Proteinuria

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Name of Symptom/Sign:
Proteinuria
Classifications and external resources
ICD-10 R80.
ICD-9 791.0
DiseasesDB 25320
eMedicine med/94 
MeSH D011507

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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]

Measurement

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. [6][7] 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.[8][9]

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.[10]

Reference Range
Physiologic protien elimination <150mg protien/24 hours
Proteinuria >150mg protein/24 hours
Microalbuminuria <30mg albumin/24 hours

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.

Conditions with proteinuria as a sign

Proteinuria may be a feature of the following conditions:[7]

Conditions with proteinuria consisting mainly of Bence-Jones proteins as a sign

Glomerular Protienuria

  • Drugs
  • Hereditary
  • Infections
  • Miscellaneous

Tubular Proteinuria

  • Connatal tulbulopathies
  • Hypokalemic nephropathy
  • Interstitial nephropathy
  • Renal Vein Thrombosis
  • Renal tubular acidosis
  • Toxic nephropathy

Prerenal and Overflow Proteinuria

Renal Parenchymal and Post Renal Proteinuria

Miscellaneous Causes for Proteinuria

See also

Footnotes

  1. ↑ The American Heritage Stedman's Medical Dictionary. KMLE Medical Dictionary Definition of proteinuria. Retrieved 2007-01-20
  2. ↑ http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20
  3. ↑ http://www.medhelp.org/forums/urology/archive/195.html Retrieved 2007-01-20
  4. ↑ Pneumaturia at GPnotebook Retrieved 2007-01-20
  5. ↑ http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20
  6. ↑ http://medlib.med.utah.edu/WebPath/TUTORIAL/URINE/URINE.html Retrieved 2007-01-20
  7. ↑ 7.0 7.1 Simerville JA, Maxted WC, Pahira JJ (2005). "Urinalysis: a comprehensive review". American family physician 71 (6): 1153-62. PMID 15791892.
  8. ↑ http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20
  9. ↑ http://www.answers.com/topic/protein-electrophoresis Retrieved 2007-01-20
  10. ↑ Identification, management and referral of adults with chronic kidney disease: concise guidelines (PDF). UK Renal Association (27/9/05). - see Guideline 4 Confirmation of proteinuria, on page 9
  11. ↑ Dettmeyer RB, Preuss J, Wollersen H, Madea B (2005). "Heroin-associated nephropathy". Expert opinion on drug safety 4 (1): 19-28. PMID 15709895.
  12. ↑ Hermann G, Zühlke V, Faul P (1970). "Gamma globulin fragments in urine of kidney transplant patients in relation to rejection crisis". European surgical research. Europäische chirurgische Forschung. Recherches chirurgicales européennes 2 (1): 55-63. PMID 4131420.
v • d • e
Abnormal clinical and laboratory findings (R70-R94, 790-796)
Blood testred blood cells (Elevated ESR, Anisocytosis, Poikilocytosis, Reticulocytosis)

blood sugar (Abnormal glucose tolerance test, Hyperglycemia, Impaired glucose tolerance, Prediabetes)

enzymes (Elevated transaminases, Cardiac marker) - elevated alpha-fetoprotein - mineral (Iron overload disorder) - pathogens (Bacteremia, Viremia) - Azotemia
Urine testProteinuria (Albuminuria, Microalbuminuria) - Glycosuria - Chyluria - Myoglobinuria - Bilirubinuria - Hemoglobinuria - Ketonuria - Crystalluria
OtherAbnormal basal metabolic rate

de:Proteinurie et:Proteinuuriafr:Protéinurie he:פרוטאינוריה nl:Proteïnurie ja:タンパク尿 fi:Proteinuria

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .

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