Investigating haematuria and proteinuria

Urinary abnormalities are common in children but are rarely persistent. Persistent haematuria (whether microscopic or macroscopic) or persistent proteinuria are uncommon and warrant further investigation as they are indicators of potentially significant underlying renal disease. The finding of haematuria with proteinuria, especially if associated with impaired renal function and hypertension, warrants urgent specialist review. Initial investigations include serial urine testing and urine testing of all first-degree relatives when the index case is found to have persistent microscopic haematuria. Renal imaging is of limited value but much valuable information can be gained from laboratory analysis of the urine and from standard haematological, biochemical and immunological investigations. The decision to proceed to renal biopsy can be contentious and requires specialist review. When renal biopsy is undertaken, it is likely to provide a diagnosis but specific therapies are not available for a number of diagnoses.