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Clinical examination and renal ultrasound in the recumbent position were unremarkable. Her serum albumin level was 46 g/L, and her urinary protein level was 0.82 g/day, consisting mainly of albumin without hematuria or other abnormal findings in the urinary sediment, indicating the absence of [http://www.selleckchem.com/products/MG132.html MG-132 mw] active proliferative glomerular nephritis. To examine the cause of proteinuria, she was admitted to our hospital. Initially, we planned to perform percutaneous needle biopsy of the kidney; however, her urinary protein-to-creatinine ratio fluctuated highly [30.5�C183.3 mg/mmol (270�C1620 mg/g)], and we thus considered the possibility of orthostatic proteinuria (Figure?1). To make a definite diagnosis of orthostatic proteinuria, [http://www.selleckchem.com/products/epacadostat-incb024360.html Epacadostat] the next morning, we collected a urine sample with the patient lying in the recumbent position after an extended period of rest and another sample immediately after assuming the lordotic position for 5 min. The ratio of urinary protein-to-urinary creatinine increased from 18.1 mg/mmol (160 mg/g) in the recumbent position to 575.8 mg/mmol (5090 mg/g) in the lordotic position, which is regarded as nephrotic-range proteinuria. On further assessment, we found completely bland urinary sediments and an absence of serum markers, such as autoantibodies, as well as hypocomplementemia. Based on the clinical course, laboratory data and the results of the urine samples collected in the recumbent and lordotic positions, we diagnosed orthostatic proteinuria. The patient was uneventfully discharged the next day and is currently being followed [http://en.wikipedia.org/wiki/ATPase ATPase] twice a year. At the latest visit, her urine protein-to-urinary creatinine ratio obtained in the recumbent position was