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You are evaluating a 3-year-old girl for fever of 102 for the last 3 days and few other symptoms. As part of her evaluation you obtain a dip urinalysis to assess for UTI. It is completely normal except for 1+ proteinuria. Other than fever she has been asymptomatic – she has no edema nor abdominal pain, and her blood pressure is normal for age.
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November 6, 2025 at 11:36 am
B) Order a repeat urinalysis and spot urine protein/creatinine ratio to be performed on a first AM void in 1 week and have patient follow up with their PCP after the test is done
Incidental proteinuria is a common finding in children who undergo urinalysis in the ED. Two common benign causes include transient proteinuria, which can be brought on by stressors such as fever, exercise, hypovolemia, and orthostatic proteinuria (proteinuria seen when a patient is upright but not when the patient is recumbent). A normal urine Pr/Cr ratio is < 0.2 for children over 2 years old and older, and < 0.5 for children age 6-24 months. If the repeat urine has no protein, then the proteinuria was transient. If there is proteinuria on the repeat urine but the urine Pr/Cr is normal, the likely diagnosis is orthostatic proteinuria. Familial thin basement membrane nephropathy results in microscopic hematuria, not proteinuria. In this child without symptoms of nephrotic syndrome or glomerulonephritis, lab tests and nephrology referrals are unnecessary unless persistent pathologic proteinuria is confirmed. The spot urine Pr/Cr ratio is generally as informative and much less difficult to collect than the 24-hour urine collection.