Paeds Cases · nephrology-urology-fluids-and-electrolytes
Proteinuria: diagnostic approach — case
A clinical reasoning case on a 14-year-old girl found to have proteinuria at a school sports screen, applying the repeat first-morning confirmation discipline, the quantification with UPr/Cr, the classification of orthostatic proteinuria, and the long-term monitoring plan.
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RACP DCEMRCPCH ClinicalABP General Pediatrics
Prompt
A 14-year-old girl with proteinuria on a school sports screen dipstick, asymptomatic, with a normal blood pressure, whose daytime dipsticks remain positive but whose first-morning UPr/Cr is normal.
Vignette
A 14-year-old girl is found to have 1+ protein on a dipstick at a school sports screen. She is asymptomatic, trains as a long-distance runner, and has no oedema, haematuria or family history of renal disease. Her blood pressure is at the 50th centile for age, sex and height. [6]
References5ShowHide
- [1]Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int, 2024.PMID 38490803
- [2]Hogg RJ; Portman RJ; Milliner D; Lemley KV; Eddy A; Ingelfinger J Evaluation and management of proteinuria and nephrotic 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.PMID 10835064
- [4]Shin JI; Park SJ Re-evaluation of orthostatic proteinuria in children and adolescence: beyond the benign prognosis. Pediatr Nephrol, 2026.PMID 42420526
- [5]Pasini A; Nardini B; Alberici I; Pillon R; Fabbrizio B; Massella L Proteinuria in adolescence. Pediatr Nephrol, 2026.PMID 41553433
- [6]Leung AK; Wong AH; Barg SS Proteinuria in Children: Evaluation and Differential Diagnosis. Am Fam Physician, 2017.PMID 28290633