INDIAN PEDIATRICS 205 VOLUME 45__MARCH 17, 2008 GUIDELINES: N EPHROTIC SYNDROME benefits of therapy with deflazocort for nephrotic syndrome. Treatment regimen: Various treatment regimens have been used for the treatment of the initial episode of nephrotic syndrome Nephrotic syndrome in childhood Allison A Eddy, Jordan M Symons Childhood nephrotic syndromes are most commonly caused by one of two idiopathic diseases: minimal-change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS). A third distinct type, membranous nephropathy, is rare in children . Avoid the side effects of the treatment The s r
. The current guideline was prepared according to the policy of the MINDS. The previous Japanese NS guidelines were not compliant with that policy This study shows major differences in steroid and symptomatic treatment of nephrotic syndrome by pediatricians and pediatric nephrologists. As these differences can influence the efficacy of the treatments and the appearance of side-effects, shared guidelines and their implementation through widespread educational activities are necessary
. The prevalence worldwide is approximately 16 cases per 100,000 children with an incidence of 2 to 7 per 100,000 children The guideline may not be relevant to the management of children with atypical presentations and does not apply to children with congenital nephrotic syndrome, steroid resistant nephrotic syndrome and nephrotic syndrome secondary to other systemic disease (e.g. SLE) or other structural glomerular disease (e.g. Alport Syndrome) Nephrotic syndrome (NS) is a clinical syndrome defined by massive proteinuria (greater than 40 mg/m2 per hour) responsible for hypoalbuminemia (less than 30 g/L), with resulting hyperlipidemia, edema, and various complications. It is caused by increased permeability through the damaged basement membrane in the renal glomerulus especially infectious or thrombo-embolic Treatment of the nephrotic syndrome associated with primary glomerulonephritis The term nephrotic syndrome (NS) refers to a condition characterized by heavy proteinuria, hypoalbuminemia, edema and hyperlipidemia. The NS is often seen when the urinary protein excretion exceeds 3.5 g/day and is almost invariably present whe
What is the main treatment of nephrotic syndrome? A steroid drug called Prednisolone is given to all children diagnosed with nephrotic syndrome. In 90% of cases it causes a complete remission of the condition. The protein in the urine (proteinuria) and the oedema disappear. These children have steroid responsive nephrotic syndrome If your child's nephrotic syndrome keeps coming back, this is called frequently relapsing nephrotic syndrome. Your doctor will consider the best treatment for your child. Follow up All children with nephrotic syndrome need to go back to the hospital or clinic for follow-up appointments to check for any health problems. Remember to bring the. Treatment of children with frequently relapsing steroid-sensitive nephrotic syndrome Clinical Trial Outcomes • Many corticosteroid-sparing agents are consid- ered in the guidelines  , but there is no clear rec Referral to a pediatric nephrologist is mandatory for all children with nephrotic syndrome whose symptoms fail to respond to initial therapy (complete remission of proteinuria); in most of these patients, a percutaneous renal biopsy is indicated, and an alternative treatment plan may be desirable 183 Table 10. Definitions of nephrotic syndrome in adults with FSGS 184 Table 11. Treatment schedules 187 Table 12. Reported causes of secondary MN (% in adults) 188 Table 13. Reported causes of secondary MN 188 Table 14. Definitions of complete and partial remission in IMN 189 Table 15
The committee is pleased to announce the publication of the first IPNA guideline on « steroid-resistant nephrotic syndrome in children ». Since its release in May 2020 in Pediatric Nephrology, the committee as well as many dedicated IPNA colleagues have been busy translating the document into different languages, some of which are already. Children with any other type of nephrotic syndrome and those presenting after the first 3 months of life were excluded. These centres represent the key tertiary nephrology units across Europe and cover ∼105 paediatric PD and 105 paediatric haemodialysis (HD) patients per year and perform ∼180 paediatric renal transplants per year diopathic nephrotic syndrome, characterized by altered permselectivity of the glomerular filter, is a common chronic renal disorder in children. Most patients are steroid sensitive and respond to therapy with remission of proteinuria (steroid sensitive nephrotic syndrome). Revised Guidelines for treatment of these patients were published. In sub-Saharan Africa, glomerular disease, specifically nephrotic syndrome (NS), is the leading cause of chronic kidney disease and end-stage kidney disease in children.1-3 The prevalence of NS is estimated at 2 to 7 per 100,000 children worldwide,1 and it is one of the more common causes of pediatric kidney disorders in Africa. Despite limited reports from Nigeria and Sudan,2-4 the. Nephrotic syndrome (NS) is one of the most frequent occurring chronic kidney diseases in childhood, despite its rarely occurrence in the general population. Detailed information about clinical data of NS (e.g. average length of stay, complications) as well as of secondary nephrotic syndrome (SNS) is not well known. A nationwide ESPED follow-up study presenting the clinical course and.
