It is normal for healthy children to excrete 150 mg of protein in urine per day (24 hours). This amount of proteinuria is shown as “negative” in urine dipsticks and other methods that measure urine protein. The presence of more than normal protein in the urine in children is called proteinuria and is often considered a symptom of kidney disease. When proteinuria is detected, the main difficulty is to find an answer to the question of whether this is a temporary or benign proteinuria or whether it is caused by a significant kidney disease.
Proteinuria in children with a dipstick; negative, trace, 1+, 2+, 3+ and 4+. With biochemical methods, these positivity; trace proteinuria: 15-30 mg/dl, 1+ proteinuria: between 30-100 mg/dl, 2+ proteinuria: 100-300 mg/dl, 3+ proteinuria: 300-1000 mg/dl and 4+ proteinuria: >1000 It is considered equivalent to mg/dl. The reasons for false positive proteinuria with the dipstick, that is, falsely showing proteinuria when it is not actually present; excessively concentrated urine, alkaline urine, antiseptics and substances used in radiology filming are mixed into the urine. For this reason, if radiological imaging is performed by administering contrast material, testing the urine for proteinuria before 24 hours will give misleading results.
The method that can be used to detect proteinuria in older children is to measure 24-hour urine protein. To do this, 24 hours of urine is collected from the child and the amount of protein obtained in the biochemistry laboratory is calculated with the formula. 24-hour urine protein is below 4 mg/m2/hour in normal healthy children. Nephritis proteinuria is mild to moderate and is between 4-40 mg/m2/hour; Nephrotic (severe) proteinuria is proteinuria above 40 mg/m2/hour. However, since it is difficult and sometimes impossible to collect 24-hour urine in young children, proteinuria level can be evaluated by looking at the protein/creatinine ratio in instant urine. Spot urine protein/creatinine ratio below 0.2 means normal, between 0.2-2.0 means nephritis proteinuria, and above 2.0 means nephrotic (severe) proteinuria.
Proteinuria in children can be temporary or permanent. Proteinuria can be a benign condition or a warning sign of a condition such as nephritis, systemic disease, or chronic kidney disease. light alone Although f proteinuria is usually a benign condition, persistent proteinuria that gradually increases in amount may be taken as a sign of progressive kidney disease. Transient proteinuria is not due to a kidney disease, but often develops as a result of fever, exercise, stress or fluid loss from the body, and proteinuria improves when these causes pass.
Orthostatic proteinuria is where proteinuria occurs in the standing position in children with no additional disease symptoms. It is a harmless condition that improves in the lying position. Orthostatic proteinuria is seen in 2-5% of older children and adolescents. The absence of proteinuria in night urine (the first urine taken in the morning) and the presence of proteinuria in urine samples taken during the day confirms this diagnosis. It is mostly seen in adolescents, has a benign course and improves in the lying position. The cause is unknown, his future is good and there is no need for treatment.
When evaluating a pediatric patient with proteinuria, the following points should be taken into consideration: While taking the patient's history; Body swelling, headache, blood in the urine (hematuria), joint pain, skin rash, increased blood pressure, urinary tract infection, recent throat or skin infection, loss of appetite, weight loss and recent medications should be questioned. In the family history, it should be questioned whether family members have cystic kidney disease, deafness, visual impairment, kidney disease, kidney failure or dialysis. If there is a urinary tract infection with proteinuria on urinalysis, and proteinuria still persists after the infection is treated, further investigations should be performed. A pediatric patient with persistent proteinuria and a protein/creatinine ratio >1 in spot urine should be referred to a Pediatric Nephrologist.
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