Proteinuria = Kidney Disease?

Proteinuria—also called albuminuria is a condition in which the urine contains an abnormal amount of protein in it. Albumin is the major component of protein in the blood where proteins are the building blocks for all body parts, including muscles, bones, hair, and nails. Proteins in the blood also perform a number of important functions where they protect the body from infection, help blood clotting process, and keep the right amount of fluid circulating throughout the body.

Protein in your Urine?

As blood passes through healthy kidneys, they filter out the waste products and leave in the things the body needs, like albumin and other proteins. Most protein molecules are too big to pass through the kidneys' filters into the urine. However, proteins from the blood can leak into the urine when the filters of the kidney, called glomeruli, are damaged.

How Proteinuria happens

Proteinuria is a sign of chronic kidney disease (CKD), which can be resulting from diabetes, high blood pressure, and diseases that cause inflammation in the kidneys. For this reason, testing for albumin in the urine is part of a routine medical assessment for everyone. If CKD progresses, it can lead to end-stage renal disease where the kidneys fail completely. A person with end-stage renal disease must receive a kidney transplant or regular blood-cleansing treatments called dialysis.

What are the signs and symptoms of Proteinuria?

Proteinuria has no signs or symptoms in the early stages. Large amounts of protein in the urine may cause it to look foamy or fizzing in the toilet. Laboratory testing is the only way to find out whether a person is having proteinuria before extensive kidney damage occurs.

Check for Urine Protein

A 1996 study sponsored by the National Institutes of Health determined that proteinuria is the best predictor of progressive kidney failure in people with type 2 diabetes. The American Diabetes Association recommends regular urine testing for proteinuria for people with type 1 or type 2 diabetes. The National Kidney Foundation recommends that routine checkups include testing for excess protein in the urine, especially for people in high-risk groups.

What are the tests for Proteinuria?

An accurate protein measurement of urine required a 24-hour urine collection. In a 24-hour collection, the patient urinates into a container, which is kept refrigerated between trips to the bathroom. The patient is instructed to begin collecting urine after the first trip to the bathroom in the morning. Every drop of urine for the rest of the day is to be collected in the container. The next morning, the patient adds the first urination after waking and the collection is complete.

24 hours Urine Protein Test

In recent years, researchers have found that a single urine sample can provide the needed information - Urine Microalbumin. In this newer technique, the amount of albumin in the urine sample is compared with the amount of creatinine, a waste product of normal muscle breakdown. The measurement is called a urine albumin-to-creatinine ratio (UACR). A urine sample containing more than 30 milligrams of albumin for each gram of creatinine (30 mg/g) is a warning that there may be a problem. If the laboratory test exceeds 30 mg/g, another UACR test should be done 1 to 2 weeks later. If the second test also shows high levels of protein, the person has persistent proteinuria, a sign of declining kidney function, and should have additional tests to evaluate kidney function.

Microalbumin testing

What additional tests for kidney disease may be needed?

Tests that measure the amount of creatinine in the blood will show whether a person’s kidneys are removing wastes efficiently. Having too much creatinine in the blood is a sign that a person has kidney damage. The doctor can use the creatinine measurement to estimate how efficiently the kidneys are filtering the blood. This calculation is called the estimated glomerular filtration rate, or eGFR. CKD is present when the eGFR is less than 60 milliliters per minute (mL/min).

Estimated Glomerular Filtration Rate (eGFR)

Who is at risk for proteinuria?

People with diabetes, hypertension, or certain family backgrounds are at risk for proteinuria. according to studies, diabetes is the leading cause of ESRD. In both type 1 and type 2 diabetes, albumin in the urine is one of the first signs of deteriorating kidney function. As kidney function declines, the amount of albumin in the urine increases.

Another risk factor for developing proteinuria is hypertension, or high blood pressure. Proteinuria in a person with high blood pressure is an indicator of declining kidney function. If the hypertension is not controlled, the person can progress to full kidney failure.

Hypertension damages glomeruli

What should a person with proteinuria do?

If a person has diabetes, hypertension, or both, the first goal of treatment will be to control blood glucose, also called blood sugar, and blood pressure. People with diabetes should test their blood glucose often, follow a healthy eating plan, take prescribed medicines, and get the amount of exercise recommended by their doctor. A person with diabetes and high blood pressure may need a medicine from a class of drugs called angiotensin-converting enzyme (ACE) inhibitors or a similar class called angiotensin receptor blockers (ARBs). These drugs have been found to protect kidney function even more than other drugs that provide the same level of blood pressure control. Many patients with proteinuria but without hypertension may also benefit from ACE inhibitors or ARBs.

Doctor Prescription

People who have high blood pressure and proteinuria, but not diabetes, also benefit from taking an ACE inhibitor or ARB. Health care providers recommend that people with kidney disease keep their blood pressure below 140/90. To maintain this target, a person may need to take a combination of two or more blood pressure medicines. A doctor may also prescribe a diuretic in addition to an ACE inhibitor or ARB. Diuretics are also called "water pills" because they help a person urinate and get rid of excess fluid in the body.

In addition to blood glucose and blood pressure control, the National Kidney Foundation recommends restricting dietary salt and protein. A doctor may refer a patient to a dietitian to help develop and follow a healthy eating plan.

Eat Healthy

Other Conditions that can cause a temporary rise in the levels of protein in urine, but don't necessarily indicate kidney damage, include: 

• Cold exposure 
• Emotional stress 
• Fever 
• Heat exposure 
• Strenuous exercise 

You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

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