From the Guidelines
A 7-year-old presenting with vomiting and proteinuria should be evaluated for possible nephrotic syndrome or glomerulonephritis, and prompt medical attention is necessary to prevent potential long-term kidney damage and other complications. The child needs to be assessed for vital signs, hydration status, and a comprehensive laboratory workup including complete blood count, comprehensive metabolic panel, urinalysis with microscopy, urine protein-to-creatinine ratio, and serum albumin 1.
Key Considerations
- While awaiting medical care, maintain hydration with small sips of clear fluids if the child can tolerate it, but do not force fluids if vomiting persists.
- Avoid NSAIDs as they may worsen kidney function.
- The combination of vomiting and proteinuria could indicate several conditions including post-infectious glomerulonephritis, minimal change disease, or other kidney disorders.
- Proteinuria suggests glomerular damage allowing protein to leak into urine, while vomiting may result from uremia, electrolyte disturbances, or gastrointestinal illness.
Treatment and Management
- Treatment will depend on the specific diagnosis but may include corticosteroids, diuretics, fluid/dietary sodium restriction, and supportive care.
- According to the KDIGO practice guideline on glomerulonephritis, antiproteinuric and antihypertensive therapy with ACEi or ARB is recommended for patients with proteinuria ≥1 g/day 1.
- The goal of treatment is to reduce proteinuria to <1 g/day and achieve a target blood pressure to prevent progression of kidney disease.
Prognosis and Outcome
- The prognosis and outcome depend on the underlying cause of the proteinuria and the severity of the kidney damage.
- Early diagnosis and treatment can improve the prognosis and prevent long-term kidney damage and other complications.
- Regular follow-up with a pediatric nephrologist is necessary to monitor the child's condition and adjust treatment as needed.
From the Research
Clinical Presentation
The 7-year-old patient presenting with vomiting and a urinalysis (UA) positive for protein may indicate an underlying renal issue.
- Vomiting can be a non-specific symptom, but in combination with proteinuria, it may suggest a more serious condition.
- Proteinuria, or the presence of excess protein in the urine, can be a sign of kidney damage or disease.
Possible Causes
Several studies suggest that proteinuria in children can be caused by various factors, including:
- Transient or orthostatic proteinuria, which is usually benign 2
- Glomerular or tubular dysfunction 3
- Nephrotic syndrome, a condition characterized by heavy proteinuria, edema, and hypoalbuminemia 4, 5
- Other systemic disorders, such as diabetes mellitus or systemic lupus erythematosus 4, 5
Evaluation and Management
To determine the cause of proteinuria, a thorough evaluation is necessary, including:
- Urine protein-to-creatinine ratio (PCR) to quantify proteinuria 3, 2
- Physical examination and medical history to identify signs of underlying disease 3, 6
- Laboratory tests, such as blood work and imaging studies, to assess kidney function and rule out other conditions 4, 6
- Referral to a pediatric nephrologist if proteinuria is persistent, heavy, or accompanied by other symptoms, such as hematuria or hypertension 3, 2, 6