II. Epidemiology: ProteinuriaIncidence

  1. School aged children: 5-6%
  2. Adolescent peak: 11%

III. Causes: Benign Causes (75%)

  1. Orthostatic Proteinuria
  2. Transient Causes
    1. Fever
    2. Exercise
    3. Dehydration
    4. Congestive Heart Failure
    5. Abdominal Surgery
    6. Extreme Cold

IV. Causes: Persistant Proteinuria - Glomerular Causes

  1. Adaptive hyperfiltration to nephron losses
  2. Alport syndrome
  3. Collagen vascular disease
    1. Henoch-Schonlein Purpura
    2. Systemic Lupus Erythematosus
  4. Diabetes Mellitus
  5. Glomerulonephropathy
    1. Minimal Change Glomerulonephropathy (most common cause of pediatric Nephrotic Syndrome)
    2. Focal Segmental Glomerulosclerosis
    3. Mesangial proliferative Glomerulonephritis
    4. IgA Nephropathy
    5. Membranoproliferative Glomerulonephritis
  6. Infectious Causes
    1. Group A Beta Hemolytic Streptococcus
    2. Hepatitis B Infection
    3. Hepatitis C Infection
    4. Human Immunodeficiency Virus
    5. Mononucleosis
    6. Malaria
    7. Syphilis
  7. Miscellaneous causes
    1. Lymphoma
    2. Solid Cancers
    3. Mercury Poisoning

VI. Labs: Initial for Persistent Proteinuria

  1. Urinalysis (first morning void) with microscopy
    1. See Urine Protein
    2. Consider ambulatory and recumbent Urinalysis
  2. Urine Protein to Creatinine Ratio (random urine)
  3. Urine Protein 24 Hour collection
  4. Comprehensive Metabolic Panel (electrolytes, Glucose, Renal Function tests, Serum Protein and albumin)
  5. Complete Blood Count with platelets
  6. Total Cholesterol
  7. Complement level (C3, C4)
  8. Anti-streptolysin O titer (ASO Titer)
  9. Antinuclear Antibody (ANA)

VII. Labs: As Indicated

  1. Hepatitis Serology
  2. Toxin levels (Mercury, Lead, Copper)

VIII. Imaging

  1. Renal Ultrasound

IX. Management: Referral Indications

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