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Abstract: Hematuria is one of the most common chief complaints in pediatric emergency and outpatient settings，as well as pediatric nephrology clinics. It can either be a transient and benign finding or an early sign of glomerular disease or hereditary nephropathy. Clinical evaluation requires establishing a reasonable diagnostic pathway：first，confirm“true hematuria”and its persistence，and then determine the“glomerular/non-glomerular”localization based on urine sediment morphology，urinary protein，blood pressure，and renal function，followed by stratification using warning signs to decide on examinations and follow-up. For most low-risk children，standardized follow-up is a form of treatment：through dynamic monitoring of changes in urinary red blood cells，microalbumin，and renal function，it not only avoids excessive examinations and iatrogenic anxiety but also enables timely escalation of evaluation and intervention when proteinuria，elevated blood pressure，or decreased renal function occurs. Based on clinical practice，this article summarizes the core principles，key steps，and common pitfalls. in the diagnosis and managment of hematuria，proposes reasonable initial screening items and stratified follow-up strategies，and provides a practical pathway for junior clinicians to refer to.

Key words: hematuria, child, diagnostic approach, risk stratification, follow-up