Asymptomatic low molecular weight proteinuria: a report on 5 cases

In children with asymptomatic proteinuria, a high proportion of low molecular weight (LMW) proteins is an indicator of tubular malfunction. In a routine screening program covering the last 15 years and involving 280,000 children, aged between 3 and 19 years, we have identified 5 boys with LMW proteinuria. In 4 of these, renal biopsy was histologically normal on the first presentation. Follow-up for 4-16 years showed normal growth curves, but further evidence of tubular dysfunction appeared: glycosuria and hypophosphatemia in 2 patients; one of them had also aminoaciduria and rising serum creatinine (greater than 1.2 mg/100 ml). Another patient had only increased serum creatinine. The other two, still less than 13 years old, show so far no other abnormality than persistent LMW proteinuria. It is suggested that early identification of LMW proteinuria may presage gradual development of progressive tubular dysfunction with age and that such patients should be followed up indefinitely.