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==Overview==
==Overview==
Proteinuria (from ''protein'' and ''urine'') means the presence of an excess of serum [[protein]]s in the [[urine]].<ref>{{cite web | url = http://www.kmle.com/search.php?Search=proteinuria | title = ''KMLE Medical Dictionary Definition of proteinuria'' | author = [http://www.kmle.com The American Heritage Stedman's Medical Dictionary]}} Retrieved 2007-01-20</ref> 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]]),<ref>http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20</ref> [[retrograde ejaculation]],<ref>http://www.medhelp.org/forums/urology/archive/195.html Retrieved 2007-01-20</ref> pneumaturia (air bubbles in the urine) due to a [[fistula]],<ref>{{GPnotebook|1161101335|Pneumaturia}} Retrieved 2007-01-20</ref> or drugs such as [[pyridium]].<ref>http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20</ref>  
Proteinuria (from ''protein'' and ''urine'') means the presence of an excess of serum [[protein]]s in the [[urine]].<ref>{{cite web | url = http://www.kmle.com/search.php?Search=proteinuria | title = ''KMLE Medical Dictionary Definition of proteinuria'' | author = [http://www.kmle.com The American Heritage Stedman's Medical Dictionary]}} Retrieved 2007-01-20</ref> 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]]),<ref>http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20</ref> [[retrograde ejaculation]],<ref>http://www.medhelp.org/forums/urology/archive/195.html Retrieved 2007-01-20</ref> pneumaturia (air bubbles in the urine) due to a [[fistula]],<ref>{{GPnotebook|1161101335|Pneumaturia}} Retrieved 2007-01-20</ref> or drugs such as [[pyridium]].<ref>http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20</ref>


==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. <ref>http://medlib.med.utah.edu/WebPath/TUTORIAL/URINE/URINE.html Retrieved 2007-01-20</ref><ref name="pmid15791892">{{cite journal |author=Simerville JA, Maxted WC, Pahira JJ |title=Urinalysis: a comprehensive review |journal=American family physician |volume=71 |issue=6 |pages=1153-62 |year=2005 |pmid=15791892 |doi= |url=http://www.aafp.org/afp/20050315/1153.html}}</ref> 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]].<ref>http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20</ref><ref>http://www.answers.com/topic/protein-electrophoresis Retrieved 2007-01-20</ref>
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 [[Microalbuminuria|Albumin:creatinine ratio]] of >30 mg/mmol) with very high levels of [[nephrotic syndrome]] being for PCR > 100 mg/mmol.<ref>{{cite web |title=Identification, management and referral of adults with chronic kidney disease: concise guidelines |url=http://www.renal.org/CKDguide/full/Conciseguid141205.pdf |format=PDF |date=27/9/05 |publisher=UK Renal Association}} - see Guideline 4 Confirmation of proteinuria, on page 9</ref>
{| - style="background:silver; color:black"
|-
| '''Reference Range'''
|-
|- style="background:silver; color:black"
|'''Physiologic protien elimination'''
| <150mg protien/24 hours
|-
|- style="background:silver; color:black"
|'''Proteinuria'''
| >150mg protein/24 hours
|-
|- style="background:silver; color:black"
| '''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.
==Causes==
==Causes==
===Conditions with proteinuria as a sign===
Proteinuria may be a feature of the following conditions:<ref name="pmid15791892">{{cite journal |author=Simerville JA, Maxted WC, Pahira JJ |title=Urinalysis: a comprehensive review |journal=American family physician |volume=71 |issue=6 |pages=1153-62 |year=2005 |pmid=15791892 |doi= |url=http://www.aafp.org/afp/20050315/1153.html}}</ref>
Proteinuria may be a feature of the following conditions:<ref name="pmid15791892">{{cite journal |author=Simerville JA, Maxted WC, Pahira JJ |title=Urinalysis: a comprehensive review |journal=American family physician |volume=71 |issue=6 |pages=1153-62 |year=2005 |pmid=15791892 |doi= |url=http://www.aafp.org/afp/20050315/1153.html}}</ref>
* [[Nephrotic syndromes]] (i.e. intrinsic renal failure)
* [[Nephrotic syndromes]] (i.e. intrinsic renal failure)
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* [[Familial Mediterranean fever]]
* [[Familial Mediterranean fever]]


===Conditions with proteinuria consisting mainly of Bence-Jones proteins as a sign===
===Causes of Bence-Jones proteinuria===
* Waldenstrom's macroglobulinemia
* Waldenstrom's macroglobulinemia
* [[Chronic lymphocytic leukemia]]
* [[Chronic lymphocytic leukemia]]
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* [[Multiple myeloma]]
* [[Multiple myeloma]]


