2: Peds Proteinuria

Question 1

Isolated or transient proteinuria?

Persistent asymptomatic proteinuria

Answer 1

Isolated

Question 2

What is orthostatic proteinuria?

Answer 2

Pt excretes normal amounts of protein while lying down, but abnormal amounts when upright.

Question 3

Isolated or transient proteinuria?

Cold/infx/seizure/CHF

Answer 3

Transient (functional)

Question 4

Refer to nephrology, yes or no?

Orthostatic proteinuria.

Answer 4

No

Question 5

Refer to nephrology, yes or no?

Nephrotic levels of protein.

Answer 5

Yes

Question 6

When proteinuria is significant enough to cause HYPOproteinemia, _____ occurs.

Answer 6

systemic edema

Question 7

How is orthostatic proteinuria diagnosed?

Answer 7

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.

Question 8

Refer to nephrology, yes or no?

Elevated BUN, creatinine, or BP.

Answer 8

Yes

Question 9

Isolated or transient proteinuria?

Exercise induced

Answer 9

Transient (functional)

Question 10

If proteinuria is present, what other diagnostics should be considered?

Answer 10

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

Question 11

Refer to nephrology, yes or no?

Transient nonorthostatic proteinuria with no other complications.

Answer 11

No

Question 12

T/F Fatigue, malaise, and pallor may be present with proteinuria.

Answer 12

True

Question 13

Refer to nephrology, yes or no?

Family hx of renal failure, GN or sensorineural loss.

Answer 13

Yes

Question 14

Refer to nephrology, yes or no?

Hematuria and proteinuria.

Answer 14

Yes

Question 15

Urinalysis can be falsely positive or negative for protein based on _____ and _____.

Answer 15

pH

dilution

Question 16

If protein is trace or 1+ and/or specific gravity is >1.105, then recheck monthly for _____ months.

Answer 16

4-6

Question 17

Peak incidence of proteinuria occurs in _____.

Answer 17

adolescence

Question 18

Isolated or transient proteinuria?

Orthostatic proteinuria

Answer 18

Isolated

Question 19

Isolated or transient proteinuria?

Stress-induced

Answer 19

Transient (functional)

Question 20

If first morning void shows 1+ protein, then proteinuria is not orthostatic. What are the next steps?

Answer 20

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.

Question 21

Name 2 drugs that can cause pseudo-proteinuria.

Answer 21

Semisynthetic PCN

Benzalkonium chloride

Question 22

What family hx may be present with proteinuria (3)?

Answer 22

Deafness
Visual problems
Renal dz

Question 23

What is the origin of proteinuria?

Answer 23

Problems with glomerular filtration, tubular reabsorption, secretion, or both.

Question 24

If protein is >1+, check for _____. If not present, refer pt.

Answer 24

orthostatic proteinuria

Question 25

Refer to nephrology, yes or no? | Polyuria or oliguria.

Answer 25

Yes

Question 26

Refer to nephrology, yes or no? | Presence of RBC or WBC casts.

Answer 26

Yes

Question 27

Refer to nephrology, yes or no? | Persistent unexplained nonorthostatic proteinuria.

Answer 27

Yes

Question 28

``` Refer to nephrology, yes or no? Systemic complaints (joint pain, rashes, arthralgias). ```

Answer 28

Yes

Question 29

Isolated or transient proteinuria? | Fever induced

Answer 29

Transient (functional)

Question 30

What percent of school-age children have proteinuria on urine screening?

Answer 30

5-15%. Decreases to 0.1% if 4 consecutive urines counted.

Question 31

What is the most common type of proteinuria in children and adolescents?

Answer 31

Orthostatic Proteinuria 60% in children 75% in adolescents

Question 32

Normal protein:creatinine ratio: 2 years + <2 years

Answer 32

2 years or older = <0.2 | Under 2 years = <0.5

Question 33

What are the 4 classes of proteinuria?

Answer 33

Isolated Transient (functional) Glomerular Tubulointerstitial

Question 34

``` Levels of protein in urine: Qualitative UA? Qualitative USG? Quantitative timed urine? 24-hour urine? ```

Answer 34

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

Question 35

Name 7 red flags for renal dz.

Answer 35

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

Question 36

Protein and creatinine can be done on _____ or _____ urine.

Answer 36

24-hour | spot