II. Pathophysiology
- Glomerulus is permeable
- Molecular Weight under 60,000 Daltons may be filtered
- Albumin (MW 65,000) should not be filtered
- Normal Urinary Protein Excretion <150 mg/day
- Immunoglobulin (20,000 Daltons) 20%
- Albumin (65,000 Daltons) 40%
- Tamm-Horsfall Mucoprotein (distal tubule secrete) 40%
III. Causes
IV. Labs: Step 1
- Qualitative Protein: Random dipstick Urinalysis
- Obtain first morning void
- See Urine Protein
- Confirm Proteinuria with Sulfosalicylic Acid Test or quantitative Protein in step 2
-
Microscopic Urinalysis findings of renal disease
- Urine fats (Nephrotic Syndrome)
- Urine WBCs without bacteruria (Renal Interstitial)
- Dysmorphic erythrocytes (Glomerular disease)
- Cellular or Granular Casts (chronic renal disease)
- Urine Eosinophils
- Drug-induced Acute Interstitial Nephritis
- Criteria for Step 2 evaluation below
- Nephrology consult for positive microscopic findings
- Urinalysis with 3+ to 4+ Urine Protein
- Urine Protein trace to 2+ on 2-3 Urinalysis in 1 month
- Repeat if related to transient cause (e.g. UTI, Exercise, Fever, CHF, Dehydration)
V. Labs: Step 2
- Quantitative Protein (2 samples within 3-6 months) severe cutoffs
- Urine Albumin to Creatinine Ratio (random urine) 500-1000 mg/g or
- Urine Protein to Creatinine Ratio (random urine) 300 mg/g or
- Urine Protein 24 Hour collection 2 grams/day
- Interpretation of 24 Hour Urine Protein Excretion or Albumin to Creatinine Ratio
- Severe Proteinuria, Macroalbuminuria criteria met
- Nephrology Consultation
- Determine Creatinine Clearance
- Monthly monitoring (see below)
- Proteinuria level below cutoffs listed above
- Determine Creatinine Clearance
- Creatinine Clearance normal
- Orthostatic Proteinuria
- Consider in age under 30 years
- Collect Split 24 Hour Urine Protein
- Isolated poteinuria
- Recheck every 6 months
- Orthostatic Proteinuria
- Creatine Clearance decreased
- Consider nephrology Consultation
- Monthly monitoring (see below)
- Severe Proteinuria, Macroalbuminuria criteria met
VI. Monitoring
- Frequency (see lab protocol above)
- Orthostatic Proteinuria: every 1-2 years
- Isolated Proteinuria (<2 grams/day): every 6 months
- Large Proteinuria (>2 grams/day): every month
- Testing
- Nephrology Consultation criteria (see lab protocol)
- Large Proteinuria (>2 grams/day)
- Urine microscopy positive for signs of renal disease
- Renal Insufficiency (decreased Creatinine Clearance)
VII. Prevention
VIII. References
- Carroll (2000) Am Fam Physician 62:1333-40 [PubMed]
- Molitch (2004) Diabetes Care 27(suppl 1): S79-S83 [PubMed]
- Dornbrand (1992) Adult Ambulatory Care, p. 270-4
- Friedman (1991) Problem Oriented Diagnosis, p. 261-3
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Related Studies
| Definition (CHV) | abnormal presence of protein in urine |
| Definition (CHV) | abnormal presence of protein in urine |
| Definition (NCI_CTCAE) | A disorder characterized by laboratory test results that indicate the presence of excessive protein in the urine. It is predominantly albumin, but also globulin. |
| Definition (NCI) | The presence of excessive protein, chiefly albumin but also globulin, in the urine. |
| Definition (MSH) | The presence of proteins in the urine, an indicator of KIDNEY DISEASES. |
| Definition (CSP) | presence of excess protein in the urine. |
| Concepts | Finding (T033) |
| MSH | D011507 |
| ICD9 | 791.0 |
| ICD10 | R80 , R80.9 |
| SnomedCT | 207310001, 207315006, 158568007, 167279003, 144515004, 158565005, 236719005, 232691000, 29738008 |
| LNC | LA18970-6 |
| English | Proteinurias, PROTEINURIA, Proteinuria NOS, [D]Proteinuria, [D]Proteinuria NOS, [D]Proteinuria (context-dependent category), [D]Proteinuria NOS (context-dependent category), proteinuria, proteinuria (diagnosis), Urinary protein positive, Protein urine positive, Proteinuria present, Proteinuria [Disease/Finding], proteinurias, Proteinuria, unspecified, [D]Proteinuria NOS (situation), [D]Proteinuria (situation), Proteinuria (disorder), Abnormal presence of protein in urine, Proteinuria (finding), Proteinuria, NOS, Proteinuria [Ambiguous], Proteinuria |
| French | PROTEINURIE, Protéine dans l'urine positive, Protéine urinaire positive, Protéinurie |
| Portuguese | PROTEINURIA, Proteína na urina positiva, Proteinúria presente, Proteinúria |
| Spanish | PROTEINURIA, Proteínas positivas en orina, Presencia de proteinuria, [D]proteinuria (categoría dependiente del contexto), [D]proteinuria, SAI (categoría dependiente del contexto), albuminuria, [D]proteinuria, SAI (situación), [D]proteinuria, SAI, [D]proteinuria (situación), [D]proteinuria, presencia anormal de proteínas en orina, proteinuria (hallazgo), proteinuria, Proteinuria |
| German | PROTEINURIE, Proteinurie nachweisbar, Urinprotein positiv, Protein im Urin positiv, Proteinurie |
| Dutch | urinair eiwit positief, eiwit urine positief, aanwezige proteïnurie, proteïnurie, Proteïnurie |
| Italian | Presenza di proteine nelle urine, Proteine urinarie positive, Proteinuria |
| Japanese | 蛋白尿陽性, 蛋白尿, 尿蛋白陽性, ﾀﾝﾊﾟｸﾆｮｳ, ﾆｮｳﾀﾝﾊﾟｸﾖｳｾｲ, ﾀﾝﾊﾟｸﾆｮｳﾖｳｾｲ |
| Swedish | Äggvita i urin |
| Czech | proteinurie, Proteinurie, Přítomnost proteinurie, Bílkovina v moči pozitivní |
| Finnish | Proteinuria |
| Russian | PROTEINURIIA, ПРОТЕИНУРИЯ |
| Croatian | PROTEINURIJA |
| Polish | Białkomocz |
| Hungarian | Fehérje vizeletben pozitív, proteinuria kimutatható, proteinuria, Vizelet fehérje pozitív |
| Norwegian | Proteinuri, Eggehvite i urinen |
