Introduction: The prevalence of pediatric stone disease has increased over the last few decades. In children, the clinical attributes are not typical and require a high index of suspicion for correct diagnosis. We aimed to evaluate the role of microscopic hematuria as a diagnostic tool in children presenting with symptomatic urinary stones compared to the adult population. Methods: A retrospective review of consecutive cases of suspected symptomatic urinary stones between 2016-2021 at a pediatric referral center's emergency department. Collected data included: medical history, clinical symptoms, laboratory, and radiological findings. We compared the prevalence of microscopic hematuria in children with radiologically confirmed urinary stones to a similar adult cohort and examined the associations between microscopic hematuria and the clinical, laboratory, and radiological findings in children. Results: Of 184 patients reviewed, ninety-four children were diagnosed with symptomatic urinary stones confirmed by ultrasound (55%) or computed tomography (45%). Median age was 10 years (IQR 6-15) and 55% were males. Compared to an adult cohort [n=90, median age 52 years (IQR 41-65)], microscopic hematuria prevalence was significantly lower in children (62.8 vs. 82%, p=0.005). Reported clinical symptoms included flank/abdominal pain (47%), hematuria (27.7%), fever (21.3), and LUTS (12.8%). Children who presented with flank/abdominal pain and concurrent fever were associated with lower rates of microscopic hematuria on multivariate analysis [OR=0.24 (CI 0.06-0.089), p=0.03]. Conclusions: Microscopic hematuria prevalence is significantly lower in the pediatric population compared to the adult population and should not be used as a single guide to further evaluation when urinary stones are suspected. SOURCE OF Funding: no sources
