Evaluation and Management of Proteinuria in Children

This review discusses the quantification, classification, and initial evaluation for proteinuria in children. Using the severity of proteinuria and associated symptoms, we provide a framework that classifies suspected causes of proteinuria to guide the pediatric providers towards appropriate work-up and referral to nephrology. Additionally, we discuss initial management and complications of idiopathic nephrotic syndrome.

International clinical practice guidelines, including revised definitions for classification and treatment of nephrotic syndrome outcomes, aim to standardize the management of steroid sensitive and steroid resistant nephrotic syndrome. Investigations into the pathophysiology of different histological subtypes of nephrotic syndrome, which is currently not well understood, has identified antibodies that could inform new monitoring and management strategies.

Proteinuria is a common finding in the general pediatric setting and requires appropriate evaluation to discern between benign etiologies and underlying kidney disease. Age at presentation, family history, and associated symptoms are key factors that will inform initial work up and management, particularly the use of empiric corticosteroids.