2: Peds Proteinuria Flashcards
Isolated or transient proteinuria?
Persistent asymptomatic proteinuria
Isolated
What is orthostatic proteinuria?
Pt excretes normal amounts of protein while lying down, but abnormal amounts when upright.
Isolated or transient proteinuria?
Cold/infx/seizure/CHF
Transient (functional)
Refer to nephrology, yes or no?
Orthostatic proteinuria.
No
Refer to nephrology, yes or no?
Nephrotic levels of protein.
Yes
When proteinuria is significant enough to cause HYPOproteinemia, _____ occurs.
systemic edema
How is orthostatic proteinuria diagnosed?
Compare first morning void with UA obtained during the day. If <1+, no further workup is needed. Repeat urine for 3 months up to 1 year. This is a benign condition.
Refer to nephrology, yes or no?
Elevated BUN, creatinine, or BP.
Yes
Isolated or transient proteinuria?
Exercise induced
Transient (functional)
If proteinuria is present, what other diagnostics should be considered?
CBC Electrolytes, BUN, creatinine Albumin, total serum protein Liver function tests C3, C4 Cholesterol Urine culture (rule out UTI) Renal US, VCUG, radionuclide scans if indicated ANA ASO Streptozyme Hepatitis B HIV Tuberculosis
Refer to nephrology, yes or no?
Transient nonorthostatic proteinuria with no other complications.
No
T/F Fatigue, malaise, and pallor may be present with proteinuria.
True
Refer to nephrology, yes or no?
Family hx of renal failure, GN or sensorineural loss.
Yes
Refer to nephrology, yes or no?
Hematuria and proteinuria.
Yes
Urinalysis can be falsely positive or negative for protein based on _____ and _____.
pH
dilution
If protein is trace or 1+ and/or specific gravity is >1.105, then recheck monthly for _____ months.
4-6
Peak incidence of proteinuria occurs in _____.
adolescence
Isolated or transient proteinuria?
Orthostatic proteinuria
Isolated
Isolated or transient proteinuria?
Stress-induced
Transient (functional)
If first morning void shows 1+ protein, then proteinuria is not orthostatic. What are the next steps?
Perform 24-hr urine protein excretion test.
Or perform random spot protein/creatinine ratio.
If hematuria present, work up for nephritis.
Close follow-up is essential.
Refer if persistent.
Name 2 drugs that can cause pseudo-proteinuria.
Semisynthetic PCN
Benzalkonium chloride
What family hx may be present with proteinuria (3)?
Deafness
Visual problems
Renal dz
What is the origin of proteinuria?
Problems with glomerular filtration, tubular reabsorption, secretion, or both.
If protein is >1+, check for _____. If not present, refer pt.
orthostatic proteinuria
Refer to nephrology, yes or no?
Polyuria or oliguria.
Yes
Refer to nephrology, yes or no?
Presence of RBC or WBC casts.
Yes
Refer to nephrology, yes or no?
Persistent unexplained nonorthostatic proteinuria.
Yes
Refer to nephrology, yes or no? Systemic complaints (joint pain, rashes, arthralgias).
Yes
Isolated or transient proteinuria?
Fever induced
Transient (functional)
What percent of school-age children have proteinuria on urine screening?
5-15%. Decreases to 0.1% if 4 consecutive urines counted.
What is the most common type of proteinuria in children and adolescents?
Orthostatic Proteinuria
60% in children
75% in adolescents
Normal protein:creatinine ratio:
2 years +
<2 years
2 years or older = <0.2
Under 2 years = <0.5
What are the 4 classes of proteinuria?
Isolated
Transient (functional)
Glomerular
Tubulointerstitial
Levels of protein in urine: Qualitative UA? Qualitative USG? Quantitative timed urine? 24-hour urine?
Qualitative UA 1+ abnormal
Qualitative USG >1.105 abnormal
Quantitative timed urine <4 mg/m2/hr normal
24-hour urine <150 mg/24 hr normal
Name 7 red flags for renal dz.
Failure to thrive
Chronic anemia (normocytic, normochromic)
Complicated enuresis
Prolonged unexplained nausea and vomiting, inability to eat, weight loss
Hypotension
Unusual bone disease
Poor school performance
Protein and creatinine can be done on _____ or _____ urine.
24-hour
spot
