Macroscopic Haematuria - Paediatric CPC

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Southern Adelaide Local Health Network

• Flinders Medical Centre (08) 8204 5511

Women's and Children's Health Network

• Women’s and Children’s Hospital (08) 8161 7000

Exclusions

• clinical suspicion of post-streptococcal glomerulonephritis – refer to nephrology or emergency department if indicated
• concerns of ‘childhood non-accidental injury’ – refer to Child Protection Services for further information. If requiring clinical care please, refer to both urology and Child Protection Services.
• microscopic haematuria - refer to nephrology
• sexually transmitted infections – refer to Adelaide Sexual Health Centre

Triage categories

Category 1 (appointment clinically indicated within 30 days)

• macroscopic haematuria

Category 2 (appointment clinically indicated within 90 days)

• nil

Category 3 (appointment clinically indicated within 365 days)

• nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

• past medical/surgical/psychosocial history
  
• family history of haematuria, renal disease/stones
• current medications, allergies e.g. non-steroidal anti-inflammatory drugs (NSAIDs), rifampicin, metronidazole, nitrofurantoin, or cyclophosphamide
• allergies and sensitivities
• presenting symptoms history, including:
  • onset/duration
  • previous episodes of haematuria
  • symptoms of urinary infection e.g., dysuria, frequency, pain, fever
  • systemic symptoms e.g., fatigue, oedema, rash, arthralgia, or coryza
  • recent surgery or trauma including non-accidental injury
  • history of underlying bleeding disorder or immunodeficiency
  • food intake as beetroot and berries can colour urine to pink or red
  • exercise
• height/weight
• body mass index (BMI)
• growth chart trends
• blood pressure (trends)
• physical examination findings e.g., review eyes, skin, genitalia, joint tenderness or swelling, and signs of oedema or organomegaly
• pathology
  • mid-stream urine (MSU) microscopy, culture and sensitivity (M/C/S)
  • sexually active people complete a sexually transmitted infection (STI) screen, including chlamydia and gonorrhoea which requires:
    • endocervical/penile swab for culture and
    • endocervical/penile polymerase chain reaction (PCR) swab or urine sample
• medical imaging
  • kidneys, ureters and bladder (KUB) ultrasound (US)
  • relevant diagnostic/imaging reports, including location of company and accession number

Additional information to assist triage categorisation

• pathology:
  • complete blood examination (CBE)
  • electrolytes, urea & creatinine (EUC)
  • liver function test (LFT)
  • coagulation studies (coags)
  • urine culture, protein, creatinine ratio

Clinical resources

• Royal Children’s Hospital Melbourne – Haematuria Clinical Guidelines
• Royal Children’s Hospital Melbourne – Paediatric Hypertension Guidelines

Consumer resources

• National Kidney Foundation – Haematuria in Children

Reason for request

• to establish a diagnosis
• for treatment or intervention
• for advice and management
• for specialist to take over management
• for a specified test/investigation the General Practitioner cannot order
• for other reason (e.g. rapidly accelerating disease progression)
• transfer of care from another tertiary service
• clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

• full name, including aliases
• date of birth
• residential and postal address
• telephone contact number/s – home, mobile and alternative
• Medicare number, where eligible
• name of the parent or caregiver, if appropriate
• preferred language and interpreter requirements
• identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

• impact on employment
• impact on education
• impact on home
• impact on activities of daily living
• impact on ability to care for others
• impact on personal frailty or safety
• identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

• Willingness to have surgery, where surgery is a likely intervention.
• Choice to be treated as a public or private patient.
• Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
• Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
• Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  
• Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
• A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
• All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.