Compare a rested first-morning protein ratio with daytime urine. A postural protein pattern does not explain persistent glomerular hematuria. Recheck BP, kidney function and urine, and record a multigenerational family history. Hematuria with familial hearing loss or kidney failure warrants nephrology and genetic counseling; a pedigree does not prove the gene. Consider COL4A3/4/5 testing when indicated. Visible hematuria or clots in an older smoker still needs urologic evaluation despite anticoagulation. Familial CKD with bland urine and early gout suggests a different pattern such as ADTKD.
ERKNet/ERA/ESPN Alport guideline — PubMed · AAP: proteinuria in children · AUA/SUFU hematuria guidance
Andrew Bland, MD, FACP, FAAP