Pediatric Nephrology Fellowship Program at Yale University School of Medicine

Orthostatic proteinuria accounts for 60% of all children and 75% of adolescents with proteinuria. Despite its frequent occurrence, the underlying pathophysiologic mechanisms remain unclear. The following three possibilities have been reviewed: ( 1) a normal variant; (2) a glomerular abnormality; (3) a I Received June 9, 1992. Accepted November 30, 1992. 2 Correspondenceto Dr. P. Devarajan, 333 Cedar Street, New Haven, CT 06510. 3 Under the guidance of Norman J. siegel, M.D., Director of Pediatric Nephrology, Yale University. 1046-6673/0401-0036503.00/0 Journal of the American 5ociety of Nephrology Copyright © 1993 by the American Society of Nephrology perience with an individual who had orthostatic proteinuria and who was a donor of a living-related kidney transplant, novel insights and a potentially unifying hypothesis for the pathogenesis of this condition are presented. It is suggested that individuals with orthostatic proteinuria may be predisposed by a subtle glomerular abnormality. However, a precipitating factor, in the form of an exaggerated response to the upright position, appears to be essential to unmask the condition.