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Approach to the Child with Hematuria and/or Proteinuria

Pediatric Nephrology

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Abstract

Hematuria and proteinuria are among the common reason why children are referred to a pediatric nephrologist. The initial step in a child with hematuria is to establish the diagnosis by performing a urine microscopy to look for the presence of >5 RBC/microliter in a fresh uncentrifuged urine specimen. The prevalence of isolated hematuria is reported to be 0.4–0.5% in large epidemiological studies. There is increasing evidence that persistent hematuria, particularly if associated with proteinuria, is a risk factor for chronic kidney disease in the longer term. Therefore, careful history and clinical examination is important so that appropriate investigations are undertaken to identify the etiology. Glomerular causes of hematuria (glomerulonephritis and familial hematuria) are more common in children than lower tract causes of hematuria (cystitis and hypercalciuria). There is increasing role for genetic testing in children with hematuria, particularly where there is family history of hematuria, deafness, or chronic kidney disease. Imaging (ultrasound and CT scan) is important if urolithiasis or a structural abnormality is suspected.

Proteinuria can be nonpathological (febrile, exercise, or orthostatic) or pathological. Children with persistent proteinuria can be asymptomatic or they can present with nephrotic syndrome. Spot first morning urine sample for urine protein: creatinine ratio (PCR), or albumin: creatinine ratio (ACR) is the ideal test to confirm the presence of proteinuria. Children with urine PCR >50 mg/mmol (>1 g/1.73 m2/day) merit further evaluation in order to exclude significant pathology like primary or secondary glomerulonephritis. Renal biopsy should be considered in children with persistent proteinuria, especially if it is associated with hematuria, reduced GFR, or hypertension.

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Authors and Affiliations

  1. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Hui-Kim Yap

  2. Department of Paediatric Nephrology, Royal Manchester Children’s Hospital, Manchester, UK

    Mohan A. Shenoy

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  1. Hui-Kim Yap
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  2. Mohan A. Shenoy
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Correspondence to Hui-Kim Yap .

Editor information

Editors and Affiliations

  1. Division of Nephrology, Bambino Gesù Children’s Hospital –, ROMA, Roma, Italy

    Francesco Emma

  2. Division of Nephrology and Hypertension The Heart Institute, University of Cincinnati Cincinnati Children’s Hospital Medical C, Cincinnati, OH, USA

    Stuart Goldstein

  3. Division of Nephrology, All India Institute of Medical Sciences, Ansari Nagar East, Delhi, India

    Arvind Bagga

  4. Division of Pediatric Nephrology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Carlton M. Bates

  5. Renal Unit, Graet Ormond Street Hospital, London, UK

    Rukshana Shroff

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Yap, HK., Shenoy, M.A. (2021). Approach to the Child with Hematuria and/or Proteinuria. In: Emma, F., Goldstein, S., Bagga, A., Bates, C.M., Shroff, R. (eds) Pediatric Nephrology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27843-3_89-1

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  • DOI: https://doi.org/10.1007/978-3-642-27843-3_89-1

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  1. Latest

    Approach to the Child with Hematuria and/or Proteinuria
    Published:
    04 March 2022

    DOI: https://doi.org/10.1007/978-3-642-27843-3_89-2

  2. Original

    Approach to the Child with Hematuria and/or Proteinuria
    Published:
    27 October 2021

    DOI: https://doi.org/10.1007/978-3-642-27843-3_89-1

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