Nephrotic syndrome (NS) consists of peripheral edema, heavy proteinuria, and hypoalbuminemia, often with hyperlipidemia. Patients typically present with edema and fatigue, without evidence of. Treatment. Treatment for nephrotic syndrome involves treating any medical condition that might be causing your nephrotic syndrome. Your doctor might also recommend medications and changes in your diet to help control your signs and symptoms or treat complications of nephrotic syndrome. Medications might include: Blood pressure medications thromboembolic events in patients with nephrotic syndrome: results from a large retrospective cohort study. Circulation 2008; 117:224-30. 2. Kayali F, Najjar R, Aswad F, Matta F, Stein PD. Venous thromboembolism in patients hospitalized with nephrotic syndrome. Am J Med 2008; 121:226 30. 3. Loscalzo J. Venous thrombosis in the nephrotic syndrome
The incidence of idiopathic nephrotic syndrome (NS) is 1·15-16·9 per 100 000 children, varying by ethnicity and region. The cause remains unknown but the pathogenesis of idiopathic NS is thought to involve immune dysregulation, systemic circulating factors, or inherited structural abnormalities of the podocyte. Genetic risk is more commonly described among children with steroid-resistant. Objective. To examine the efficacy and complications of albumin and diuretic therapy in the treatment of edema due to the nephrotic syndrome. Methods. The clinical and biochemical effects of 35 treatment courses of albumin and diuretics administered to 21 children with nephrotic syndrome were retrospectively examined. Treatment consisted of intravenous infusion of 25% albumin and furosemide Pediatric Nephrotic Syndrome September 1, 2020 . Nephrotic syndrome is a condition that indicates the loss of abnormal amounts of protein in humans. It can affect anyone, be it adult or children. The condition of nephrotic syndrome in children is called pediatric nephrotic syndrome Introduction. Nephrotic syndrome (NS) is one of the most common childhood kidney diseases worldwide, with a reported incidence of 2-16.9/100,000 children (1, 2).NS encompasses several primary and secondary renal diseases that have common physical changes in glomerular filtration barrier, which result in a massive leak of serum proteins into the urine
Pediatric Nephrotic Syndrome. Childhood nephrotic syndrome is a group of symptoms that occur because of damage to the kidneys. Nephrotic syndrome can occur in children at any age, but usually is found in children between 18 months and 5 years of age Objective. Nephrotic syndrome (NS) is one of the most frequent occurring chronic kidney diseases in children. In this study, our aim was to assess the sociodemographic structure, determination of clinical data, diagnostic approaches, treatment methods applied and the factors effective on prognosis in patients followed with a diagnosis of nephrotic syndrome in our clinic Abstract. Renal disease of glomerular origin has three major clinical presentations: asymptomatic hematuria and/or proteinuria; acute nephritic syndrome, characterized by the sudden onset of hematuria, edema, hypertension, and azotemia; and nephrotic syndrome (NS), characterized by the insidious onset of edema with massive proteinuria and hypoalbuminemia
Nephrotic syndrome is a common kidney disease characterized by heavy loss of protein in the urine, low blood protein levels, high cholesterol levels, and swelling. This disease can occur at any age but is seen more frequently in children compared to adults. Nephrotic syndrome is characterized by its cycle of response to treatment, manifested by gradual tapering and discontinuation of. Caucasian children . Treatment is usually indicated due to the major psychosocial stress on the affected child . Current paediatric specific guidelines recommend a dose of 1-2g/kg of Spironolactone for the oedema and nephrotic syndrome; reduction of hypokalemia induced by other diuretics or amphotericin Management of patients with steroid sensitive nephrotic syndrome Dr Naveen Kumar Cheri S.V. Medical College, Tirupati 21. Steroid resistant nephrotic syndrome • Failure to achieve remission despite therapy with daily prednisolone at a dose of 2 mg/kg per day for 4 weeks is called steroid resistance. • Incidence approximately 10-20% The nephrotic syndrome is one of the best known