Hematuria and Proteinuria in Children

1. Bernarda Viteri, MD* 2. Jessica Reid-Adam, MD* 1. *Icahn School of Medicine at Mount Sinai, New York, NY * Abbreviations: AS: : Alport syndrome CKD: : chronic kidney disease CNS: : congenital nephrotic syndrome ESRD: : end-stage renal disease FSGS: : focal segmental glomerular sclerosis GN: : glomerulonephritis HSP: : Henoch-Schonlein purpura HPF: : high-power field Ig: : immunoglobulin LMW: : low molecular weight MCD: : minimal change disease RBC: : red blood cell SLE: : systemic lupus erythematosus UA: : urinalysis U p/c: : urine protein/creatinine ratio Pediatricians must be aware of screening indications and the evaluation and management of a child with hematuria and/or proteinuria. After completing this article, readers should be able to: 1. Understand the common causes of proteinuria and hematuria and be able to differentiate between benign and serious causes. 2. Describe screening techniques for initial evaluation of hematuria and proteinuria. 3. Recognize the criteria for diagnosis of proteinuria and hematuria. 4. Plan the appropriate initial evaluation for hematuria and proteinuria and interpret laboratory findings essential for diagnosis. 5. Recognize serious causes of hematuria and proteinuria that warrant immediate referral. Hematuria and proteinuria are common findings in primary care practice. Although the American Academy of Pediatrics eliminated routine urine screening from its preventive care guidelines a decade ago, many pediatricians continue to use screening urinalysis (UA) as part of their health supervision visits. Most pediatric patients who are diagnosed as having hematuria or proteinuria through screening UA do not have renal disease, and abnormal findings usually resolve on repeated testing. However, hematuria or proteinuria that persists on repeated testing warrants additional evaluation, and, depending on history along with initial evaluation in the primary care office, may warrant referral to a pediatric nephrologist for further management. Although guidelines put forth by the American Academy of Pediatrics do not recommend yearly evaluation of urine by dipstick analysis for children, regular routine screening of pediatric populations has been established in Japan, Taiwan, and Korea. (1)(2)(3)(4) Our practice recommends screening of certain patient populations at increased risk for renal disease over a lifetime (Table 1 …