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[Proteinuria in children: practical approach]
L H Thoai1, F Cachat, J P Guignard
1Département médico-chirurgical de pédiatrie, CHUV, Lausanne.
Insights
Significant proteinuria in children requires quantitative assessment. Persistent cases necessitate thorough investigation, potentially including a renal biopsy, to determine the underlying cause and prognosis.
Area of Science:
- Pediatric Nephrology
- Clinical Diagnostics
- Urine Analysis
Context:
- Proteinuria is a common finding in pediatric populations.
- Initial detection often occurs via urine dipstick testing.
- Variable underlying causes necessitate careful evaluation.
Purpose:
- To outline the diagnostic approach for proteinuria in children.
- To differentiate between intermittent and persistent proteinuria.
- To emphasize the importance of quantitative assessment and further investigation.
Summary:
- Significant proteinuria in children requires quantitative assessment using the urinary protein/creatinine ratio.
- Orthostatic proteinuria is a common cause of intermittent proteinuria.
- Persistent proteinuria, whether glomerular or tubular, indicates underlying kidney disease and requires comprehensive investigation, potentially including renal biopsy.
Impact:
- Guides clinicians in the appropriate management of pediatric proteinuria.
- Highlights the diagnostic value of the protein/creatinine ratio.
- Underscores the necessity of renal biopsy for diagnosing persistent proteinuria and determining prognosis.
Abstract:
Significant proteinuria is not an unfinding in children. Its causes are variable. When detected by dipstick examination of urine, the proteinuria must be assessed quantitatively by measuring the urinary protein/creatinine ratio in a spot sample. Orthostatic proteinuria is the most common cause of intermittent proteinuria. Persistent glomerular or tubular proteinuria are the consequences of various glomerulopathies or tubulopathies, the prognosis of which is variable. Whether glomerular or tubular, persistent proteinuria must be fully investigated, including by renal biopsy.