presentations of adult or paediatric kidney disease. The term describes the association of (heavy) proteinuria with peripheral oedema, hypoalbuminaemia, and hypercholesterolaemia (box 1). Protein in the urine (coagulable urine) was first described in 1821, 15 years before Richard Bright's celebrated series of descriptions of albuminous. This consensus document is aimed at providing an updated, multidisciplinary overview on the diagnosis and treatment of pediatric nephrotic syndrome (NS) at first presentation. It is the first consensus document of its kind to be produced by all the pediatric nephrology centres in Italy, in line with what is already present in other countries such as France, Germany and the USA
The typical first-line treatment of new-onset nephrotic syndrome in children is steroids, but in this case, we were concerned about immune system suppression with steroid use because of the reported high virulence associated with COVID-19 infection. Additionally, the effects of COVID-19 on organs such as kidneys were still under investigation Title: Pediatric Idiopathic Nephrotic Syndrome: Treatment Strategies in Steroid Dependent and Steroid Resistant Forms VOLUME: 17 ISSUE: 9 Author(s):T. Ulinski and B. Aoun Affiliation:Department of Pediatric Nephrology, Hopital Armand-Trousseau, AP-HP, University Pierre et Marie Curie, Paris VI, 26 Avenue du Docteur Arnold Netter, 75571 Paris Cedex 12, France Nephrotic syndrome (NS) as a glomerular basal membrane disease has different outcomes. The current study aimed at evaluating epidemiologic status in NS and its correlation with the outcome in children.The current hospital based study evaluated the patients of pediatric clinic at Amir-Kabir hospital. Demographic information was obtained by interviewing both the physicians and patients Acute nephritic syndrome and/or nephrotic syndrome; A typical presentation of primary IgA is recurrent macroscopic haematuria occurring 2-3 days after the onset of an upper respiratory tract infection. The interval between precipitating infection and the onset of haematuria is much shorter than the 1-2 weeks seen in post infectious GN
Patients with relapse of nephrotic syndrome are at greater risk of severe steroid toxicity, as they are exposed to continuous prednisolone therapy to maintain remission. Objective: To compare the effectiveness and safety profile of deflazacort and prednisolone in the treatment of idiopathic nephrotic syndrome in children Treatment of steroid-resistant nephrotic syndrome (SRNS) remains a huge challenge in pediatric patients. Immunosuppressive agents including cyclosporine A (CsA), tacrolimus (TAC) and mycophenolate mofetil (MMF) are recommended for the management of children with SRNS. The aim of this study was to compare the efficacy of CsA, TAC and MMF in children with SRNS and provide guidance for clinical. Nephrotic syndrome is a group of symptoms that indicate your kidneys are not working properly. These symptoms include. too much protein in your urine, called proteinuria. low levels of a protein called albumin in your blood, called hypoalbuminemia. swelling in parts of your body, called edema Nephrotic syndrome is defined as the presence of proteinuria (>3.5 g/24 hours), hypoalbuminaemia (<30 g/L), and peripheral oedema. Hyperlipidaemia and thrombotic disease are also frequently seen. Despite heavy proteinuria and lipiduria, the urine contains few cells or casts. This is in contrast t..
Minimal change disease (MCD) is a major cause of idiopathic nephrotic syndrome (NS), characterized by intense proteinuria leading to edema and intravascular volume depletion. In adults, it accounts for approximately 15% of patients with idiopathic NS, reaching a much higher percentage at younger ages, up to 70%-90% in children >1 year of age. In the pediatric setting, a renal biopsy is. Children who suffer from nephrotic syndrome have, in addition to extra protein in their urine, a sudden increase in weight and swelling in their abdomen, face (especially around the eyes), and extremities. In the latter case, this mainly causes swelling in their ankles and toes after standing or sitting for a long time The nephrotic syndrome is defined by a urinary protein level exceeding 3.5 g per 1.73 m2 of body-surface area per day. At the turn of the century, clinicians distinguished a nephritic syndrome of i..
