Hematuria and Proteinuria in Children

Abstract

Practice Gap: Pediatricians must be aware of screening indications and the evaluation

and management of a child with hematuria and/or proteinuria.

Objectives: 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.

Figure 1

Approach to a child with microscopic hematuria. Caution items warrant urgent consultation with a nephrologist. AKI=acute kidney injury; BP=blood pressure; BUN=blood urea nitrogen; CKD= chronic kidney disease; Cr=creatinine; ESRD=end-stage renal disease; HTN=hypertension; UA=urinalysis. (Adapted from refs , , , and 17)

Figure 2

Approach to a child with asymptomatic proteinuria. Caution items warrant urgent consultation with a nephrologist. ANA=antinuclear antibody; AKI=acute kidney injury; BP=blood pressure; BUN=blood urea nitrogen; C3=complement component 3; C4=complement component 4; Ca/Cr=calcium/creatinine; CKD=chronic kidney disease; ESRD=end-stage renal disease; HPF=high-power field; HTN=hypertension; RBC=red blood cell; UA=urinalysis; U p/c=urine protein/creatinine ratio. (Adapted from refs , , , and .)