Orthostatic proteinuria

• This is the commonest cause of proteinuria in children
• It is generally benign and requires no active management
• It typically presents in adolescence

Transient proteinuria

• Children will often be found to have proteinuria incidentally when being investigated
• Commonest causes are concurrent infections or a recent seizure
• This is benign and usually self-limiting, with the proteinuria receding as the precipitant is treated

Nephrotic syndrome

• When children have 3+ proteinuria on dipstick it is worth consider whether the patient has nephrotic syndrome
• The commonest cause in children is idiopathic nephrotic syndrome (minimal change disease) and they should be started empirically on steroids
• Pathophysiology - defect in filtration barrier causing increased permeability = loss of albumin and protein and 3rd spacing of fluid (oedema)
• Management - controlling fluid input using albumin to allow concentration gradients to help with fluid reabsorption. steroids is the definitive Tx

Type 1 diabetes mellitus

• Just like in adults, poorly controlled diabetes can result in diabetic glomerulopathy.
• Good control of diabetes can limit its progression.

Management

• For any child with proteinuria, at least two separate urine samples should be sent for protein:creatinine ratios with one sample being an early morning sample.
• All patients should have their blood pressure measured at rest to ensure they aren't hypertensive