==Glomerular Protienuria==
===Glomerular Proteinuria===
*Allergins
*Allergins
*[[Glomerulonephritis]]
*[[Glomerulonephritis]]
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:*[[Diabetes Mellitus]]
:*[[Diabetes Mellitus]]


==Tubular Proteinuria==
===Tubular Proteinuria===
*Connatal tulbulopathies  
*Connatal tulbulopathies  
*Hypokalemic nephropathy
*Hypokalemic nephropathy
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*Toxic nephropathy
*Toxic nephropathy


==Prerenal and Overflow Proteinuria==
===Prerenal and Overflow Proteinuria===
*[[Bence-Jones Proteinuria]]
*[[Bence-Jones Proteinuria]]
*[[Hemoglobinura]]
*[[Hemoglobinura]]
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*[[Myoglobinuria]]
*[[Myoglobinuria]]


==Renal Parenchymal and Post Renal Proteinuria==
===Renal Parenchymal and Post Renal Causes of Proteinuria===
*Hemmorhage in the urinary tract
*Hemmorhage in the urinary tract
*Local infections
*Local infections
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*Tamm-Horsfall protein
*Tamm-Horsfall protein


==Miscellaneous Causes for Proteinuria==
===Miscellaneous Causes of Proteinuria===
*Arteriolar nephrosclerosis
*Arteriolar nephrosclerosis
*Chronic [[Pyelonephritis]]
*Chronic [[Pyelonephritis]]
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*[[Tricuspid insufficiency]]
*[[Tricuspid insufficiency]]
*Unilateral kidney
*Unilateral kidney
==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. <ref>http://medlib.med.utah.edu/WebPath/TUTORIAL/URINE/URINE.html Retrieved 2007-01-20</ref><ref name="pmid15791892">{{cite journal |author=Simerville JA, Maxted WC, Pahira JJ |title=Urinalysis: a comprehensive review |journal=American family physician |volume=71 |issue=6 |pages=1153-62 |year=2005 |pmid=15791892 |doi= |url=http://www.aafp.org/afp/20050315/1153.html}}</ref> 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]].<ref>http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20</ref><ref>http://www.answers.com/topic/protein-electrophoresis Retrieved 2007-01-20</ref>
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 [[Microalbuminuria|Albumin:creatinine ratio]] of >30 mg/mmol) with very high levels of [[nephrotic syndrome]] being for PCR > 100 mg/mmol.<ref>{{cite web |title=Identification, management and referral of adults with chronic kidney disease: concise guidelines |url=http://www.renal.org/CKDguide/full/Conciseguid141205.pdf |format=PDF |date=27/9/05 |publisher=UK Renal Association}} - see Guideline 4 Confirmation of proteinuria, on page 9</ref>
{| - style="background:silver; color:black"
|-
| '''Reference Range'''
|-
|- style="background:silver; color:black"
|'''Physiologic protien elimination'''
| <150mg protien/24 hours
|-
|- style="background:silver; color:black"
|'''Proteinuria'''
| >150mg protein/24 hours
|-
|- style="background:silver; color:black"
| '''Microalbuminuria'''
| <30mg albumin/24 hours
|}


==Related Chapters==
==Related Chapters==

Revision as of 15:53, 11 April 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Synonyms and keywords: Urinary protein levels raised; urine protein raised

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

Proteinuria may be a feature of the following conditions:[6]

Causes of Bence-Jones proteinuria

Glomerular Proteinuria

  • 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 Causes of Proteinuria

Miscellaneous Causes of Proteinuria

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. [9][6] 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.[10][11]

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.[12]

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

Related Chapters

References

  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. Template:GPnotebook Retrieved 2007-01-20
  5. http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20
  6. 6.0 6.1 Simerville JA, Maxted WC, Pahira JJ (2005). "Urinalysis: a comprehensive review". American family physician. 71 (6): 1153–62. PMID 15791892.
  7. Dettmeyer RB, Preuss J, Wollersen H, Madea B (2005). "Heroin-associated nephropathy". Expert opinion on drug safety. 4 (1): 19–28. PMID 15709895.
  8. 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.
  9. http://medlib.med.utah.edu/WebPath/TUTORIAL/URINE/URINE.html Retrieved 2007-01-20
  10. http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20
  11. http://www.answers.com/topic/protein-electrophoresis Retrieved 2007-01-20
  12. "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

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