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Clinical practice

Proteinuria

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Abstract

Proteinuria detection in children is a challenge. Five percent to 15% and 0.4–1% of school children present either transient (benign) or persistent increased amount of protein in urine, respectively. Persistent proteinuria constitutes not only a sign of overt kidney disease but may also be the first indicator of silent renal damage. Proteinuria is a marker for hyperfiltration in individuals with reduced nephron mass and one of the most important independent risk factor for renal disease progression as well. It constitutes the single most important risk factor for future loss of kidney function, preceding glomerular filtration rate reduction. Further, proteinuria itself is diagnostic of cardiovascular disease with prognostic value and target organ involvement in high-risk populations such as diabetic, obese, hypertensive children, or those with known reduced renal mass or previous renal injury. Current strategies to prevent CKD progression, a concept known as renoprotection, are focused on reducing urinary protein excretion among other factors. Reversibility of organ damage in early stages is possible; therefore, pediatricians should screen children for proteinuria or microalbuminuria, mainly in high-risk groups.

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References

  1. Abitbol CL, Chandar J, Onder AM et al (2006) Profiling proteinuria in pediatric patients. Pediatr Nephrol 21:995–1002

    Article  PubMed  Google Scholar 

  2. Ardissino G, Dacco V, Testa S et al (2003) Epidemiology of chronic renal failure in children: data from the ItalKid Project. Pediatrics 111:382–287

    Article  Google Scholar 

  3. Brandt JR, Jacobs A, Raissy HH et al (2010) Orthostatic proteinuria and the spectrum of diurnal variability of urinary protein in healthy children. Pediatr Nephrol 25:1131–1137

    Article  PubMed  Google Scholar 

  4. Chadban SJ, Atkins RC (2005) Glomerulonephritis. Lancet 365:1797–1806

    Article  CAS  PubMed  Google Scholar 

  5. Cho HY, Lee BH, Choi HJ et al (2008) Renal manifestations of Dent disease and Lowe syndrome. Pediatr Nephrol 23:243–249

    Article  PubMed  Google Scholar 

  6. Copelovitch L, Nash MA, Kaplan BS (2007) Hypothesis: Dent disease is an underrecognized cause of focal glomerulosclerosis. Clin J Am Soc Nephrol 2:914–918

    Article  CAS  PubMed  Google Scholar 

  7. Dent CE, Friedman M (1964) Hypercalciuric rickets associated with renal tubular damage. Arch Dis Child 39:240–249

    Article  CAS  PubMed  Google Scholar 

  8. Eddy AA, Symonds JM (2003) Nephrotic syndrome in childhood. Lancet 23:629–639

    Article  Google Scholar 

  9. Edström Halling S (2010) Predictors of outcome in Henoch-Schönlein nephritis. Pediatr Nephrol 25(6):1101–1108

    Article  PubMed  Google Scholar 

  10. Frymoyer PA, Scheinman SJ, Dunham PB et al (1991) X-linked recessive nephrolithiasis with renal failure. N Engl J Med 325:681–686

    Article  CAS  PubMed  Google Scholar 

  11. Glassock RJ (2005) Hematuria and proteinuria. In: Greenberg A, Cheung AK, Coffman TM, Falk RJ, Jennette JC (eds) Primer on kidney disease: National Kidney Foundation, 4th edn. Saunders, Philadelphia, pp 36–46

    Google Scholar 

  12. Gorman D, Sochett E, Daneman D (1999) The natural history of microalbuminuria in adolescents with type I diabetes. J Pediatr 134:333–337

    Article  CAS  PubMed  Google Scholar 

  13. Haraldsson B, Nystrom J, Deen WM (2008) Properties of the glomerular barrier and mechanisms of proteinuria. Physiol Rev 88:451–487

    Article  CAS  PubMed  Google Scholar 

  14. Hogg R (2009) Screening for CKD in children: a global controversy. Clin J Am Soc Nephrol 4:509–515

    Article  CAS  PubMed  Google Scholar 

  15. Hogg RJ, Portman RJ, Milliner D et al (2000) Evaluation and management of proteinuria and nephrotic syndrome in children: recommendations from a pediatric nephrology panel established at the National Kidney Foundation Conference on proteinuria, albuminuria, risk, assessment, detection, and elimination (PARADE). Pediatrics 105:1242–1249

    Article  CAS  PubMed  Google Scholar 

  16. Hoopes RR Jr, Shrimpton AE, Knohl SJ et al (2005) Dent disease with mutations in OCRL1. Am J Hum Genet 76:260–267

    Article  CAS  PubMed  Google Scholar 

  17. Houser MT (1984) Assessment of proteinuria using random urine samples. J Pediatr 104:845–848

    Article  CAS  PubMed  Google Scholar 

  18. Jensen JS, Feldt-Rasmussen B, Strandgaard S et al (2000) Arterial hypertension, microalbuminuria and risk of ischemic heart disease. Hypertension 35:898–903

