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What is proteinuria?

Proteinuria is when protein is found in the urine. As blood moves through the kidneys, the kidneys filter out waste, excess fluid and salt. These wastes leave the body in urine. Usually, no protein is found in urine because most proteins are too big to go through the kidneys.

If your healthcare provider finds protein in your child’s urine, it means your child’s kidneys may not be working as they should—possibly because of inflammation (swelling). Sometimes infection or chemicals damage the kidneys, and this makes protein show up in the urine.

If there is only a little protein in the urine, your child probably has a benign (harmless) condition such as orthostatic proteinuria (see below). If a lot of protein is found in your child’s urine, a more serious kidney disease might be the problem. Proteinuria doesn’t cause pain. But when a lot of protein is in the urine, the level of protein in the blood may go down. This can cause swelling in your child’s eyelids, ankles and legs. High blood pressure is another sign of this problem.

How is proteinuria diagnosed?

Your healthcare provider may ask you to collect a 24-hour urine sample from your child. Directions for doing this are at the end of this handout. A 24-hour urine collection lets your healthcare provider measure the protein in the urine. A special strip of paper is dipped into a sample of urine to check for protein. This test helps show how well your child’s kidneys are working. Your healthcare provider may also do some blood tests.

What is orthostatic proteinuria?

Orthostatic proteinuria occurs in some older children and teenagers. The word orthostatic means “upright.” The condition is called “orthostatic proteinuria” because protein goes into the urine only when the child is standing up.  Children who have this condition have no kidney damage but, for some unknown reason, they lose protein into the urine during the day when they are active. At night, while they sleep, their kidneys don’t let any protein into the urine.

Your healthcare provider diagnoses this harmless condition by checking 2 urine samples. The first is collected in the morning, right after your child gets up. The second sample is collected throughout the day. The samples are kept in separate containers. If your child has orthostatic proteinuria, the morning sample won’t have protein in it, but the urine collected during the day will have protein in it.

How is proteinuria treated?

If your child has orthostatic proteinuria or only small amounts of protein in the urine, no treatment is needed. Sometimes your healthcare provider will check your child’s urine again after a few months to see whether the amount of protein in the urine goes down. If the amount of protein in the urine doesn’t change or if there is more protein, your healthcare provider may send your child to a kidney specialist (called a nephrologist). The nephrologist may perform a kidney biopsy. (A small piece of kidney tissue is taken out using a needle, and looked at under a microscope.) When your healthcare provider finds out what causes the protein in your child’s urine, they can treat the problem.

No matter what caused the kidney problem, a few simple things can help your child. Eating less salt can reduce the swelling. Medicine can control the inflammation (swelling) of the kidneys that may be causing protein to get into the urine. The medicine is usually given in a high dose at first, and in a lower dose later on. Some children take a low dose of medicine for months, or even years. It’s important to follow your healthcare provider’s instructions about taking the medicine. It’s also important to visit your child’s healthcare provider for regular checkups.

Do I need to restrict my child’s activities?

No. Although protein in the urine can increase during exercise, this won’t hurt your child’s kidneys. So you don’t need to limit your child’s activities.

How do I do a 24-hour urine collection?

In children who are potty-trained, you should start the collection on a day when your child doesn’t go to school, usually on a Sunday. As soon as your child gets out of bed in the morning, have them urinate into the toilet. This urine is not saved; just flush it down the toilet.  On the bottle label, write down your child’s name, the date, their health care number, and the exact time your child urinates. (Children who aren’t potty-trained usually go in the hospital for this test.)

After this, whenever your child needs to urinate, have your child urinate in the special container the healthcare provider or the laboratory gives you. For girls, first collect the urine in a urine “hat,” then pour it into the special container. You don’t need to mark the times when these urine samples are collected. Be sure to wash your hands after handling the container.

It’s important to collect all the urine your child produces all day and in the night. The next morning, wake your child up at about the same time as you did the day before. Have your child urinate into the container one last time. This ends the 24-hour collection. Now write the date and the time on the container label. Bring the bottle to an approved drop-off site as soon as you finish the 24-hour collection.

Since bacteria can grow in urine at room temperature, it’s important to keep the urine container in a refrigerator during the collection and before you deliver it to the lab.

Sources

Evaluating Proteinuria in Children by M Loghman-Adham, M.D. (10/01/98, http://www.aafp.org/afp/981001ap/loghman.html)