# Orthostatic (postural) proteinuria

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- 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 date: 2026-08

## Verified against

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

## Treatment metadata

- No drug therapy in primary care (Recognition & Referral)

## Complete treatment card

```text
ORTHOSTATIC (POSTURAL) PROTEINURIA
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/
Review status: REVIEWED against the source listed above  (2026-08)

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
  Source  StatPearls "Orthostatic Proteinuria" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)[1st line]
   Adult    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
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   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.
   Caution  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.
```

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