In children with nephrotic syndrome, response to initial glucocorticoid treatment was the best indicator of disease prognosis . As such, young children with nephrotic syndrome typically receive empiric steroid treatment at diagnosis and only those who fail to enter clinical remission require a kidney biopsy Nephrotic syndrome is defined as: more than 3.5 g of proteinuria/24 h, serum albumin less than 3 mg/dL, edema, hyperlipidemia, and lipiduria. Nephrotic syndrome may appear as a primary (idiopathic) renal disease or occur in association with any of a number of systemic conditions and hereditary diseases Nephrotic syndrome is a collection of symptoms due to kidney damage. This includes protein in the urine, low blood albumin levels, high blood lipids, and significant swelling. Other symptoms may include weight gain, feeling tired, and foamy urine. Complications may include blood clots, infections, and high blood pressure.. Causes include a number of kidney diseases such as focal segmental.
Nephrotic syndrome in children. Nephrotic syndrome is a condition that causes the kidneys to leak large amounts of protein into the urine. This can lead to a range of problems, including swelling of body tissues and a greater chance of catching infections. Although nephrotic syndrome can affect people of any age, it's usually first diagnosed in. Summary - Glomerulonephritis vs Nephrotic Syndrome. Both nephritic syndrome and nephrotic syndrome are renal disorders which share few common symptoms. But the fine line which makes them two separate disease entities is drawn across the degree of proteinuria, If the protein loss is higher than 3.5g/day then it is nephrotic syndrome and vice. Childhood nephrotic syndrome clinical pathway: physician care summary The physician care portion of the childhood nephrotic syndrome (NS) clinical pathway highlights the role of physicians in the evaluation and treatment of children with NS. Enclosed is a quick and concise visual reference of the steps to be taken by physicians, from initia Treatment aims to reduce the symptoms of Nephrotic Syndrome. Presently, there is no cure and children may have multiple episodes or relapses. However relapses may become less frequent and virtually all children will eventually grow out of the syndrome. Steroid treatment aims to reduce the swelling within 2 days to 4 weeks. The dose of steroids i -Steroid responsive nephrotic syndrome (steroid-sensitive): majority of patient, the most likely histologic lesion is MCD, and no need for renal biopsy. -Steroid resistant nephrotic syndrome: 20% of patients and consider renal biopsy. Those patient failed to initiate steroid course regardless the course is oral or IV or steroid sparing agent
Further Information: Refer to Consensus Statement of Management of Idiopathic Nephrotic Syndrome in Childhood 1999 which is available on the website www.acadmed.org.my under clinical practice guidelines. Specific Treatment for Nephrotic Syndrome in ADULTS. Specific treatment offered will depend on the results of the biopsy Range from uncomplicated upper respiratory tract viral infection to pneumonia, acute respiratory distress syndrome (ARDS), sepsis, and septic shock (Table 1). No specific data is available establishing risk factors for severe COVID-19 disease in children.23 A rare but serious inflammatory syndrome in children has been linked to COVID-19 The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. A report of the International Study of Kidney Disease in Children. J Pediatr 1981; 98:561. White RH, Glasgow EF, Mills RJ. Clinicopathological study of nephrotic syndrome in childhood. Lancet 1970; 1.
