Proteinuria in Children
Proteinuria is significant presence of protein in urine. Physiological proteinuria should not be higher than 100 mg/m2/24 hrs.
Proteinuria can be:
- glomerular proteinuria - usually albuminuria (selective),
- tubular proteinuria - usually globulins and albumin (nonselective).
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:
- 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,
- 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:
- minimal change nephrotic syndrome
- focal segmental glomerulosclerosis
- membranous nepropathy
- congenital nephrotic syndrome.
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]
Related articles[✎ 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. 5th edition. Philadelphia : Elsevier, 2006. ISBN 1-4160-0159-X.