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Proteinuria on urinalysis in the Emergency Department

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Action and Follow-up Instructions for the Emergency Department Team

For patients with 2+ protein or more:

  • Please also refer to the glomerulonephritis and nephrotic syndrome guidelines to check possible diagnoses and subsequent investigation/management. The information below is about ensuring appropriate community follow-up.
  • If your patient has Henoch-Schonlein Purpura then the investigation and follow-up plan should be in line with the specific guideline.
  • In all cases with clinical concerns regarding nephrotic syndrome or 3+ or more of protein please send a formal urine sample for a protein:creatinine ratio to the lab

  • "Please give the family the Parent Information leaflet: “There’s something in my child’s pee” with a universal container to take home and a copy of the GP letter to hand in with the sample to their GP practice. For all other patients with incidental findings i.e. during a urinary tract infection/intercurrent illness please advise follow up in 1-2 weeks at their GP. This should include an early morning urine sample being sent for a protein:creatinine ratio.
  • On the discharge letter please inform the GP that the patient will hand a sample in to the practice in 1-2 weeks from their ED attendance and that this should be sent for protein:creatinine ratio (as per the RHCG proteinuria guideline found at


Editorial Information

Last reviewed: 16 February 2022

Next review: 31 October 2023

Author(s): Dr Steffi McCallion (Paediatric Medicine trainee, RHCG) & Dr Natalie Bee (Consultant in Paediatric Emergency Medicine, RHCG)

Co-Author(s): Co-authors/stakeholders: Dr Ben Reynolds (Consultant in Paediatric Nephrology, RHCG); Correspondence link: Dr Steve Foster (RHC ED guidelines co-ordinator, RHCG).

Approved By: Revised guidance authorised by RHCG, ED Consultant Group