    CAS  PubMed  Google Scholar 

  19. Litwin M, Grenda R, Sladowska J, Antoniewicz J (2006) Add-on therapy with angiotensin II receptor 1 blocker in children with chronic kidney disease already treated with angiotensin-converting enzyme inhibitors. Pediatr Nephrol 21:1716–1722

    Article  PubMed  Google Scholar 

  20. Locatelli F, Marcelli D, Comelli M et al (1996) Proteinuria and blood pressure as causal components of progression to end-stage-kidney failure. Northern Italian Cooperative Study Group. NDT 11:461–467

    CAS  Google Scholar 

  21. Loi M (2006) Lowe syndrome. Orphanet J Rare Dis 1:16

    Article  PubMed  Google Scholar 

  22. Norden AGW, Scheinman SJ, Deschodt-Lanckman MM et al (2000) Tubular proteinuria defined by a study of Dent’s (CLCN5 mutation) and other tubular diseases. Kidney Int 57:240–249

    Article  CAS  PubMed  Google Scholar 

  23. Quigley R (2008) Evaluation of hematuria and proteinuria: how should a pediatrician proceed? Curr Opin Pediatr 20:140–144

    Article  PubMed  Google Scholar 

  24. Rademacher ER, Sinaiko AR (2009) Albuminuria in children. Curr Opin Nephrol Hypertens 18:246–251

    Article  CAS  PubMed  Google Scholar 

  25. Ramaswami U, Najafian B, Schieppati A et al (2010) Assesment of renal pathology and dysfunction in children with Fabry Disease. Clin J Am Soc Nephrol 5:365–370

    Article  PubMed  Google Scholar 

  26. Ritz E (1999) Nephropathy in patients with type 2 diabetes mellitus. N Eng J Med 341:1127–1133

    Article  CAS  Google Scholar 

  27. Reichel H, Zeier M, Ritz E (2004) Proteinuria after renal transplantation: pathogenesis and management. NDT 19:301–305

    Article  Google Scholar 

  28. Salgado CM, Jardim PC, Teles FB, Nunes MC (2009) Influence of low birth weight on microalbuminuria and blood pressure of school children. Clin Nephrol 71(4):367–374

    CAS  PubMed  Google Scholar 

  29. Savino A, Pelliccia P, Chiarelli F, Mohn A (2010) Obesity-related renal injury in childhood (2010). Horm Res Paediatr 73:303–311

    Article  CAS  PubMed  Google Scholar 

  30. Seeman T, Dusek J, Vondrak K et al (2009) Profiling proteinuria in children after renal transplantation. Pediatr Nephrol 24:2439–2444

    Article  PubMed  Google Scholar 

  31. TØndel C, Bostad L, Hirth A, Svarstad E (2008) Renal biopsy findings in children and adolescents with Fabry Disease and minimal albuminuria. Am J Kidney Dis 51:767–776

    Article  PubMed  Google Scholar 

  32. Tomlinson PA, Dalton RN, Turner C, Chantler C (1990). Measurement of beta 2-microglobulin, retinol-binding protein, alpha 1-microglobulin and urine protein 1 in healthy children using enzyme-linked immunosorbent assay. Clin Chem Acta 192(2):99–106

    Article  CAS  Google Scholar 

  33. Yap HK, Lau YW (2008) Hematuria and proteinuria. In: Geary DF, Schaefer F (eds) Comprehensive pediatric nephrology. Elsevier, Philadelphia, pp 179–193

    Chapter  Google Scholar 

  34. Van Dyck M, Proesmans W (2004) Renoprotection by ACE inhibitors after severe hemolytic uremic syndrome. Pediatr Nephrol 19:688–690

    Article  PubMed  Google Scholar 

  35. Viberti GC, Hill RD, Jarrett RJ et al (1982) Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet 1:1430–1432

    Article  CAS  PubMed  Google Scholar 

  36. Wühl E, Schaefer F (2008) Therapeutic strategies to slow chronic disease progression. Pediatr Nephrol 23:705–716

    Article  PubMed  Google Scholar 

  37. Wühl E, Trivelli A, Picca S, The escape trial group et al (2009) Strict blood-pressure control and progression of renal failure in children. N Engl J Med 361:1639–1650

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Hospital de Cruces, School of Medicine, University of The Basque Country, P/Cruces s/n. 48903, Baracaldo, Vizcaya, Spain

    Gema Ariceta

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  1. Gema Ariceta
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Correspondence to Gema Ariceta.

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Ariceta, G. Clinical practice. Eur J Pediatr 170, 15–20 (2011). https://doi.org/10.1007/s00431-010-1334-0

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  • DOI: https://doi.org/10.1007/s00431-010-1334-0

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