PERSISTENT ASYMPTOMATIC PROTEINURIA
 
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PERSISTENT ASYMPTOMATIC PROTEINURIA

 

DEFINITION:

An asymptomatic proteinuria in an apparently healthy child that occurs without hematuria and persists for 3-6 months.

EPIDEMIOLOGY:

  • incidence: prevalence is 6% of school-aged children
  • age of onset:
    • ?
  • risk factors:
    • ?

PATHOGENESIS:

1. Background

  • unknown etiology but may be a variant of orthostatic proteinuria

CLINICAL FEATURES:

1. Renal Manifestations

1. Proteinuria

  • asymptomatic
  • never associated with edema

2. Complications

  • Chronic Renal Failure
    • only in those with Focal Segmental Glomerulosclerosis

INVESTIGATIONS:

1. Urinalysis

  • proteinuria rarely exceeds 2g in 24 hours
  • no hematuria

2. Serum

  • normal BUN, creatinine, lytes, C3, C4, total protein, albumin, cholesterol, IgA

3. Renal Biopsy

1. Group 1 (53%)

  • minimal glomerular changes
    • slight mesangial proliferation

2. Group 2 (47%)

  • significant glomerular changes
    • 60% - focal segmental glomerulosclerosis (FSGS)
    • 16% - IgA Nephropathy
    • 12% - diffuse mesangial proliferative GN
    • 12% - membranous glomerulonephritis

4. Renal Imaging

  • normal renal ultrasound and function

MANAGEMENT:

1. Supportive

  • prolonged follow up with sequential urinalyses
  • biopsy: a biopsy is indicated for any child who has constant isolated proteinuria (no hematuria) lasting longer than 6 months (Yoshikawa et al., 1991)

2. Prognosis

  • a portion of those with FSGS will go on to develop chronic renal impairment

 

 

 

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