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Proteinuria in AdultsAka: Proteinuria

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  1. See Also
    1. Pediatric Proteinuria
  2. Pathophysiology
    1. Glomerulus is permeable
      1. Molecular Weight under 60,000 Daltons may be filtered
      2. Albumin (MW 65,000) should not be filtered minimally
    2. Normal Urinary Protein Excretion <150 mg/day
      1. Immunoglobulin (20,000 Daltons) 20%
      2. Albumin (65,000 Daltons) 40%
      3. Tamm-Horsfall Mucoprotein (distal tubule secrete) 40%
  3. Causes
    1. See Proteinuria Causes
  4. Labs: Step 1
    1. Qualitative Protein: Random dipstick Urinalysis
      1. Obtain first morning void
      2. See Urine Protein
      3. Confirm Proteinuria with Sulfosalicylic acid
    2. Microscopic Urinalysis findings of renal disease
      1. Urine fats (Nephrotic Syndrome)
      2. Urine WBCs without bacteruria (Renal Interstitial)
      3. Dysmorphic erythrocytes (Glomerular disease)
      4. Cellular or granular casts (chronic renal disease)
      5. Urine Eosinophils
        1. Drug-induced Acute Interstitial Nephritis
    3. Criteria for Step 2 evaluation below
      1. Urinalysis with 3+ to 4+ Urine Protein
      2. Urine Protein trace to 2+ on 2-3 Urinalysis in month
      3. Nephrology consult for positive microscopic findings
  5. Labs: Step 2
    1. Quantitative Protein
      1. Urine Albumin to Creatinine Ratio (random urine) or
      2. Urine Protein to Creatinine Ratio (random urine) or
      3. Urine Protein 24 Hour collection
    2. Interpretation of 24 Hour Urine Protein Excretion
      1. Urine Protein 24 Hour excretion > 2 grams per day
        1. Nephrology Consultation
        2. Determine Creatinine Clearance
        3. Monthly monitoring (see below)
      2. Urine Protein 24 Hour excretion < 2 grams per day
        1. Determine Creatinine Clearance
        2. Creatinine Clearance normal
          1. Orthostatic Proteinuria
            1. Consider in age under 30 years
            2. Collect Split 24 Hour Urine Protein
          2. Isolated poteinuria
        3. Creatine Clearance decreased
          1. Consider nephrology consultation
          2. Monthly monitoring (see below)
  6. Monitoring
    1. Frequency (see lab protocol above)
      1. Orthostatic Proteinuria: every 1-2 years
      2. Isolated Proteinuria (<2 grams/day): every 6 months
      3. Large Proteinuria (>2 grams/day): every month
    2. Testing
      1. Blood Pressure
      2. Urinalysis
      3. Renal Function test
    3. Nephrology Consultation criteria (see lab protocol)
      1. Large proteinuria (>2 grams/day)
      2. Urine microscopy positive for signs of renal disease
      3. Renal insufficiency (decreased Creatinine Clearance)
  7. Prevention
    1. See Prevention of Kidney Disease Progression
  8. References
    1. Carroll (2000) Am Fam Physician 62:1333
    2. Dornbrand (1992) Adult Ambulatory Care, p. 270-4
    3. Friedman (1991) Problem Oriented Diagnosis, p. 261-3

Proteinuria (C0033687)

Definition (MSH)The presence of proteins in the urine, an indicator of KIDNEY DISEASES.
Definition (CSP)presence of excess protein in the urine.
Definition (NCI)Proteinuria; the presence of excessive protein, chiefly albumin but also globulin, in the urine.
ConceptsDisease or Syndrome (T047)
ICD9791.0
EnglishAbnormal presence of protein in urine, Proteinuria, Proteinurias
Spanishalbuminuria, presencia anormal de proteínas en orina, presencia anormal de proteinas en orina, proteinuria
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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