck – keep us posted.

13

This is almost certainly not the problem, but I thought I’d ask anyway: has your little girl been in a tropical place in the last 2-3 months? Was she in any body of fresh water, there? I understand that schistosomiasis causes mild flu-like symptoms when first contracted, and if it settles in the bladder, bloody urine. If she has not been outside the US in this time frame, then she definitely doesn’t have it. The lab reports surely would have found it, if that’s what it was, actually.

Just thought I’d throw in the idea. The inflammation explanation seems to be the right one.

14

What is a “whelp”? A “bleb”? I have never heard these terms before. Sorry, no medical advice. Hope all works out well. Sick children are scary.

15

Whelp is most likely colloq. term. but means an indurated area of skin, raised but not blistered. Also called welt …used interchangeably. Usually goes away.

Bleb is more of a blister, sac-like.

:slight_smile:

16

BoringDad - Around here (Tennessee), people say “whelp” instead of welt. I always want to say that a whelp is a puppy. “Bleb” I say would be a blotch, based on context.

StG

17

Welt…not “whelp”. Whelp is the process of birthing puppies, isn’t it? I think a bleb is a bruise.

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So how’s she doin?

19

Thanks to everyone for the replies. I will make this a quick update and will update tomorrow after her appointment.

She is the same. Her urine looks like V-8 juice, except not as thick. Otherwise, she is doing just fine, running around and playing, no fever, nothing. It is really bizarre to me. Her skin isn’t over reacting anymore. I have spoken to a couple of my nursing instructors and to another pediatrician in detail and they feel that we are on the right track, with just a watch and wait approach. Tomorrow she will get another UA and CBC taken.

I was able to go to my classes today (first day back). The pediatrician offered to call the daycare for me and explain that this is not contagious, and not really a reason she shouldn’t be able to go there. However, when I got there to talk to them about it, oddly enough, one of the daycare providers had the same thing happen to her daughter so she was familiar with it. They just want something written from the doc tomorrow after her appointment.

The pediatrician is great. He’s been in touch every day at least once. He called me this morning on my cell phone as I was on my way to class to see how she was through the night. Also, I suspect that he realizes how anxiety provoking it is for me, because he is very reassuring. (Which helps me until the next time she urinates!)

It is still a shock to see this urine…and even stranger that we are not doing anything for her. But I am hopeful that they know what is going on and that it will hopefully turn out to be ok.

I have a list of questions to discuss with her doc tomorrow. I just keep hoping every time that she pees that it will get lighter and lighter and eventually go away, but so far it hasn’t. I’ll be curious about the number of RBC’s in tomorrows sample.

Thanks for thinking of us!!
I’ll keep you posted.

20

Thanks for updating :slight_smile: just checking back on you…hope all goes well at the peds tomorrow…