Dawaa Reference

chronic

Orthostatic (postural) proteinuria

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class US50.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Proteinuria - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK564390/

Verified against1 document
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

  • Proteinuria only while the patient is upright, and normal lying down - protein spills into the urine on standing [proteinuria]
  • It affects 2 to 5% of adolescents and becomes uncommon past the age of 30
  • It is benign, and the point of naming it correctly is to prevent a kidney biopsy nobody needed

Signs — what you find (1)

  • It persists more in thin patients, and the gap between the superior mesenteric artery and the aorta narrows as body mass falls

Tests (4)

  • A first-morning urine sample with normal protein means no further kidney work-up is needed
  • Normal daily urine protein loss is generally under 150 mg
  • A normal protein-to-creatinine ratio lying down, under 0.2 mg/mg, with a raised ratio standing confirms the diagnosis
  • Kidney biopsy is not indicated for isolated, asymptomatic orthostatic proteinuria

If not this — what else fits (4)

  • Persistent, not just positional, proteinuria is the key differential to exclude
  • Signs of vasculitis, active urinary sediment, hypertension, gross or persistent blood in the urine, reduced kidney function, or low complement point to true renal disease rather than the benign postural form
  • Proteinuria appearing together with blood in the urine makes a significant kidney disease more likely
  • Other things that cause true, non-postural proteinuria in children include kidney malformations, infections, tumors, toxins, and inherited conditions such as Alport syndrome or polycystic kidney disease

SourceStatPearls "Orthostatic Proteinuria" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)

1st line
Adult dose and duration

A benign finding of protein in the urine only when upright, common in young people; primary care recognises the pattern, confirms with repeat testing, and reassures without treatment. - Refer

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

A benign finding of protein in the urine only when upright, common in young people; primary care recognises the pattern, confirms with repeat testing, and reassures without treatment.

Cautions
  • RED FLAG - Macroscopic hematuria or nephrotic-range proteinuria: assess urgently and refer.
  • RED FLAG - Persistent non-orthostatic proteinuria (suggestive of intrinsic renal disease like glomerulonephritis): assess urgently and refer.
  • Persistent protein in the urine while lying down rules out this benign diagnosis and needs full kidney work-up.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.