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Quick reference medical handouts used by Pediatric offices

Proteinuria in Children

Proteinuria is the medical term to describe a condition in which the urine contains abnormal amounts of protein


Proteinuria is the medical term to describe a condition in which the urine contains protein. Proteins play an important role in children and adults: they are the building blocks for body parts, they protect from the body from infection, they assist in blood clotting and help regulate the amount of fluid.

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Proteinuria is a common laboratory finding in children. It can be identified as either a transient or a persistent finding and can represent a benign condition or a serious disease.
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Healthy kidneys filter the blood, removing waste products and retaining essential nutrients, like proteins. Therefore, protein should not normally appear in the urine in detectable amounts.  When the kidneys are damaged, protein molecules slip through the kidney's filtering system and appear in the urine. Diseases and inflammation that affect the filtering units themselves are the most common cause of large amounts of protein in the urine, often referred to as "glomerulonephritis."

Protein is detected in the urine by dipping a special strip of paper into the urine sample. Finding a large amount of protein in the urine is usually important, requiring further evaluation. Sometimes low levels of proteinuria are an early sign of kidney disease, but when only a little protein is found in the urine, a child probably has a harmless condition such as orthostatic proteinuria.  Other examples of finding protein in the urine that is not important is when protein appears in the urine only after strenuous exercise, or it only occurs when the child has a fever.

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Orthostatic proteinuria, which accounts for up to 60 percent of all cases of asymptomatic proteinuria in children, has an excellent prognosis.
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Orthostatic proteinuria is the cause of proteinuria in many youngsters. Children with this condition have no kidney damage or disease, but for some unknown reason, lose protein in the urine during the day when they are active and standing up (hence the name "orthostatic," which means "upright.") The diagnosis of this harmless condition is made by testing two urine samples, one first thing in the morning after the child gets up, and the second test taken during the day. If the child has "orthostatic proteinuria" the morning sample will be free of protein while the sample collected during the day will test positive for protein. No treatment is needed for children with orthostatic proteinuria. Most physicians, however, will want to check your child's urine a few times a year,  just to be on the safe side.

Most children with proteinuria have no signs or symptoms and the condition might have gone undetected if the urine had not been checked.  Therefore, the urinalysis is an important test in monitoring your youngster's health and well-being. If there is a large amount of protein in your child's urine, then the youngster's doctor might refer him or her  to a kidney specialist ("nephrologist") for further tests and evaluation. Once the specialist finds out what is causing the protein in your child's urine, the doctor can find the best way to treat the problem.

In general, the finding of proteinuria during a routine examination in a child's urinalysis should not cause parents to become too alarmed nor does it mean an automatic referral to a specialist for more extensive tests. Only if there are multiple positive urine tests on different occasions should a more thorough evaluation take place. This might include collecting a 24-hour urinalysis and/or evaluation by a specialist. 

Two common medical causes of Proteinuria in Children

Nephrotic Syndrome: is a medical condition in which the kidneys leak protein into the urine. The "basement membrane" of the kidney's filtering system, the glomeruli,  becomes leaky to proteins and these spill out into the urine. The resultant low blood protein levels cause water to build up in the tissues and the child becomes quite puffy. This disease often follows a routine viral respiratory illness; the cause is not known but is assumed to be an auto-immune phenomenon. In the majority of cases the illness is self-limited. Steroids often produce rapid improvement. Sometimes nephrosis is part of a larger problem of inflammation of the kidney, and then favorable prognosis is more uncertain.

Acute postinfectious glomerulonephritis is an inflammation of the kidney (glomeruli) following a streptococcal infection such as strep throat. Symptoms of acute poststreptococcal glomerulonephrists include: 
  • fluid accumulation and tissue swelling initially in the face and around the eyes, later in the legs
  • low urine output (oliguria)
  • blood in the urine (hematuria)
  • protein in the urine (proteinuria)
  • high blood pressure
  • joint pain or stiffness

Most children (up to 95 percent) fully recover  in a matter of weeks or months.

posted 09-10-03 on


As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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