Proteinuria In Children: Causes, Symptoms, Risks & Treatment

Proteinuria in children is usually harmless and may indicate improper functioning of kidneys, renal diseases, or other underlying conditions. Also called urinary protein excretion, this condition is characterized by excess protein levels in the urine (1) (2).

Protein molecules typically cannot pass through the kidneys and do not enter the urine due to their large size, but the above conditions may show protein in the urine, indicating a disorder. However, proper diagnosis and timely treatment could help manage the condition.

This post will help you know about proteinuria in children, including its causes, symptoms, and treatments.

Is Proteinuria Common In Children?

About two or three out of 100 children develop mild proteinuria during childhood, while one in 100 children may develop persistent proteinuria (3).

Most children have “orthostatic proteinuria,” meaning they show protein in the urine only when they are in an upright position, generally in the mornings. This type of proteinuria is benign, and there is no protein removed via urine at night (4). However, persistent protein in the urine could indicate an imbalance in kidney function.

What Are The Causes Of Proteinuria In Children?

Protein in urine could be due to benign conditions or as a result of other health conditions. Benign causes may include (1) (2) (5)

• Gravity
• Dehydration
• Aspirin therapy,
• Cold weather,
• Stress
• Fever.
• Sometimes, protein may be observed in the urine after an intense physical activity

Persistent proteinuria could be an indication of an underlying illness such as (2) (3)

• Nephrotic Syndrome
• Glomerular diseases
• Urinary tract infection
• Immune disorders such as Systemic Lupus Erythematosus (SLE) or Goodpasture’s Syndrome
• Cardiovascular diseases
• Renal dysplasia
• Renal cancer
• Intravascular hemolysis (red blood cells are destroyed, and haemoglobin is released into the bloodstream)
• Toxin attack
• Acute kidney injury
• High blood pressure,

What Are The Risk Factors For Proteinuria In Children?

The following factors may put a few children at risk of proteinuria (6).

• Hypercholesterolaemia
• Any cardiac disease
• Obesity
• Hypertension
• A family history of a chronic kidney disease
• Kidney or urinary tract problems at birth (5)

What Are The Symptoms Of Proteinuria?

Children with asymptomatic proteinuria usually have the orthostatic or transient types. In the case of persistent proteinuria, the following symptoms may be observed (2) (7).

• Frequent urination
• Muscle cramps (especially at night)
• Frothy urine
• Swollen eyelids, hands, and feet (edema)
• Nausea and/or vomiting
• Loss of appetite

What Are The Complications Of Proteinuria?

The complications of proteinuria may arise based on the underlying cause. However, some common complications of proteinuria include high blood pressure and high cholesterol (8).

If proteinuria is accompanied by high blood pressure, it could lead to a heart attack or a stroke. Alternatively, this increased pressure may even cause other chronic kidney diseases, including kidney failure.

Similarly, kidney problems accompanied by higher cholesterol levels in the blood are not a good sign, as they could increase the child’s risk of a heart attack.

How Is Proteinuria Diagnosed?

Urine tests are conducted to know the presence of protein in the urine. Since pediatric proteinuria could be short-lived, a morning urine sample and the one collected later that day can offer better insights. In the cases of orthostatic proteinuria, the morning sample would be devoid of protein.

If there are other accompanying symptoms, consecutive tests offer reliable protein urine values. Your child’s doctor will also recommend a 24-hour urine collection to measure the amount of protein in the urine (1).

If a high level of protein in the urine is identified, your pediatrician may recommend the following tests for further evaluation (5).

• Imaging tests such as CT scan, MRI, or ultrasound of the kidneys and urinary tracts to identify any tumors or blockages
• Blood tests to determine the glomerular filtration rate and creatinine levels
• Kidney biopsy

What Are The Treatments For Proteinuria In Children?

Orthostatic proteinuria requires no treatment. However, your child’s doctor may suggest another urine test after a stipulated time.

If persistent proteinuria is identified, further treatments are ordered based on the underlying condition. The primary goal would be to avoid renal failure. For diabetes and hypertension, appropriate pharmacological therapies as well as diet and lifestyle modifications would be advised to keep the protein levels under control.

In addition, you would be asked to monitor the child’s blood pressure and blood sugar levels. As a precautionary measure, medications that lower the blood pressure, such as Angiotensin-Converting Enzyme inhibitor (ACE) and Angiotensin Receptor Blocker (ARB), may be prescribed (2) (7).

How Can Proteinuria Be Prevented?

Proteinuria cannot be prevented, but you can prevent its progression into a chronic illness. Once the underlying cause of persistent proteinuria is identified, you can take preventive measures based on it. Dietary and lifestyle modifications are helpful if the cause is diabetes, hypertension, or a kidney issue. You would also be asked to visit a nephrologist regularly (2).

References

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Reviewer

Maria Carmela Villania-MamauagMD, DPPS

 

Maria Carmela Villania-Mamauag is a board certified diplomate of the Philippine Pediatric Society with a degree of Doctor of Medicine from Our Lady of Fatima University, Valenzuela City and a Bachelor in Science in Psychology from Saint Louis University, Baguio City which was augmented by a year of Bachelor in Science in Family Life and Child development at the University of the Philippines, Diliman, Quezon City.

Read full bio of Maria Carmela Villania-Mamauag