In the ED (as well as the primary care office), we obtain a lot of urine samples. Most often looking for signs of infection, but also looking for potential evidence of renal disease (in the child who presents with swollen eyelids for instance). But what do you do when you get a result that you weren’t necessarily looking for? Ignore it? I’d like to often… but that likely isn’t the correct answer.
1. Proteinuria on U/A may suggest underlying renal disease; however, it may be present for benign reasons as well:
⇒ A very concentrated urine (SG 1.020)
⇒ Alkaline urine (pH 7.5)
⇒ Presence of mucoproteins
⇒ Acute illness
2. Benign processes almost never produce proteinuria above 1+.
3. If proteinuria is detected in the ED in an asymptomatic patient:
⇒ Have the patient f/u with PMD for repeat u/a within 1-2 weeks
⇒ Recommend checking a first morning urine sample (send them home with a urine collection cup) so that a urine protein:creatinine ratio can be determined (to rule out orthostatic/transient proteinuria).
4. If proteinuria persists or is evident on first morning urine sample, then further evaluation may be warranted.
⇒ Chemistry panels, CBC’s, renal ultrasound, and 24-hour urine collection rarely change the plan.
⇒ Serial measurements and close follow-up may be all that is needed.
⇒ Renal biopsy may be considered
• If isolated proteinuria persists for more than 1 year, it is then unlikely to spontaneously resolve, at which time a renal biopsy is indicated to determine underlying renal pathology.
Chandar J, Gomez-Martin O, del Pozo R, et al. Role of routine urinalysis in asymptomatic pediatric patients. Clin Pediatr (Phila). 2005; 44:44-48.
Hogg RJ, Portman Rj, Milliner D, Lemley KV, Eddy A, Ingelfinger J. Evaluation and management of proteinuria and nephritic syndrome in children recommendations from a pediatric nephrology panel established at the National Kidney Foundation Conference on Proteinuria, Albuminuria, Risk, Assessment, Detection, and Elimination (PARADE). Pediatrics. 2000; 105: 1242-1249.
Trachtman H, Bergwerk A, Gauthier B. Isolated Proteinuria in Children: Natural History and Indications for Renal Biopsy. Clin Pediatr August 1994 vol. 33 no. 8 468-472