What Is The Cause Of Protein In Urine – The main protein in your blood is called albumin. Proteins have many important functions in the body, such as contributing to the construction of bones and muscles, preventing infection and controlling the amount of liquid in the blood.

Each normal kidney has about a million working units called nephrons. Each nephron has a filtration unit called a glomerulus, in which the blood is filtered, and filtrate is produced. A nephron also has tube-like parts called tubules that absorb and release urinary components from the filtrate and ultimately urine is produced which is excreted. Protein in the urine called proteinuria is one of the important signs of kidney disease.

What Is The Cause Of Protein In Urine

Healthy kidneys eliminate excess liquid and waste from your food, but allow protein and other important nutrients to pass through and return to your bloodstream. When the kidneys work properly, they can let some proteins (albumin) escape from their filters in the 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 early development of renal disease.

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Anyone can develop proteinuria. You may have a higher risk if you have one or more of the risk factors for kidney disease, such as:

If we take a normal kidney, about 180 liters of filtrate are produced from plasma (liquid component of blood) in a whole day. The amount of plasma filtered to produce 180 Liters of filtrate has about 10 kg of protein. However, only 0.01% or 1 gram of protein passes into the filtrate in the glomerulus. This is due to the “filtration barrier” inside the glomerulus, which restricts large molecules such as albumin in the urine and allows the passage of water and small solvents. Because of the filtration barrier, only small amounts of albumin pass into the urine. Small molecules called low molecular weight (LMW) proteins easily pass the filtration barrier in the filtrate. The filtered load of these small molecules is less and they are ultimately eliminated in even lower amounts because the LMW proteins are reabsorbed by the kidney tubules. There are also small amounts of protein in the urine that are not filtered but secreted directly into the urine by the kidneys (eg Tamm-Horsfall protein).

The proteins found in the urine are of two main groups: proteins from the plasma (mainly albumin, although in small amounts) and proteins that come out of the tubules in the kidney. Combined together less than 150 mg of protein is eliminated daily in the urine whose albumin is less than 30 mg per day.

Proteinuria may be seen in healthy young adults due to upright posture. This is called postural proteinuria, which is usually less than 1 gram/day. In this condition, a random urine sample shows protein but the first urine sample in the morning (after being in a lying position at night) shows no protein. This condition is benign and does not indicate kidney disease. Normal people and those with chronic kidney disease (CKD) have diurnal variation in protein excretion. At night, protein excretion is lower and less variable than during the day. Samples taken first thing in the morning are more likely to accurately predict 24-hour protein and albumin excretion.

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When your kidneys start to have problems and you don’t have a lot of protein in your urine, you don’t feel symptoms. The only way to know if you have protein in your urine, is to have a urinalysis. The urine protein test measures the amount of albumin in your urine, compared to the amount of creatinine in your urine.

When kidney damage worsens and large amounts of protein in the urine, the following symptoms can be observed:

If you have any of these symptoms, the damage to your kidneys may be serious. Talk to your doctor immediately about what may be causing your symptoms and what treatment is best for your situation.

The routine complete urinalysis test uses a multireagent dipstick to screen for protein in the urine. It is low-cost, widely available and provides rapid point-of-care information. These dipstick reagents have a pH-sensitive colorimetric indicator that changes color when proteins bind to it. Based on the color, the amount of proteinuria is estimated semiquantitatively (reported as trace/+/++/+++). These dipsticks mostly detect albumin and are likely to miss non-albumin proteins and small LMW. Very dilute urine can give a false negative result and very concentrated urine can give a false positive result. Blood in the urine can also give a false positive result, which is usually seen in menstruating women if the urine sample is collected during the days of menstrual bleeding.

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Repeatedly positive proteinuria on dipstick needs to be quantified which can be done by 24-hour total urine protein or albumin quantification (gold standard) for which urine should be collected over 24 hours.

The 24-hour urine collection is the gold standard for measuring protein excretion. The main problem with this method is the inaccurate collection of urine because it can be cumbersome to do. Random or spot samples for urinary protein alone are often inaccurate due to the patient’s hydration status leading to change in urine concentration and also day-to-night variation in protein excretion.

To address these issues of urinary concentration and protein excretion rate variation the Protein Creatinine Ratio (PCR) and Albumin Creatinine Ratio (ACR) are used. They are derived by dividing the urine protein concentration by the urine creatinine concentration is the same sample. This takes care of the problem of urine concentration and the first empty sample early in the morning is taken to address the daily variation in protein excretion. The general values ​​of PCR and ACR can give reasonably reliable information to doctors and easy to do for patients.

If protein is found on a complete urinalysis (using the dipstick method) it needs to be reconfirmed with repeat testing. If there is persistent proteinuria found on a complete urine examination and temporary causes of protein excretion excluded, then the amount of protein in the urine needs to be quantified and a nephrologist consultation is made for further evaluation and management.

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Next steps in management include urinalysis and microscopy to check for red blood cells in the urine and assessment of kidney function (measurement of blood urea and serum creatinine ) along with an ultrasound of the kidneys and bladder to look for their size and evidence of any infection or stones. Based on the information obtained after the above testing and clinical examination, a kidney biopsy may be necessary for further identification of a specific cause of proteinuria, which will further guide the treatment.

If you have diabetes or high blood pressure, the main causes of kidney disease, it is important to ensure that these conditions are controlled.

If you have diabetes, controlling it means checking your blood sugar level, taking your medications as directed by your doctor and maintaining a healthy diet and exercise plan. If you have high blood pressure, your doctor will recommend you to take medicines to lower your blood pressure and protect your kidneys from additional damage.

If you have protein in your urine, but you don’t have diabetes or high blood pressure, talk to your doctor to choose the best treatment for your situation.

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