🧪 Proteinuria · Nephrotic syndrome · Orthostatic · Glomerulonephritis · UPCR

Schwartz Clinical Handbook — Chapter 62 · Dipstick (1+ to 4+) · First‑morning vs random · Orthostatic proteinuria · Nephrotic (4+, hypoalbuminemia, edema) · Glomerulonephritis (RBC casts, hypertension)

Select dipstick protein, UPCR (>0.2), edema, hypertension, hematuria, fever, exercise, and family history → differentiate orthostatic proteinuria (benign) from glomerular disease (nephrotic syndrome, glomerulonephritis) and tubular proteinuria.
⚠️ Red flags: edema, hypoalbuminemia, nephrotic‑range proteinuria (UPCR >2) → nephrotic syndrome (steroids). Hematuria + hypertension + proteinuria → glomerulonephritis (nephrology referral).

📋 Step 1 — Proteinuria & clinical clues
📌 Diagnostic impressions
📖 Schwartz Ch 62

Select dipstick protein (trace to 4+), UPCR (protein/creatinine ratio), edema, hypertension, hematuria, fever, exercise, and first‑morning vs random sample → differentiate orthostatic proteinuria (benign, negative first‑morning) from persistent glomerular disease (nephrotic syndrome, glomerulonephritis) or tubular proteinuria.

✔️ Orthostatic: negative first‑morning, positive upright, UPCR <0.5.
✔️ Nephrotic syndrome: UPCR >2, hypoalbuminemia, edema, hyperlipidemia.
✔️ Glomerulonephritis: hematuria (RBC casts), hypertension, variable proteinuria.
✔️ Tubular: low molecular weight proteins, glucosuria, normal anion gap acidosis.
📘 Schwartz pearls (Chapter 62)
• First‑morning urine to rule out orthostatic proteinuria.
• UPCR >2 mg/mg (or >200 mg/mmol) = nephrotic range.
• Minimal change disease: most common cause of nephrotic syndrome in children, prednisone responsive.
• Persistent proteinuria + hematuria + hypertension → renal biopsy.
• Proteinuria in adolescent girls + normal first‑morning → orthostatic.