Proteinuria In Children

Haematuria may be microscopic or visible and can originate anywhere from the glomerulus to the urethra.

The central clinical distinction is between glomerular and nonglomerular haematuria.

Glomerular haematuria often produces uniformly dark, tea or cola coloured urine and may accompany proteinuria, oedema or hypertension.

Lower tract bleeding more often produces bright red urine, clots, dysuria or urinary frequency.

• Confirm blood using urine microscopy because dipstick also detects free haemoglobin and myoglobin.

• Assess urine protein.

• Measure blood pressure.

• Check renal function.

Dysmorphic red cells and red cell casts suggest glomerular bleeding.

Consider:

• Urine calcium to creatinine ratio
• Complement
• Streptococcal serology
• Renal ultrasound
• Autoimmune investigations

depending on presentation.

Treatment is cause specific.

Isolated transient microscopic haematuria after exercise or minor illness may only require repeat urinalysis.

Persistent haematuria accompanied by proteinuria, hypertension, impaired renal function or abnormal complement warrants paediatric nephrology evaluation.