Protein in the urine or proteinuria


What does it mean when proteins are in the urine?

The excretory apparatus (which consists of kidneys, ureters and urethra) is one of the most important systems in the body.

The kidneys (main organs of the excretory apparatus) filter the waste products from the blood, which are then excreted from the body via the urine.
Because protein molecules are large, they usually cannot pass through the vascular tangles of the kidney (glomeruli) or kidney filters.
As a rule, no proteins should be found in the urine, but some traces of them are normal.
Nevertheless, sometimes too many proteins can be present in the urine.

The reference values for proteins in urine are between 0.8 and 2 mg/dl. Some substances, such as sugar and protein, cause a high specific gravity of urine, which should be between 1002 and 1028 g/l.

Causes and types of proteinuria

Transient proteinuria
There are some diseases that can temporarily lead to an increase in protein levels.
Transient proteinuria is not a cause for concern as it is not linked to any serious medical conditions.
Incidentally, it usually regresses itself.
This clinical picture can occur due to:

► Extreme exposure
to cold ► High fever ► Intense physical activity

► Stress

Often, a small increase in protein levels in the urine does not cause any symptoms. In addition, protein levels drop again after recovery from the disease.

Orthostatic proteinuria
Orthostatic proteinuria (position-dependent proteinuria) is another type of proteinuria in which the amount of proteins in the urine is higher when the person stands during the day.
It is not known what this type of proteinuria depends on.
This disease is observed in children and adolescents who are tall and slender.
The secretion of proteins occurs mainly during the day, when activity levels are high.
That’s why morning urine samples don’t contain protein.

Persistent proteinuria
Greatly increased protein levels in the urine usually indicate some diseases.
Abnormal amounts of protein may indicate the following systemic diseases:

► Polycystic kidney is a disease that leads to the enlargement of these organs due to the development of many cysts in the kidneys. This often causes high blood pressure (hypertension). People affected by this kidney disease may have elevated protein levels in their urine.
► Proteinuria can be caused by an infection of the kidneys, glomerulonephritis (inflammation of the glomeruli), Goodpasture syndrome (an autoimmune disease that affects the kidneys).
In case of kidney infection, increased leukocytes are also found in the urine, which often has a foul odor.
► Diabetes (a disease characterized by high blood sugar levels) can damage the kidneys by affecting the ability of this organ to filter the blood or reabsorb the proteins into the circulation.
► High blood pressure is one of the main causes of kidney disease. Hypertension damages the arteries inside and around the kidneys and thus negatively affects the functioning of these organs.
► Long-term use of some nonsteroidal anti-inflammatory drugs can lead to proteinuria.
► Amyloidosis (a disease characterized by the growth of proteins in tissues and organs) can be a triggering factor.
► Preeclampsia is a complication in pregnancy that can occur after the twentieth week of pregnancy. Characteristic are proteinuria and hypertension.
► Rheumatoid arthritis, heart disease, Hodgkin’s lymphoma, multiple myeloma, lupus, sarcoidosis, etc. can also be responsible for proteinuria.

Abnormal levels in 24-hour urine collection

Protein in 24-hour urine more than 150 mgProteinuria
Ratio albumin creatinine about 35 – 300 mg per gram creatinineMicroalbuminuria
Ratio albumin creatinine more than 30 per gram of creatinineAlbuminuria

Possible causes of protein in urine in children

Training, stress and illness
Although diseases of the kidneys and glomeruli may be associated with proteinuria, transient proteinuria usually occurs in benign diseases.

Exertion and heavy exercise are the most common factors that can cause a temporary increase in protein levels in the urine. Other factors that can cause transient proteinuria in children include:

  • emotional stress,
  • Infections
  • Fever
  • extreme exposure to cold or heat,

Orthostatic proteinuria Another common cause of protein in urine is orthostatic proteinuria
This is a benign disease characterized by increased secretion of protein into the urine during the day when the child is in an upright position.
During the night, when the child sleeps, protein excretion into the urine is normal.
Orthostatic proteinuria is not linked to any clinical picture or kidney disorder.

Nephrotic syndrome in childhood
Persistent proteinuria may be caused by glomerular disease or disorders that interfere with glomerular filtration.
One of the most common causes of proteinuria in children is nephrotic syndrome, which mostly affects children in the age group from 2 to 5 years.
However, nephrotic syndrome is not an independent disease.
Rather, it is a collective term for a series of signs and symptoms that usually occur at the same time.
Two other conditions that can cause childhood nephrotic syndrome and proteinuria are focal segmental glomerulosclerosis (FSGS) and membranoproliferative glomerulonephritis (MPGN).

