Proteinuria: diagnostic approach — viva

Stage 1 — The asymptomatic adolescent

Examiner: A 14-year-old girl is found to have 1+ protein on a dipstick at a school sports screen. She is well. Take me through your diagnostic approach. ^[6]

Expected thread: Resist the single-dipstick diagnosis. Confirm the proteinuria on repeat first-morning urine samples taken weeks apart when she is well, because a single reading during activity is most likely transient (functional) proteinuria. State that the first-morning sample is the test because it is passed after overnight recumbency and a normal value excludes orthostatic proteinuria. If the daytime dipsticks remain positive but the first-morning UPr/Cr is normal, classify the pattern as orthostatic (postural) proteinuria. Measure her blood pressure against paediatric centiles and examine for oedema and growth failure before deciding between monitoring and referral. ^[2]