Nephrotic syndrome is not a specific disease, but the name given to the set of problems that can arise if the kidneys become damaged. One of the main jobs of the kidneys is to filter the blood . This allows the body to pass waste products, extra fluid and salts through the urine Columbus, OH — March 2018. Moderate-to-severe hyperlipidemia is almost universal in people with persistent nephrotic syndrome. It is a major risk factor in the acceleration of cardiovascular disease, and because of lipid-related renal injury, likely itself has a role in the pathogenesis of nephrotic syndrome
In some children the nephrotic syndrome keeps coming back, even after successful treatment with steroids - this is called frequently relapsing nephrotic syndrome. A few children (about 1 in 10) have a type that cannot be treated by steroids alone - this is called steroidresistant nephrotic syndrome (SRNS) because it is resistant (does. The type of nephrotic syndrome that is most common in children is called idiopathic nephrotic syndrome. It accounts for about 90 percent of children with nephrotic syndrome. Idiopathic means that a disease occurs with no known cause. The most common type of idiopathic nephrotic syndrome is called minimal-change nephrotic syndrome (MCNS) Children with frequently relapsing nephrotic syndrome (FRNS) often develop adverse effects from prednisone. Attempts to induce long-term remission in such patients have had varying levels of success. In this multicenter, prospective, open-label study, 14 centers enrolled 33 patients with FRNS, all of whom were in remission at the time of entry Indian Pediatric Nephrology Group, Indian Academy of Pediatrics, Bagga A, Ali U, Banerjee S, Kanitkar M, Phadke KD, et al. Management of steroid sensitive nephrotic syndrome: revised guidelines. Indian Pediatrics 2008 ; 45 (3):203-14
More than 90% of children who present with idiopathic nephrotic syndrome respond to a course of high dose oral corticosteroid, and current practice is to treat most patients with prednisolone The Kidney Disease: Improving Global Outcomes 2012 treatment guidelines recommended that prednisolone be administered daily for four to six week Introduction. Nephrotic syndrome is a clinical condition characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Nephrotic syndrome represents the most common primary glomerular disease in children and affects ~2 per 100,000 children aged <16 years in Europe and North America. 1,2 At the time of first presentation, ~80% of children achieve complete remission within 4 weeks of.
Primary nephrotic syndrome is the most common type in children. Some children can have something called congenital nephrotic syndrome, which happens in the first 3 months of life Introduction. Nephrotic syndrome is characterised by the triad of severe proteinuria, hypoalbuminaemia and oedema. It is one of the most common glomerular diseases in children with an incidence of 1-7 per 100 000 children per year (Dutch data: 1.52/100 000) and a prevalence of 16 per 100 000 children.1-3 Most children have minimal change nephrotic syndrome and will have favourable.
Tacrolimus therapy in pediatric patients with treatment-resistant nephrotic syndrome By Verna Yiu Unexpected Efficacy of Rituximab in Multirelapsing Minimal Change Nephrotic Syndrome in the Adult: First Case Report and Pathophysiological Consideration Nephrotic syndrome is a glomerular disorder which presents as a classical triad of generalised oedema, heavy proteinuria (>200mg/mmol) and hypoalbuminaemia (<25g/L). This article describes the epidemiology and pathophysiology of nephrotic syndrome in children, typical and atypical features, important investigations and management Uncu N, et al. Primary peritonitis in children with nephrotic syndrome: results of a 5-year multicenter study. Eur J Pediatr. 2010 Jan;169(1):73-6. Primary peritonitis is a well-described infectious complication of nephrotic syndrome. Current data on the true incidence of peritonitis and efficacy of preventive pneumococcal vaccination are not clear in this group of children Nephrotic syndrome, or nephrosis, is defined by the presence of nephrotic-range proteinuria, edema, hyperlipidemia, and hypoalbuminemia. While nephrotic-range proteinuria in adults is characterized by protein excretion of 3.5 g or more per day, in children it is defined as protein excretion of more than 40 mg/m 2 /h or a first-morning urine. Nephrotic syndrome is defined as the presence of proteinuria (>3.5 g/24 hours), hypoalbuminemia (<3.0 g/dL), and peripheral edema. Hyperlipidemia and thrombotic disease are also frequently seen. Despite heavy proteinuria and lipiduria, the urine contains few cells or casts. This is in contrast to..
Childhood nephrotic syndrome is characterized by se- sized in reviews, local guidelines , and in an inter-national clinical practice guideline . There is a lack of the association of nephrotic syndrome treatment variation with relapse rates. The design and methods of this pape Nephrotic syndrome is 15 times more common in children Most cases in children are due to minimal-change disease. In adults, the most common form is membranous glomerulonephritis, followed by FSGS. Diabetic nephropathy is emerging as a major cause of nephrotic syndrome 7. Nephron 8. Normal glomerulus 9
Overview. Nephrotic syndrome is a kidney disorder where the body releases too much protein into the urine. This reduces the amount of protein in your blood and affects how your body balances water Refractory nephrotic syndrome (RNS) is an immune-related kidney disease with poor clinical outcomes. Standard treatments include corticosteroids as the initial therapy and other immunosuppressants as second-line options. A substantial proportion of patients with RNS are resistant to or dependent on immunosuppressive drugs and often experience unremitting edema and proteinuria, cycles of. Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine. Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood. The condition causes swelling, particularly in your feet and ankles, and increases the. Childhood nephrotic syndrome is characterized by severe proteinuria and hypoalbuminemia, with edema as the most common presenting symptom [1, 2].The majority of (> 90%) children with nephrotic syndrome will have minimal change disease and enter remission of proteinuria with glucocorticoid treatment #NephroticSyndrome #NephriticSyndrome #Nephrology Like this video? Sign up now on our website at https://www.DrNajeebLectures.com to access 800+ Exclusive vi..
