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Which of the following would raise concerns for renal disease in a 2-year-old, asymptomatic child with proteinuria on urinalysis (UA)?

A. Hypertension

B. Urine/Creatinine ratio (UPr/Cr) = 0.4

C. 2+ protein on urine dipstick

D. History of fever

Answer: A

Proteinuria is common in children; up to 10% of children will have a urine dipstick positive for protein. Most causes of proteinuria are benign, may be either 0 to 3+ on urine dipstick, and are due to either transient proteinuria or orthostatic proteinuria. Persistent proteinuria is concerning for renal disease. Transient proteinuria may be due to recent exercise, fever, stress, or cold exposure. The UPr/Cr ratio in children 6 months to 2 years old is normal if less than 0.5. In children older than 2, the UPr/Cr ratio is normal if less than 0.2. Signs and symptoms that raise concern for renal disease include hematuria, hypertension, and peripheral edema.

Reference: Leung AKC, Wong AHC, Barg SSN. Proteinuria in Children. Evaluation and Differential Diagnosis. Am Fam Physician. 2017;95(4):248-254. Pubmed ID: 28290633.

According to the American Academy of Pediatrics (AAP) recommendations, what age should screening urinalysis begin in asymptomatic children and how often should it be performed?

A. Start at 2, screen yearly

B. Start at 5, screen yearly

C. Screen at 4, 8, 12, and 16 years old

D. The AAP does not recommend screening urinalysis for asymptomatic children

Answer: D

Due to the high rate of false-positive results, the AAP does not recommend screening urinalysis for asymptomatic children.

Reference Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.

The collection process to evaluate orthostatic proteinuria includes each of the following steps except:

A. Urinate before going to bed and discard the sample

B. Collect urine sample in the morning after the patient lies recumbent during the night

C. Collect urine sample midday and discard the sample

D. Collect urine throughout the day during normal daily activity

Answer: C

The urine sample should be collected throughout the day during normal daily activity to capture ...

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