+1 protein in urine

What You Should Know About Albuminuria (Proteinuria)

What is a urine protein (albumin) test?

It is a test that looks for the presence of albumin in your urine. Albumin is a type of protein that is normally found in the blood. Your body needs protein. It is an important nutrient that helps build muscle, repair tissue, and fight infection. But protein should be in your blood, not your urine.

How is a urine test done?

A simple urine test can be done in your doctor’s office. You will be asked to pee into a clean cup called a “specimen cup.” Only a small amount of your urine is needed (about two tablespoons) to do the test. Some of the urine is tested right away with a dipstick — a thin, plastic strip that is placed in the urine. The rest is examined under a microscope.

What’s wrong with having albumin (protein) in my urine?

One of the main jobs of your kidneys is to filter your blood. When your kidneys are healthy, they keep important things your body needs inside your blood, like protein. They also remove things your body doesn’t need, like waste products and extra water.

If your kidneys are damaged, protein can “leak” out of the kidneys into your urine. Having protein in your urine is called “albuminuria” or “proteinuria.”

If I have albuminuria, does it mean I have kidney disease?

It may be an early sign of kidney disease, but your doctor will check you again to make sure albuminuria is not caused by something else, like not drinking enough water. If your doctor suspects that you have kidney disease, the urine test for albumin will be repeated. Three positive results over three months or more is a sign of kidney disease.

You will also be given a simple blood test to estimate GFR. GFR stands for glomerular filtration rate. Your GFR number tells you how well your kidneys are working.

You may also be given:

  • Imaging tests. (An ultrasound or CT scan). This produces a picture of your kidneys and urinary tract. It can show whether your kidneys have kidney stones or other problems.

  • A kidney biopsy. This can help find out what caused your kidney disease and how much damage to the kidneys has happened.

How often do I need to have a test for albuminuria (proteinuria)?

People who are at increased risk for kidney disease should have this test as part of routine checkups by a healthcare provider. Those at increased risk include:

  • People with diabetes

  • People with high blood pressure

  • People with a family history of kidney failure

  • People who are 65 years or older

  • Certain ethnic groups including African Americans, Hispanics, Asians, American Indians

If I have albuminuria, will I need treatment?

If kidney disease is confirmed, your healthcare provider will create a treatment plan for you. You may also be asked to see a special kidney doctor called a nephrologist. Your treatment may include:

  • Medications

  • Changes in your diet

  • Lifestyle changes such as losing extra weight, exercising, and stopping smoking.

What are the symptoms of kidney disease?

Most people with kidney disease do not have symptoms unless the disease is very advanced. However, you may feel:

  • Swelling

  • Shortness of breath

  • Needing to urinate more often

  • Hiccups

  • Fatigue (feeling tired)

  • Trouble sleeping

  • Nausea and vomiting

  • Dry, itchy skin.

For more information:

  • Speak to your healthcare provider

  • Call the National Kidney Foundation’s toll-free number 1-800-622-9010.

Proteinuria

What is proteinuria?

Proteinuria is increased levels of protein in the urine. This condition can be a sign of kidney damage.

Proteins – which help build muscle and bone, regulate the amount of fluid in blood, combat infection and repair tissue – should remain in the blood. If proteins enter the urine they ultimately leave the body, which isn’t healthy.

How does protein get into urine?

Protein gets into the urine if the kidneys aren’t working properly. Normally, glomeruli, which are tiny loops of capillaries (blood vessels) in the kidneys, filter waste products and excess water from the blood.

Glomeruli pass these substances, but not larger proteins and blood cells, into the urine. If smaller proteins sneak through the glomeruli, tubules (long, thin, hollow tubes in the kidneys) recapture those proteins and keep them in the body.

However, if the glomeruli or tubules are damaged, if there is a problem with the reabsorption process of the proteins, or if there is an excessive protein load, the proteins will flow into the urine.

How common is proteinuria?

Normal amount of protein in the urine are less than 150mg/day. High levels of protein in the urine are associated with rapid decline in kidney function. It affects about 6.7 percent of the United States population. It is seen more in elderly and people with other chronic illnesses.

What causes proteinuria?

In many cases, proteinuria is caused by relatively benign (non-cancerous) or temporary medical conditions.

These include dehydration, inflammation and low blood pressure. Intense exercise or activity, emotional stress, aspirin therapy and exposure to cold can also trigger proteinuria. In addition, a kidney stone in the urinary tract can cause proteinuria.

