Prognosis in Postural (Orthostatic) Proteinuria

Rytand, David A.; Spreiter, Stephen

doi:10.1056/nejm198109103051105

Cited by 74 publications

(16 citation statements)

References 7 publications

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“…Previous studies have reported OP in 2–5% of children or young adults with asymptomatic proteinuria [3, 19, 20]. OP often resolves in adulthood, but even when it persists, it rarely indicates significant renal disease [20–22]. Using the definition of OP in the PARADE study, we found a much higher prevalence (19.8%) of OP than previously described.…”

Section: Discussionsupporting

confidence: 38%

Orthostatic proteinuria and the spectrum of diurnal variability of urinary protein excretion in healthy children

et al. 2010

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The aim of this study was to characterize the 24-h and diurnal variability of urinary protein excretion and identify the prevalence of orthostatic proteinuria (OP) in healthy children. Upright, supine, and 24-h total urinary protein (UrTP) and creatinine clearance (CrCl) were measured in 91 healthy children ages 6–19 years. Urinary protein and creatinine excretions were calculated and examined by gender, age, Tanner stage, and body mass index (BMI). Orthostatic proteinuria (OP) was defined as a 24-h UrTP >100 mg/m2 with a normal supine UrTP (<4 mg/m2/h). There exists a marked diurnal variability in UrTP. The upright UrTP rate was three to four-times greater than the supine rate. UrTP, adjusted for body surface area, is higher in boys than girls and increases with age and BMI. There is a similar increase in upright CrCl compared with supine. Urinary protein to creatinine ratio (UPcr) is strongly correlated with UrTP. OP is common, being found in 20% of children in this cohort, and is more common in boys and associated with age >10 years and BMI >85%. In children with OP, a first morning UPcr shows a value in the normal range, whereas a random daytime UPcr is elevated. There exists a diurnal variability in urinary protein excretion that is exaggerated in participants with OP. UPcr reliably estimates 24-h UrTP. Using current pediatric criteria, OP is very common, particularly in boys. A normal first morning UPcr ratio indicates that a child with elevated random urinary protein has OP.

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Section: Discussionsupporting

confidence: 38%

Orthostatic proteinuria and the spectrum of diurnal variability of urinary protein excretion in healthy children

et al. 2010

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“…The tissue obtained is frequently normal, or the abnormality is nonspecific and prognosis is favorable [121][122][123][124][125]. The 42-to 50-year follow-up of 6 of Thomas Addis' patients with postural proteinuria by Rytand andSpreiter [ 126] is reassuring as this study showed no evid ence of progressive disease. Occasionally, however, the bearing of persistent proteinuria of < 1 g/day on an appli cation for a job or insurance may be a reason for biopsy.…”

Section: A Symptomatic Proteinuriamentioning

confidence: 78%

Renal Biopsy: Current Views and Controversies

Gault¹,

Muehrcke²

1983

Nephron

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“…Proteinuria occurs commonly in healthy children and adolescents and seems not to imply serious renal disease when present in an isolated or intermittent pattern or in relationship to a change of posture [12,13]. The amount of protein excreted in the urine has diagnostic and prognostic importance and is used to assess the effectiveness of therapy [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

Quantification of proteinuria in children using the urinary protein-osmolality ratio

Kim

Cheon

Choe

et al. 2001

Pediatric Nephrology

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A prospective study was conducted to determine the correlation of early morning urinary protein/osmolality ratio (mg/l/mosmol/kg) with 24-h urinary protein excretion (mg/m2/day). Study patients consisted of 53 children (aged 1 month to 15 years). Early morning urine samples and 24-h urine samples were collected and analyzed. In group 1 (children without proteinuria), early morning urinary protein/creatinine ratio (Uprot/Ucr, mg/mg) was 0.061 +/- 0.011 and the protein/osmolality ratio (Uprot/Uosm, mg/l/mosmol/kg) was 0.073 +/- 0.014. Twenty-four hour urinary protein excretion in group 1 had no significant correlation with Uprot/Ucr or Uprot/Uosm. In group II (children with proteinuria), Uprot/Ucr was 5.78 +/- 1.10 and Uprot/Uosm was 4.42 +/- 1.34. Twenty-four hour urinary protein excretion in group 2 was 1483.6 +/- 303.7 mg/m2/day and its correlation with both Uprot/Uosm and Uprot/Ucr was highly significant (r = 0.87, P < 0.001 and r = 0.88, P < 0.001, respectively). The accepted nephrotic level of proteinuria of 40 mg/m2/h coincides with a Uprot/Uosm ratio of 1.9. In conclusion, early morning urinary Uprot/Uosm is a simple and potentially useful test for 24-h urinary protein excretion, and possibly could be used safely for the assessment of the degree of proteinuria in children.

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Prognosis in Postural (Orthostatic) Proteinuria

Cited by 74 publications

References 7 publications

Orthostatic proteinuria and the spectrum of diurnal variability of urinary protein excretion in healthy children

Orthostatic proteinuria and the spectrum of diurnal variability of urinary protein excretion in healthy children

Renal Biopsy: Current Views and Controversies

Quantification of proteinuria in children using the urinary protein-osmolality ratio

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