Proteinuria in Children

Contents 1 Differential Diagnosis of Proteinuria in Children 1.1 Mild Proteinuria 1.2 Moderate Proteinuria 1.3 Nephrotic Proteinuria 2 Management of child with proteinuria 3 Links 3.1 Related articles 3.2 References 3.3 Bibliography

Proteinuria is significant presence of protein in urine. Physiological proteinuria should not be higher than 100 mg/m²/24 hrs.^[1]

Proteinuria can be:

• glomerular proteinuria - usually albuminuria (selective),
• tubular proteinuria - usually globulins and albumin (nonselective).

edit Differential Diagnosis of Proteinuria in Children

edit Mild Proteinuria

As mild (or intermittent) proteinuria is classified every proteinuria < 0,5 g/m²/24 hrs. Typical causes of mild proteinuria in childhood are:

• pyelonephritis,
• renal cystic diseases,
• obstructive uropathies,
• mild glomerulonephritis.

edit Moderate Proteinuria

As moderate proteinuria is clasified proteinurie 0,5 - 1,0 g/m²/24 hrs. Typical causes of moderate proteinuria in children are:

• PSAGN - it is the most often cause of moderate proteinuria,
• Henoch Schoenlein nephritis,
• chronic glomerulonephritis,
• HUS,
• severe pyelonephritis.

edit Nephrotic Proteinuria

Nephrotic proteinuria - typically more than 1 g/m²/24 hrs - is associated with nephrotic syndrome (proteinuria, hypoproteinaemia, hypercholesterolemia and edema). Diseases connected with nephrotic proteinuria are:

• minimal change nephrotic syndrome
• focal segmental glomerulosclerosis
• membranous nepropathy
• congenital nephrotic syndrome.

edit Management of child with proteinuria

• complete history and physical examination (previous pharyngitis → PSAGN, gastroenteritis → HUS, present edema, petechiae, hypertension ...)
• confirmation of presence proteinuria (is necessary repeat urinalysis)
• protein/creatinine ratio (from first morning urine sample), if P/C ratio is > 0,5, other evaluation is necessary:
  • serum electrolytes analysis, creatinine clearance, serum levels of cholesterol, total protein, albumin
  • streptozyme, C3, C4, ASLO analysis
  • renal ultrasonography

edit Links

edit Related articles

• Nephrotic Syndrome in Children

edit References

1. ↑ DOLEŽALOVÁ, Šárka. Nefrologie I [lecture for subject Peadiatrics, specialization Peadiatrics, 1 LF Charles University in Prague]. Prague. 2011-11-21. Avaliable from <http://kddl.lf1.cuni.cz/download/Nefrologie.I.pdf>. 

edit Bibliography

• KLIEGMAN, Robert M, et al. Nelson Essential of Pediatrics. 5^th edition. Philadelphia : Elsevier, 2006. ISBN 1-4160-0159-X.