Occasionally, proteinuria is an early indication of chronic kidney disease, a gradual loss of kidney function that may eventually require dialysis or a kidney transplant. Diabetes and high-blood pressure can damage kidneys and are the number-one and number-two causes of kidney disease.

Other potentially kidney-harming diseases and medical conditions, which can lead to proteinuria, include:

  • Immune disorders like lupus and Goodpasture’s syndrome
  • Acute inflammation of the kidney (glomerulonephritis)
  • Cancer of plasma cells (multiple myeloma)
  • Intravascular hemolysis, which is the destruction of red blood cells and release of hemoglobin in the bloodstream
  • Cardiovascular disease
  • Preeclampsia, the simultaneous development of hypertension and proteinuria in a pregnant woman
  • Poisoning
  • Trauma
  • Kidney cancer
  • Congestive heart failure

Also, most serious illnesses can result in proteinuria.

What are the symptoms of proteinuria?

Often, someone with proteinuria doesn’t experience symptoms, especially if kidneys are just beginning to have problems. However, if proteinuria is advanced, symptoms can include:

  • More frequent urination
  • Shortness of breath
  • Tiredness
  • Nausea and vomiting
  • Swelling in the face, belly, feet or ankles
  • Lack of appetite
  • Muscle cramping at night
  • Puffiness around the eyes, especially in the morning
  • Foamy or bubbly urine

These are also symptoms of chronic kidney disease. Anyone experiencing these symptoms, especially foamy urine and swelling, should see a doctor immediately.

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On call: Protein in the urine

Published: April, 2012

Q. In the past you have discussed blood in the urine. I don’t have that problem, but during my annual checkup last week, my doctor found protein in my urine. Is it a serious problem? And what should I do about it?

A. Your kidneys have many functions, ranging from helping to regulate your blood pressure and stimulating the production of red blood cells to converting vitamin D into its active form. But their best-known job is to rid your body of excess fluids and metabolic waste products. To do that, the blood that flows into each kidney passes through about one million tiny vascular filters called glomeruli.

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Proteinuria

By Silvia German, RN, CNN, Education Manager with the DaVita® National Clinical Education Team

When healthy kidneys filter fluid, minerals and wastes from the blood, they usually do not allow large amounts of serum protein to escape into the urine. But when kidneys aren’t filtering properly, proteinuria can occur, meaning that an abnormal amount of protein is present in the urine.

The two major groups of serum proteins in the blood are albumin and globulins. Albumin is abundant in the blood, accounting for more than 50 percent of all serum proteins. Its important functions include pulling water into capillaries and maintaining the right amount of water in the circulatory system, as well as binding and carrying substances that are poorly soluble in water. Three examples of these substances are fat soluble vitamins, calcium and some medications.

Globulins are divided into alpha, beta and gamma globulins. Alpha and beta globulins also transport substances, while gamma globulins are known as immunoglobulins or antibodies. Testing for protein in the urine can include all the different proteins or albumin only.

Types of proteinuria

Transient proteinuria is the temporary excretion of protein and can be caused by strenuous exercise, a high fever, exposure to cold, stress and other conditions. Pregnant women may also excrete more protein in their urine. Transient proteinuria does not involve underlying kidney disease and requires no treatment.

Orthostatic proteinuria means an increased amount of protein is excreted when a person is in the upright position. It’s most often found in tall, thin adolescents and young adults less than 30 years of age. The kidneys are usually healthy.

Proteinuria can be caused by diseases not involving the kidneys, such as multiple myeloma, a cancer of the plasma cells in the bone marrow. In this case, the blood is flooded with too many proteins that are then filtered into the urine. The condition is known as overflow proteinuria.

The other type of proteinuria is due to kidney disease, such as glomerulonephritis, primary focal segmental glomerulosclerosis (FSGS) or kidney damage due to a systemic disease. Microalbuminuria means low levels of albumin are detected in the urine. Microalbuminuria can indicate that people with diabetes or hypertension are developing early stages of kidney disease.

Symptoms of proteinuria

In most cases, proteinuria has no symptoms and is detected during a routine screening in people with high blood pressure or diabetes. If protein loss is severe, swelling or edema can occur. Edema can be present in the:

  • Face and around the eyes
  • Arms, hands, legs, ankles and feet
  • Abdomen

Other symptoms can include:

  • Foamy urine
  • Weight gain caused by fluid retention
  • Diminished appetite
  • Hypertension

How is proteinuria diagnosed?

Urinalysis covers a number of tests performed on urine. Abnormal presence of cells and urinary casts, tiny tube-shaped particles, may reveal underlying kidney disease.

