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Child passing urine with black specks in it. Tested negative for urine infection. Cause and cure?

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Pediatrician, Surgery
Practicing since : 2003
Answered : 246 Questions
My 3yr old has black specks, like pepper, in his urine. It does not happen every time, but most times, over the past 5 days. He has a separate toddler potty that he uses, so I know it's not the toilet. I usually see 2-3 specks, but sometimes more (5-6). I took him to the pediatrician. She tested the urine in office for proteins, blood, and tests were negative. She has no idea what it could be. He is going for a sonogram in 2 days, but I want to know what it possibly could be so that I can have his doctor check for it.
Posted Wed, 17 Apr 2013 in Urinary and Bladder Problems
Answered by Dr. Anand Sinha 4 hours later
Thank you for posting your query with Health Care Magic.

I can understand your concern. The various reasons for black specks in urine can be

1.     It may indicate stones in the urinary system (which includes kidney, ureters and bladder). If the stones are really small, they are passed along with the urine and can appear so. Otherwise they might erode the lining of the urinary tract and the blood that oozes appears black when it comes out. The ultrasound should pick if there are any stones. If there is any doubt, a CT scan will be confirmatory.

2.     There are some syndromes where body starts making antibodies against the renal (kidney) tissues. These include a wide spectrum of conditions which can be collectively clubbed into nephrotic syndrome (more common) or nephritic syndrome. In these syndromes, the child can pass casts of red blood cells. They may give a smoky or hazzy look to the urine but usually not black specks. Also, they are detected as protein / blood in urine tests, which you say has turned out to be negative. Therefore it is a less likely possibility.

3. Urinary infections can also give rise to turbid urine (because pus cells are shed in infected urine). However it is usually associated with pain during passing urine and/or fever.

I would like to have some further information from your side

i. detailed results of the urine tests performed by your doctor.
ii. whether your child has any history of urinary infections or any urinary conditions in the past
iii. Is there any history of stones in your family?
iv. Does your child have any fever (indicates urinary infection)
v. Did your child suffer from a upper respiratory tract infection in the recent past (history consistent with nephrotic syndromes)

Following investigations are recommended
a. Detailed urine analysis
b. Urine culture
c. Ultrasound (further tests will be directed on the basis of the results of these tests)

Treatment options

1.     Stones: If the stones are small, they usually pass off on their own. Larger stones require removal (various options are available depending on the site and size of the stone). More importantly, children at three years normally do not develop stones. They are usually due to some metabolic abnormality. If it turns out to be a stone, then your child will need a full work up to search for such abnormality (e.g renal tubular acidosis, cysteinuria, hypercalcemia etc). If found such a condition needs to be treated else it will lead to recurrent stones.

2.     Nephrotic syndromes are usually managed by steroids

3. Urinary infections are managed with antibiotics.

Suggestions till your ultrasound:

i. Keep your child hydrated.
ii. Next time you find black specks in the urine, strain that urine to get the specs separately. These can be sent for examination
iii. Look out for fever and pain during passing urine

Hope that solves your query.
God bless you.

Above answer was peer-reviewed by
Follow-up: Child passing urine with black specks in it. Tested negative for urine infection. Cause and cure? 39 hours later
Information requested:
a) urinalysis attached
b-e) no history of any of these, no fever
My son's pediatrician just called. She informed me that the second urine sample that I brought in (clearly showing the black specks) came back clear. No RBC/WBC/CASTS/proteins, and calcium ratio was normal. We are still going for a sonogram tomorrow.
Answered by Dr. Anand Sinha 5 hours later

Thank you for your feedback.

That is really good that the urine analysis have come normal. We can safely exclude nephrotic and nephritic syndromes and any urinary infections. The only concern left would be stones. Your sonogram should be confirmatory. As I mentioned, till that time keep your child well hydrated (lots of fluids). Also take care of his local hygiene. Sometimes some smegma collects between the prepuce and the glans (it is the secretion of sebaceous glands which collects because small kids are unable to retract their prepuce). Whenever you are giving him a bath you can just clean that part gently. Kindly revert back with the sonogram report and further treatment can be decided accordingly.

Hope that helps
God bless you
Dr Anand Sinha
Pediatric Surgeon and Urologist
Above answer was peer-reviewed by
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