ureteropelvic junction In addition to congenital anomalies, renal vein thrombosis secondary to a coagulation disorder or to the placement of an umbilical catheter is a cause of hematuria in the neonate Wilms tumor is a common childhood solid tumor associated with hematuria Nephrolithiasis should be considered if there is a family history or a predisposing condition such as recurrent infection, bladder dysfunction (seen in myelomeningocele), or chronic diuretic therapy Hypercalciuria and cystinuria are metabolic diseases that also predispose patients to renal stones and hematuria Finally, urethral prolapse may present with vaginal bleeding that can contaminate a collected urine specimen and be misinterpreted as hematuria Evaluation and Decision The initial evaluation of hematuria must begin with the confirmation of blood in the urine Further investigation of the cause and treatment includes detailed patient and family histories, careful physical examination, and microscopic urinalysis A specific diagnosis may or may not be made in the ED, and the patient may require further diagnostic testing The most important role for the emergency physician in evaluating a child with hematuria is to identify serious, treatable, and progressive conditions such as trauma, nephritis associated with hypertension, bleeding disorders, and infection