The Urine Albumin to Creatinine Ratio (UACR) is a test that estimates how much albumin is excreted in a 24-hour period without requiring patients to collect urine for a whole day.

Common proteinuria blood tests check serum creatinine, albumin, cholesterol and blood glucose levels to help determine whether the condition is caused by kidney damage.

If kidney disease is suspected, any of three tests may be conducted:

  • Glomerular filtration rate (GFR): Estimates how much blood passes through these tiny filters. Normal results range from 90 to 120 mL/min,while levels below 60 mL/min for three or more months are a sign of chronic kidney disease.
  • Renal ultrasound scan: Produces an image of the kidneys. It can show obstructions, stones and tumors or cysts.
  • Kidney biopsy: Involves removal of a tiny piece of kidney tissue for examination under a microscope.

Treating proteinuria

Because proteinuria is a symptom and not a disease itself, medical care focuses on treating the underlying condition, such as normalizing blood pressure in people with hypertension or controlling blood sugar levels in those with diabetes.

People with nephrotic syndrome and fluid overload should restrict salt in their diet. The nephrologist may also recommend a mild restriction in protein intake.

ACE inhibitors are medications used primarily for the treatment of hypertension, but they’re also very effective in reducing proteinuria regardless of whether the patient has hypertension or not.

Proteinuria in Children

How is proteinuria in children diagnosed?

Because you cannot see protein in your child’s urine, it must be diagnosed with a urine sample. The sample will be sent to a lab for diagnosis. Your doctor may want to recheck your child’s urine for protein because it will often go away on its own (transient proteinuria). If it is still high, your doctor may ask you to collect a 24-hour urine sample from your child. This lets your doctor measure the amount of protein in the urine more accurately. Your doctor also may do some blood tests.

To diagnose orthostatic proteinuria, your child’s doctor will check 2 urine samples. The first is collected in the morning, right after your child gets up. The second sample is collected throughout the day. The samples are kept in separate containers. If your child has orthostatic proteinuria, the morning sample won’t have protein in it. But the urine collected during the day will have protein in it.

Here’s how to do your child’s 24-hour urine collection. For children who are potty-trained, start the collection on a day when your child doesn’t go to school. Weekends are good. When your child gets out of bed in the morning, have him or her urinate into the toilet. This urine is not saved. Flush it down the toilet. Write down the exact time your child urinates.

After this, whenever your child needs to urinate, have your child urinate in the special container the doctor or the laboratory provides. For girls, collect the urine in a urine “hat” (a specimen collection device). Pour it into the special container. You don’t need to mark the times when these urine samples are collected. Be sure to wash your hands after handling the container.

It’s important to collect all the urine your child produces all day and night. The next morning, wake your child up the same time as the previous day. Have your child urinate into the container one last time. This ends the 24-hour collection. Now write the date and the time on the container label. Bring the container to the lab on this day. Bacteria can grow in urine at room temperature. Keep the urine in a refrigerator until you deliver it to the lab.

Protein in urine

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Everyone has protein in their blood. The main protein in your blood is called albumin. Proteins have many important jobs in your body, such as helping to build your bones and muscles, prevent infection and control the amount of fluid in your blood.

Healthy kidneys remove extra fluid and waste from your blood, but let proteins and other important nutrients pass through and return to your blood stream. When your kidneys are not working as well as they should, they can let some protein (albumin) escape through their filters, into your urine. When you have protein in your urine, it is called proteinuria (or albuminuria). Having protein in your urine can be a sign of nephrotic syndrome, or an early sign of kidney disease.

Anyone can have protein in their urine. You may be more at risk for having it if you have one or more of the risk factors for kidney disease, such as:

  • Diabetes
  • High blood pressure
  • Family history of kidney disease

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  • How will I know if I have protein in my urine?
  • How is proteinuria treated?

How will I know if I have protein in my urine?

When your kidneys are first starting to have problems, and you do not have a lot of protein in your urine, you will not notice any symptoms. The only way to know if you have protein in your urine is to have a urine test. The test for protein in the urine measures the amount of albumin in your urine, compared to the amount of creatinine in your urine. This is called the urine albumin-to-creatinine ratio (UACR). A UACR more than 30 mg/g can be a sign of kidney disease.

When your kidney damage gets worse and large amounts of protein escape through your urine, you may notice the following symptoms:

  • Foamy, frothy or bubbly-looking urine when you use the toilet
  • Swelling in your hands, feet, abdomen or face

If you are having these symptoms, your kidney damage may already be severe. Talk to your health care provider immediately about what may be causing your symptoms and what treatment is best for you.

