Proteinuria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Synonyms and keywords: Elevated urinary protein levels; Elevated urine protein
To view a comprehensive algorithm of common findings of urine composition and urine output, click here
Overview
Proteinuria (from protein and urine) means the presence of an excess of serum proteins in the urine.[1] The protein in the urine often causes the urine to become foamy, although foamy urine may also be caused by bilirubin in the urine (bilirubinuria),[2] retrograde ejaculation,[3] pneumaturia (air bubbles in the urine) due to a fistula,[4] or drugs such as pyridium.[5]
Causes
Common Causes
Causes by Organ System
Causes in Alphabetical Order
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Associated Conditions
Proteinuria may be a sign of renal (kidney) damage. Since serum proteins are readily reabsorbed from urine, the presence of excess protein indicates either an insufficiency of absorption or impaired filtration. Diabetics may suffer from damaged nephrons and develop proteinuria.
With severe proteinuria, general hypoproteinemia can develop which results in diminished oncotic pressure. Symptoms of diminished oncotic pressure may include ascites, edema, and hydrothorax.
Diagnosis
Laboratory Findings
Proteinuria is often diagnosed by a simple dipstick test although it is possible for the test to give a false negative even with nephrotic range proteinuria if the urine is dilute. False negatives may also occur if the protein in the urine is composed mainly globulins or Bence-Jones Proteins because the reagent on the test strips, Bromphenol blue, is highly specific for albumin. [7][8] Traditionally dipstick protein tests would be quantified by measuring the total quantity of protein in a 24-hour urine collection test, and abnormal globulins by specific requests for Protein electrophoresis.[9][10]
Alternatively the concentration of protein in the urine may be compared to the creatinine level in a spot urine sample. This is termed Protein/Creatinine Ratio (PCR). The 2005 UK Chronic Kidney Disease guidelines states that PCR is a better test than 24 hour urinary protein measurement. Proteinuria is defined as a Protein:creatinine ratio >45 mg/mmol (which is equivalent to Albumin:creatinine ratio of >30 mg/mmol) with very high levels of nephrotic syndrome being for PCR > 100 mg/mmol.[11]
| Reference Range | |
| Physiologic protien elimination | <150mg protien/24 hours |
| Proteinuria | >150mg protein/24 hours |
| Microalbuminuria | <30mg albumin/24 hours |
Treatment
Treating proteinuria mainly needs proper diagnosis of the cause. The most common cause is diabetic nephropathy; in this case, proper glycemic control may slow the progression. Medical management consists of angiotensin converting enzyme (ACE) inhibitors, which are typically first-line therapy for proteinuria. In patients whose proteinuria is not controlled with ACE inhibitors, the addition of an aldosterone antagonist (i.e., spironolactone)[12] or angiotensin receptor blocker (ARB)[13] may further reduce protein loss. Caution must be used if these agents are added to ACE inhibitor therapy due to the risk of hyperkalemia. Proteinuria secondary to autoimmune disease should be treated with steroids or steroid-sparing agent plus the use of ACE inhibitors.
Related Chapters
References
- ↑ The American Heritage Stedman's Medical Dictionary. "KMLE Medical Dictionary Definition of proteinuria". Retrieved 2007-01-20
- ↑ http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20
- ↑ http://www.medhelp.org/forums/urology/archive/195.html Retrieved 2007-01-20
- ↑ Template:GPnotebook Retrieved 2007-01-20
- ↑ http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20
- ↑ 6.0 6.1 Van Vleet TR, Schnellmann RG (2003). "Toxic nephropathy: environmental chemicals". Semin Nephrol. 23 (5): 500–8. PMID 13680539.
- ↑ http://medlib.med.utah.edu/WebPath/TUTORIAL/URINE/URINE.html Retrieved 2007-01-20
- ↑ Simerville JA, Maxted WC, Pahira JJ (2005). "Urinalysis: a comprehensive review". American family physician. 71 (6): 1153–62. PMID 15791892.
- ↑ http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20
- ↑ http://www.answers.com/topic/protein-electrophoresis Retrieved 2007-01-20
- ↑ "Identification, management and referral of adults with chronic kidney disease: concise guidelines" (PDF). UK Renal Association. 27/9/05. Check date values in:
|date=(help) - see Guideline 4 Confirmation of proteinuria, on page 9 - ↑ Mehdi UF, Adams-Huet B, Raskin P; et al. (2009). "Addition of angiotensin receptor blockade or mineralocorticoid antagonism to maximum angiotensin-converting enzyme inhibition in diabetic nephropathy". J Am Soc Nephrol. 20 (12): 2641–50. doi:10.1681/ASN.2009070737. PMC 2794224. PMID 19926893.
- ↑ Burgess E, Muirhead N, Rene de Cotret P; et al. (2009). "Supramaximal dose of candesartan in proteinuric renal disease". J Am Soc Nephrol. 20 (4): 893–900. doi:10.1681/ASN.2008040416. PMC 2663827. PMID 19211712.