Proteinuria in Children

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).

Glomerular proteinuria - based on proteins size.

Differential Diagnosis of Proteinuria in Children[edit | edit source]

Mild Proteinuria[edit | edit source]

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.

Moderate Proteinuria[edit | edit source]

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.

Nephrotic Proteinuria[edit | edit source]

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:

Management of child with proteinuria[edit | edit source]

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

Links[edit | edit source]

References[edit | edit source]

↑ 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>.

Bibliography[edit | edit source]

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

[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>.

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