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How is proteinuria treated?

If you have diabetes or high blood pressure, the first and second most common causes of kidney disease, it is important to make sure these conditions are under control.

If you have diabetes, controlling it will mean checking your blood sugar often, taking medicines as your doctor tells you to, and following a healthy eating and exercise plan. If you have high blood pressure, your doctor may tell you to take a medicine to help lower your blood pressure and protect your kidneys from further damage. The types of medicine that can help with blood pressure and proteinuria are called angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs).

If you have protein in your urine, but you do not have diabetes or high blood pressure, an ACE inhibitor or an ARB may still help to protect your kidneys from further damage. If you have protein in your urine, talk to your doctor about choosing the best treatment option for you.

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Albuminuria: Albumin in the Urine

On this page:

  • What is albuminuria?
  • Why is urine albumin important?
  • How is albuminuria detected?
  • How can albuminuria be reduced?
  • Clinical Trials

What is albuminuria?

Albuminuria is a sign of kidney disease and means that you have too much albumin in your urine. Albumin is a protein found in the blood. A healthy kidney doesn’t let albumin pass from the blood into the urine. A damaged kidney lets some albumin pass into the urine. The less albumin in your urine, the better.

Sometimes albuminuria is also called proteinuria.

A healthy kidney doesn’t let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine.

More information is provided in the NIDDK health topics, Diabetic Kidney Disease and High Blood Pressure and Kidney Disease.

Why is urine albumin important?

Measurement of urine albumin is an important tool for

  • diagnosing kidney disease
  • monitoring the progression of kidney disease

Health care providers regularly test people for albuminuria as part of a routine medical exam and will closely monitor urine albumin in people with kidney disease.

A urine albumin level that stays the same or goes down may mean that treatments are working. Treatment that lowers the urine albumin level may lower the chances that kidney disease will progress to kidney failure.

People who have diabetes, high blood pressure, heart disease, or a family history of kidney failure are at risk for kidney disease. Talk with your health care provider about how often you should get a urine test for albumin.

How is albuminuria detected?

A health care provider often tests for albuminuria using a urine dipstick test followed by a urine albumin and creatinine measurement.

You will be asked to collect a urine sample in a special container in your health care provider’s office or a commercial facility. The office or facility tests the sample onsite or sends it to a lab for analysis.

Dipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine. For the test, a nurse or technician places a dipstick, a strip of chemically treated paper, into the urine. The dipstick changes color if albumin is present in the urine.

Albumin and creatinine measurement. A health care provider uses this measurement to determine the ratio between the albumin and creatinine in the urine and to estimate the amount of albumin excreted in 24 hours. Creatinine is a waste product that is filtered in the kidneys and excreted in the urine. Health care providers consider a urine albumin-to-creatinine ratio above 30 mg/g higher than normal.

If you have kidney disease or are at risk for kidney disease, talk with your health care provider about how often you should get a urine test for albumin.

How can albuminuria be reduced?

You may be able to reduce the amount of albumin in your urine by taking medicines that lower blood pressure called ACE inhibitors or ARBs. The names of these medicines end in -pril or -sartan.

You may also be able to protect your kidneys and reduce albuminuria by working with a registered dietitian who can help you plan meals and change your eating habits. The meal plan may help you

  • lose weight, if you are overweight
  • avoid foods high in sodium or salt
  • eat the right amounts and types of protein

Meet with a dietitian who can help you plan meals and change your eating habits.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Proteinuria Causes, Symptoms, and Treatment

If you have proteinuria, take note of your other symptoms. This will help a doctor identify the underlying cause.

Dehydration

Dehydration happens when your body loses too much fluid. It’s a common, temporary cause of proteinuria.

Your body uses water to deliver nutrients, like proteins, to the kidneys. But without enough fluid, it will have difficulty doing so.

In turn, the kidneys can’t properly recapture proteins. The protein ends up in the urine instead.

Other symptoms depend on the severity of dehydration. You may experience:

  • fatigue
  • headaches
  • dizziness
  • increased thirst
  • dark-colored urine
  • decreased urination
  • dry mouth or skin

Dehydration can be caused by:

  • diarrhea
  • vomiting
  • excessive sweating
  • fever
  • not drinking enough water

High blood pressure

High blood pressure, or hypertension, can weaken the blood vessels in the kidneys. This decreases their ability to reabsorb to protein, which flows into the urine.

