Rehab Cell

Physical Medicine and Rehabilitation

Nephrology – Proteinuria: By Manish Suneja M.D.

Nephrology – Proteinuria: By Manish Suneja M.D.

Proteinuria occurs when urinary excretion
of protein is abnormally high (>150mg/day). It is important to distinguish transient and
persistent proteinuria as it helps us to distinguish benign, self-limiting etiologies from more
significant illnesses. In fact the presence of proteinuria for more
than three months with or without a decrease in glomerular filtration rate is diagnostic
of chronic kidney disease. The list of differential diagnoses for proteinuria
includes almost any etiology of kidney disease. Although there might be exceptions, the following
framework is helpful in evaluating proteinuria: Hematuria with overt proteinuria suggests
glomerulonephritis Significant proteinuria typically suggests
glomerular diseases and plasma cell dyscrasias like multiple myeloma
Minimal to low-grade proteinuria indicates diseases that affect blood vessels Proteinuria itself typically has few signs
or symptoms. When there is significant proteinuria (especially
nephrotic-range proteinuria), patients may notice edema in the extremities and face along
with foamy urine. Nephrotic range proteinuria may also result
in volume overload and patients can present with pleural effusion and ascites. The presence of nephrotic-range proteinuria
with edema, hypoalbuminemia, and hyperlipidemia is defined as nephrotic syndrome. Proteinuria is often diagnosed incidentally
on routine qualitative dipstick testing of urine sample. However, quantitative testing is important
in evaluating proteinuria. The gold standard for confirming and quantifying
proteinuria is a 24-hour urine collection. More recently, an acceptable alternative is
calculating the protein-to-creatinine ratio and/or the albumin-to-creatinine ratio in
a random urine sample. Patients with chronic kidney disease, edema,
acute kidney injury, hematuria, or suspected vasculitis should be tested for proteinuria. Moderately increased albuminuria (formerly
called microalbuminuria) is particularly important because it signifies early stages of kidney
disease. This should be a routine measurement in people
with systemic conditions, like diabetes and hypertension, to screen for and detect nephropathy. Management of proteinuria depends on the underlying
pathology. For patients with intrinsic renal disease
or systemic illnesses, treatment with Angiotensin Converting Enzyme inhibitors and Angiotensin
Receptor Blockers are associated with improved renal outcomes. In instances where the diagnosis is not obvious
or if there is significant proteinuria (3.5g/day), referral to nephrology is essential for further
testing and management.

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