Symptoms of proteinuria

Proteinuria can be completely asymptomatic, especially in the initial phase. However, if proteins in the urine are elevated, the following symptoms and consequences may occur:

✦ Foaming urine with blistering ✦ Swelling of arms, hands, face, abdomen, ankles
and feet
✦ Weight gain (due to fluid retention)

When the proteins are excreted in the urine, they react with the air and the urine appears foamy.
The edema (or fluid retention) causes symptoms such as weight gain and swelling of the hands, face, and other areas of the body.
This is a condition in which fluids accumulate in the body’s tissues.
When a large amount of proteins (especially albumins) is removed from the body, the fluid exits the circulatory system and accumulates in the tissues.

When to worry?

Proteins in the urine can be caused by a temporary situation or by a serious illness. In any case, it is necessary to talk to the doctor to find out the cause of the problem.

Protein in the urine during pregnancy

The presence of too much protein in the urine can be a sign of certain diseases in pregnant women.

If, on the other hand, only a small amount of protein is present in the urine, there does not have to be a major health problem.

Causes of proteinuria in pregnancy
The presence of an increased amount of protein in the urine during pregnancy may mean that there is a problem with the kidneys and glomeruli.

  • Kidney diseases (such as glomerulonephritis or nephrotic syndrome) may be related to proteinuria because they affect the filtering capacity of the kidneys.
  • Some tumors can cause glomerulonephritis, such as lymphoma.
  • In pregnant women, a significant amount of proteins in the urine may be related to infections of the genitourinary tract or cystitis (cystitis).
  • In addition, there may be a link between high blood pressure and high protein levels in the urine, especially in an advanced pregnancy status.
    At this stage of pregnancy, proteinuria may be associated with preeclampsia.
    Preeclampsia is a condition in which arterial blood pressure is abnormally elevated during pregnancy.

Diagnosis of protein in urine

If often foaming urine appears with blistering on the surface, the doctor should be consulted as soon as possible.

Other possible symptoms of proteinuria:

  • swelling of the whole body or parts of the body
  • Weight increase, etc.

Doctors analyze and examine the urine samples and determine the amount of protein excreted in the urine.
In women, it is important to wait 4-5 days after the end of the cycle before taking a urine test to avoid contamination of urine with menstrual blood.

Also, a kidney biopsy can be done to find out exact problems and disorders of the kidney.

Protein analysis in urine

Normally, the presence of protein in the urine is determined by means of a “test strip” used to examine a urine sample by immersing a strip of paper containing chemical reagents.
If the urine sample contains too much protein, the test strip changes color.

However, this research mainly indicates the presence of albumin and can sometimes lead to false positive results.
It must therefore be followed by another urine test, for which the sample from a 24-hour urine is required.
This protein examination in 24-hour urine is more reliable than the reactive test strip examination and can also measure proteins that are different from albumin.
A urine protein level of less than 150 mg per day or less than 10 mg per deciliter of urine is considered normal in this test.24-hour urine test for proteins and creatinine clearance

To measure proteins and creatinine clearance, examination of 24-hour urine is required.
The relationship between protein and creatinine in urine helps evaluate and control kidney function.

In the urine routine examination, the examination of proteins in the urine is usually carried out by means of test strips.
If a larger amount of protein is found in an examination with test strips or in a spontaneous urine sample, the examination is carried out from the 24-hour urine collection.
A urine sample taken at any given time is called spontaneous urine.
The protein “albumin” is mainly found in the urine samples, which is present in larger quantities in renal dysfunction because albumin is present in larger quantities in the blood. With this study, not only albumin, but also other proteins can be measured.

In case of kidney infections, antibiotics are prescribed; in diabetes and high blood pressure, patients are asked to check blood sugar levels and blood pressure levels.

What to do? Natural remedies to reduce protein in urine

Treatment of protein in urine depends on the underlying cause.

Diet and nutrition
In addition to medication, doctors also recommend a low-protein diet so that the kidneys are not overburdened when they filter the proteins. They ask patients suffering from proteinuria to avoid some foods that are high in protein, such as:

  • Soy
  • Cheese
  • Milk
  • Poultry
  • Meat
  • Dried fruit, etc.

Instead, various fruits and vegetables should be included in the diet. Patients should drink more, as the kidneys need more water to filter the proteins. Drinking plenty of water and fresh fruit juices helps patients recover faster.

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