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

摘要： 血尿是儿科门急诊与肾脏专科最常见的主诉之一，既可能是短暂、良性的一过性表现，也可能是肾小球疾病或遗传性肾病的早期信号。临床评估需要建立合理诊断路径：先确认“真性血尿”及其持续性，再依据尿沉渣形态、尿蛋白、血压与肾功能完成“肾小球性 / 非肾小球性”定位，随后以危险信号进行分层，决定检查与随访。对多数低风险患儿，规范随访亦为一种治疗：通过动态监测尿红细胞变化、微量白蛋白及肾功能，不但可避免过度检查与医源性焦虑，又能在出现蛋白尿、血压升高或肾功能下降时及时升级评估与干预。文章结合临床实践，梳理血尿诊疗的核心思路、关键环节与常见误区，提出合理的初筛项目与分层随访策略，为青年医师提供可借鉴的实用路径。

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