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Simplified Algorithm for Evaluation of Proteinuria in Clinical Practice: How should A Clinician Approach?
Mojgan Mazaheri1, Farahnak Assadi2
1Department of Pediatrics, Section of Nephrology, Semnan University of Medical Sciences, Semnan, Iran.
Insights
Proteinuria in children is common and can be transient or persistent. A simplified diagnostic algorithm helps primary care providers evaluate asymptomatic proteinuria in adolescents, guiding referral when necessary.
Area of Science:
- Pediatric Nephrology
- Clinical Diagnostics
- Internal Medicine
Background:
- Proteinuria is a frequent laboratory finding in pediatric patients.
- It may indicate a benign condition or a serious underlying disease.
- Distinguishing between transient and persistent proteinuria is crucial for diagnosis.
Purpose of the Study:
- To develop a simplified diagnostic algorithm for evaluating asymptomatic proteinuria in primary care settings.
- To aid in the assessment of well-appearing adolescents with incidentally discovered proteinuria.
- To provide clear guidelines for referral to pediatric nephrology.
Main Methods:
- A comprehensive literature search was conducted for studies on asymptomatic proteinuria in children and adolescents.
- Databases searched included PubMed, MEDLINE, EMBASE, and Google Scholar (1980-2017).
- 24 relevant studies were included from 64 reviewed articles.
Main Results:
- The spot urine protein-to-creatinine (PCR) ratio is a reliable method for detecting proteinuria.
- Normal spot PCR is <0.3 for children ≥2 years and <0.5 for those <2 years.
- Orthostatic proteinuria, common in asymptomatic children, requires no specific therapy; referral is indicated for persistent proteinuria (>6 months) or associated abnormalities.
Conclusions:
- A simplified diagnostic algorithm is proposed for primary care evaluation of incidental proteinuria in adolescents.
- This algorithm aims to facilitate appropriate management and timely referral.
- Early identification and appropriate workup can prevent progression of kidney disease.
Background:
Proteinuria is a common laboratory finding among children and adolescents. It can be identified as either a transient or a persistent finding and can represent a benign condition or a serious disease.
Methods:
Pertinent medical literature for asymptomatic proteinuria in children and adolescents published in English was searched between January 1980 and May 2017 using PubMed, MEDLINE, EMBASE, and Google Scholar research databases. Of the 64 reviewed articles, 24 studies were eligible for inclusion.
Results:
Random spot urine protein-to-creatinine (PCR) ratio is widely used to reliably detect proteinuria. The normal value for the spot PCR in children aged 2 years or older is less than 0.3. In children aged below 2 years, the PCR can be as high as 0.5. Orthostatic proteinuria is defined as urine PCR greater than 0.3 detected in a urine specimen during the daytime activity but less than 0.3 on the first morning void specimen. PCR above 3.0 signifies heavy proteinuria as seen in nephrotic syndrome. Orthostatic proteinuria is a frequent cause of proteinuria in asymptomatic children and adolescents, which require no specific therapy except for health maintenance follow-up. Pediatric nephrologist referral is indicated when the proteinuria is constant and persists over 6 months or is associated with hematuria, hypertension, or renal dysfunction.
Conclusions:
We provide a simplified diagnostic algorithm for evaluation of proteinuria in primary care adolescents who appear well and in whom proteinuria is incidentally discovered during a routine examination.
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