Urine Protein

1. See Also
   1. 24 Hour Urine Protein
   2. Urine Protein to Creatinine Ratio
   3. Proteinuria
   4. Urine Microalbumin
2. Normal
   1. Dipstick with trace protein or less
3. Technique
   1. First morning void collected
      1. Orthostatic Proteinuria (benign, common cause in male teens) may be seen with later samples in the day
   2. Detection Method
      1. Initial: Dipstick Urine Protein
         1. High Test Sensitivity and Test Specificity (>99%) for albumin, but not for other proteins
      2. Confirmation
         1. Urine Protein to Creatinine Ratio
         2. Sulfosalicylic Acid Test (older test)
   3. Dipstick turns from yellow to green for protein present (Tetrabromophenol blue colorimetric method)
      1. Negative: <10 mg/dl
      2. Trace: 10-20 mg/dl
      3. Protein 1+: 30 mg/dl (abnormal)
      4. Protein 2+: 100 mg/dl
      5. Protein 3+: 300 mg/dl
      6. Protein 4+: 1000 mg/dl
4. Causes: Increased
   1. See Proteinuria in Adults
   2. See Proteinuria in Children
5. Causes: False Positive
   1. Alkaline urine (Urine pH >8)
   2. Increased Urine Specific Gravity (concentrated, Urine Specific Gravity >1.030)
   3. Dipstick immersed too long in urine (or placed directly in urine stream)
   4. Non-albumin proteins
   5. Medications
      1. Penicillin
      2. Sulfonamide
      3. Tolbutamide
      4. Phenazopyridine (Pyridium)
      5. Chlorhexidine contamination (Hibiclens, Peridex)
      6. Iodinated radiocontrast in urine
      7. Benzalkonium
   6. Body fluid contamination
      1. Gross Hematuria present
      2. Bacteriuria
      3. Pus
      4. Semen
      5. Vaginal secretions
6. Causes: False Negative
   1. Albumin is not the primary protein
      1. Light chain protein (detected by Sulfosalicylic acid)
   2. Dilute urine (Urine Specific Gravity <1.010)
   3. Urine Protein concentration <10 mg per deciliter
   4. Urine pH decreased (pH <4.5)
7. References
   1. Leung (2017) Am Fam Physician 95(4): 248-54 [PubMed]
   2. Simerville (2005) Am Fam Physician 71(6): 1153-62 [PubMed]