Proteinuria or nephrotic syndrome in paediatric patients

​​​​​​Emergency

If any of the following are suspected please seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary).

  • Proteinuria with any of the following features:
    • Acute abdominal pain with tenderness and guarding (i.e. peritonitis) 
    • Elevated serum creatinine 
    • Hypertension (i.e. blood pressure > 95th centile for age and height)
      Note: refer to the American Academy of Pediatrics 2017 guideline​​​
    • Macroscopic haematuria 
    • Significant peripheral oedema (e.g. scrotal oedema, ascites, pleural effusions)
    • Signs of pulmonary oedema 
    • Signs of venous thromboembolism 
    • Systemic infection

When public outpatient services are not routinely provided

  • Orthostatic proteinuria (i.e. first morning urine protein / creatinine ratio in normal range)

  • Transient proteinuria in the presence of a urinary tract infection or another febrile illness

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days
  • Idiopathic nephrotic syndrome who has not responded within 4 weeks of adequate steroid treatment
  • Persistent (i.e. at least 1 month), asymptomatic sub-nephrotic proteinuria (i.e. urine protein creatinine ratio > 50 mg/mmol or albumin creatinine ratio > 10 mg/mmol) with any of the following features:
    • Known and/or suspected auto-immune disease (e.g. lupus)
    • Low serum albumin or oedema
    • Other evidence of kidney disease (e.g. haematuria)

Category 2
Recommended to be seen within 90 calendar days.

  • Frequent relapsing or steroid dependent after previously responding to steroids
  • Persistent (i.e. at least 1 month), asymptomatic sub-nephrotic proteinuria (i.e. urine protein creatinine ratio > 50 mg/mmol or albumin creatinine ratio > 10 mg/mmol) with no other evidence of kidney disease

Category 3
Recommended to be seen within 365 calendar days.

  • Albuminuria in diabetes mellitus where patient is stable and not able to be managed in primary care or general paediatric setting

Information to include within a referral

Required

  • Reason for referral
  • Provisional diagnosis
  • Details of the presenting condition, including symptoms and their duration, and impact on activities of daily living and school attendance
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Developmental history
    • Family history
    • Growth parameters
    • Presence of symptoms or co-morbidities (e.g. oedema, hypertension, auto-immune conditions, known structural kidney disease)
    • Serial blood pressure measurements (where available)
    • Blood tests including urea, creatinine and albumin, ANA, ENA, anti-DNA Abs, C3/C4 and Hepatitis B/C serology (for Category 1 presentations)
    • Urine albumin creatinine ratio or protein creatinine ratio (ideally first morning sample)

If available

  • Other available renal imaging results
  • Timeline of symptoms
  • Ultrasound of kidney, ureters and bladder

 

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.


 

Current as at: Thursday 10 September 2026
Contact page owner: System Purchasing