Since high blood pressure develops slowly, you may not have symptoms for years. But if it becomes severe, it can cause:

  • headaches
  • shortness of breath
  • nosebleeds

Most cases of high blood pressure don’t have an underlying cause. But in some people, high blood pressure is due to:

  • kidney disease
  • thyroid problems
  • obstructive sleep apnea
  • adrenal gland tumors
  • some medications, like birth control or decongestants

Diabetes mellitus

Diabetes mellitus is a metabolic disorder that causes high levels of blood sugar. There are several types of diabetes, including type 1 and type 2 diabetes.

With diabetes, high blood sugar forces the kidneys to over filter the blood. This can cause kidney damage, allowing protein to leak into the urine.

Symptoms of diabetes depend on the severity and type. You may have:

  • increased thirst and hunger
  • frequent urination
  • fatigue
  • blurry vision
  • unexplained weight loss

Glomerulonephritis

Proteinuria may indicate glomerulonephritis, or inflammation of the glomeruli.

Normally, when the glomeruli filter blood, they reabsorb protein. But if they’re injured, protein can pass through and enter the urine.

Glomerulonephritis can cause a set of symptoms called nephrotic syndrome. In addition to proteinuria, this includes:

  • hyperlipidemia, or high blood levels of fat and cholesterol
  • swollen legs, feet, or ankles
  • hypoalbuminemia, or low blood protein levels

It may also cause high blood pressure and hematuria, or red blood cells in the urine. This makes urine look pink or cola-colored.

Typically, glomerulonephritis happens when the immune system attacks the kidneys. It’s been associated with:

  • bacterial endocarditis
  • HIV
  • hepatitis B
  • hepatitis C
  • lupus
  • diabetic nephropathy
  • high blood pressure

Chronic kidney disease

Chronic kidney disease (CKD) is the progressive loss of kidney function. It may cause proteinuria in the early stages, but it usually doesn’t cause any noticeable symptoms.

As CKD progresses, you might experience:

  • shortness of breath
  • frequent urination
  • hiccups
  • fatigue
  • nausea
  • vomiting
  • trouble sleeping
  • dry, itchy skin
  • swollen hands and feet
  • poor appetite

The following diseases can damage the kidneys and lead to CKD:

  • glomerulonephritis
  • diabetes
  • high blood pressure
  • heart disease
  • interstitial nephritis
  • polycystic kidney disease
  • recurring kidney infection

If CKD progresses, it can result in kidney failure.

Autoimmune diseases

The immune system normally produces antibodies and immunoglobulins that fight foreign organisms. But if you have an autoimmune disease, the immune system makes antibodies and immunoglobulins that attack the body’s tissues. These substances are called autoantibodies.

If the autoantibodies injure the glomeruli, inflammation can occur. This leads to kidney damage, and eventually, proteinuria.

The following autoimmune diseases are associated with proteinuria:

  • Systemic lupus erythematosus. While systemic lupus erythematosus (SLE) mainly involves the skin and joints, it can also affect the kidneys.
  • Goodpasture syndrome. In Goodpasture syndrome, the autoantibodies specifically attack the kidneys and lungs.
  • IgA nephropathy. IgA nephropathy happens when deposits of immunoglobulin A accumulate in the glomeruli.

Preeclampsia

In preeclampsia, a pregnant person develops high blood pressure at or after 20 weeks of pregnancy. This temporarily impairs the kidneys’ ability to filter protein, which causes proteinuria.

Other preeclampsia symptoms include:

  • swollen hands and face
  • headaches
  • blurry vision
  • abdominal pain on the right side
  • increased weight gain

Though preeclampsia usually goes away after delivery, it’s a serious condition that can lead to preterm birth. Pregnant individuals with preeclampsia should be carefully monitored.

Cancer

In severe cases, proteinuria is due to cancer. Several types of cancer are associated with high urine protein levels, including:

  • renal cell carcinoma
  • lung cancer
  • breast cancer
  • colorectal cancer
  • non-Hodgkin’s lymphoma
  • Hodgkin’s lymphoma
  • multiple myeloma

It’s thought that the inflammatory effect of cancer alters kidney function.

In some conditions, like multiple myeloma, kidney damage occurs when abnormal proteins in the blood bind with normal proteins in the urine. As kidney function declines, more protein ends up in the urine.

Though cancer symptoms vary greatly, general symptoms include:

  • unexplained weight loss
  • fatigue
  • fever
  • pain
  • skin changes

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