Minimal Change Disease (MCD) is a disorder where there is damage to your glomeruli. The disease gets its name because the damage cannot be seen under a regular microscope. Minimal Change Disease is the most common cause of nephrotic syndrome in children. Learn about MCD symptoms, causes, treatment, and its relation to nephrotic symptom here Manav was suffering with Nephrotic Syndrome since 18 months of age. We have been treating him at Dr Rajesh Shah's Lifeforce Homeopathy Center for 1year now and he has been improving since then. There is no protein in urine since 1 year. Manav has not shown a relapse of Nephrotic syndrome for almost a year now
Treatment of nephrotic syndrome, based on early case series, observational studies, and expert opinion, includes the following: Fluid restriction to less than 1.5 L/day. Sodium restriction to up to 3 g/day. Diuretics, most commonly loop diuretics, to allow weight loss of 0.5 to 1 kg/day Nephrotic syndrome (NS) is a rare, serious and debilitating kidney condition, caused by a range of different diseases that damage the glomeruli. The condition affects around 1 in 30,000 UK adults per year  . Glomeruli are found in the kidneys and filter fluid, electrolytes and waste products from the blood, while preventing the loss of protein, [ Introduction. First described by Gautier and Miville in 1942, congenital nephrotic syndrome (CNS) is defined as the triad of nephrotic range proteinuria (>200mg/mmol creatinine), hypoalbuminaemia and clinically detectable edema, occurring in the first three months of life. 1 It is a separate entity from idiopathic childhood nephrotic syndrome. . Congenital nephrotic syndrome is most frequently.
Nephrotic Syndrome: Causes, Symptoms and Treatment (1) - Nephrotic Syndrome is a kidney disorder, when filters present in the kidney drips large amount of protein from the blood into the urine, which leads to the, shortage of protein level in your body. | PowerPoint PPT presentation | free to view. Proteinuria and Nephrotic syndrome. Congenital nephrotic syndrome, an inherited disorder characterized by protein in the urine and swelling of the body, occurs primarily in families of Finnish origin and develops shortly after birth. The disorder commonly results in infection, malnutrition and kidney failure. It can often lead to death by five years of age Nephrotic syndrome, group of signs of kidney malfunction, including a low level of albumin (a protein) and a high level of lipids (fats) in the blood, proteins in the urine, and the accumulation of fluid in the tissues. Nephrotic syndrome typically results in the loss of more than 3.5 grams o Dufek S, Holtta T, Trautmann A, et al. Management of children with congenital nephrotic syndrome: challenging treatment paradigms. Nephrol Dial Transplant . 2018 Jun 21. [Medline] Who Gets Nephrotic Syndrome? Although primary NS is a relatively rare condition, anyone can get it. NS is one of the most common contributors of Chronic Kidney Disease (CKD) and responsible for 12% of kidney failure in adults and 20% in children. Nephrotic syndrome may affect adults and children of both sexes and of any race
Nephrotic syndrome is the most common glomerulopathy among children aged 2-18 years and high dose corticosteroids are the backbone of its management. Potentially blinding ocular complications often result from nephrotic syndrome and/or its treatment. We conducted a study to determine the prevalence and predictors of ocular complications among children undergoing nephrotic syndrome treatment. Nephrotic syndrome is urinary excretion of > 3 g of protein/day due to a glomerular disorder plus edema and hypoalbuminemia. It is more common among children and has both primary and secondary causes. Diagnosis is by determination of urine protein/creatinine ratio in a random urine sample or measurement of urinary protein in a 24-hour urine collection; cause is diagnosed based on history.