Proteinuria in Children: Advice for Referrers

RHC for Health Professionals
NHS GGC

Proteinuria in children is commonly detected and often benign. Low levels of proteinuria are very common in children during intercurrent febrile illnesses of any cause. If this resolves when the child is well, it is not concerning and does not require referral to secondary or tertiary care. However, persistent proteinuria when well warrants further investigation.

Who to refer

Indications for routine referral:         

  • Persistent proteinuria
    • Early morning urine protein: 

      • For children aged 2 years and over, >20mg/mmol creatinine on three separate occasions, taken when child is otherwise well

        For children aged >6 months to <24 months, >50mg/mmol creatinine on three separate occasions, taken when child is otherwise well

Red Flag Indications for acute referral and discussion with Paediatric Nephrology:   

  • Peripheral oedema
  • Urine Protein: Creatinine Ratio >200 mg/mmol creatinine (nephrotic range)
    • Note - this is acceptable during acute febrile illness. In the absence of other symptoms repeat and refer if remains >200 mg/mmol creatinine
  • Personal history of nephrotic syndrome
  • Hypoalbuminaemia (albumin <25 g/L) if checked

Who not to refer

A child with an isolated episode of proteinuria particularly if checked at a time of intercurrent illness.

Please include the following points from history in the referral letter

  • What symptoms (if any) does the child have?
  • Why was initial dipstick performed (is this an incidental pick-up?)
  • Family history of kidney disease
  • Personal history of inflammatory or auto-immune disease
  • Association with viral illnesses, urinary tract infection

Please include the following points from the clinical examination in the referral letter

  • What are the findings on clinical examination?
  • Is there any evidence of oedema?
  • Is the child otherwise well and thriving?
  • Any other findings on urinalysis?
  • Measure blood pressure if possible, and appropriate sized cuff available
  • Weight and height of child

Initial Investigations prior to referral

  • Please undertake an early morning protein: creatinine ratio and include result in your referral
  • If the child is of an age where it is possible in primary care, please could you send bloods for FBC/U+E/LFT/Bone profile /Mg, and include results in the referral

Useful resources for parents while awaiting out-patient appointment

https://www.infokid.org.uk/conditions/proteinuria/

Useful resources for health professionals

AAFP: Proteinuria in Children: Evaluation and Differential Diagnosis

 

Editorial Information

Last reviewed: 25/11/2024

Next review date: 30/11/2029

Author(s): Dr Peter Schulga, Paediatric Nephrology GRID trainee; Dr Allison Mckie, Medical Paediatric Consultant.

Approved By: Medical Paediatrics