Hematuria as a predictor of renal and ureteral calculi in children; a diagnostic cross‑sectional study

Milad Rastegar , Mohammad Golshan Tafti , Ahmad Shajari^*

¹ Department of Medicine, YMS. C., Islamic Azad University, Yazd, Iran

*Corresponding Author: Ahmad Shajari, Email: dr.shajari@iau.ac.ir

Abstract

Introduction: Pediatric nephrolithiasis is increasingly recognized worldwide and often presents with nonspecific symptoms that can delay diagnosis and treatment. Early identification of renal and ureteral calculi is essential to prevent complications such as obstruction, infection, and long‑term renal impairment. Ultrasound is the preferred imaging modality in children, but its availability and cost may limit routine use in some settings. Hematuria is a common and easily assessed finding in suspected stone disease, yet its standalone diagnostic value in the pediatric population remains uncertain.

Objectives: This study aimed to evaluate the performance of hematuria as a predictor of renal and ureteral calculi in children, using ultrasound as the reference standard.

Materials and Methods: We conducted a retrospective diagnostic cross‑sectional study of children aged 1–12 years with suspected nephrolithiasis who were referred to two tertiary hospitals in Yazd between January 2018 and January 2020. Clinical data, urinalysis results for hematuria, and renal ultrasound reports were extracted from medical records using predefined eligibility criteria and a standardized data collection form. Hematuria was classified as present or absent on urinalysis, while ultrasound served as the reference standard for confirming or excluding renal or ureteral calculi. The diagnostic performance of hematuria was evaluated by calculating sensitivity, specificity, positive and negative predictive values (PPV and NPV), accuracy, likelihood ratios (LRs), and Cohen’s kappa coefficient.

Results: Among 70 children aged 1–12 years with suspected nephrolithiasis, hematuria demonstrated good diagnostic performance against ultrasound, with an accuracy of 81.4%, sensitivity of 80.8%, specificity of 81.8%, PPV of 72.4%, and NPV of 87.8%.

Conclusion: Hematuria demonstrated good overall diagnostic accuracy for detecting pediatric nephrolithiasis compared with ultrasound and may serve as a simple, accessible screening tool in suspected cases. Nevertheless, due to residual false‑positive and false‑negative results, imaging remains necessary for definitive diagnosis and management.

Keywords: Hematuria, Pediatric nephrolithiasis, Renal calculi, Ureteral stones, Urinalysis, Ultrasound

Implication for health policy/practice/research/medical education:

Hematuria demonstrated acceptable diagnostic accuracy for detecting nephrolithiasis in children when benchmarked against ultrasound, indicating that routine urinalysis may provide a practical initial screening approach in suspected cases. In contexts with constrained resources or high patient volumes, this simple test could help prioritize children who warrant prompt imaging evaluation. Nonetheless, the presence of misclassified cases means that hematuria cannot be relied upon as a standalone diagnostic method, and radiologic imaging remains indispensable for confirming stone disease and guiding subsequent management.

Please cite this paper as: Rastegar M, Golshan Tafti M, Shajari A. Hematuria as a predictor of renal and ureteral calculi in children; a diagnostic cross‑sectional study. J Nephropathol. 2026;x(x):e28727. DOI: 10.34172/jnp.28727.