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14-September-2008 18:02:40 - Proteinuria Symptom/Sign: Proteinuria Classifications and external resources ICD-10 R80. ICD-9 791.0 DiseasesDB 25320 eMedicine med/94 MeSH D011507 Proteinuria from protein and urine means the presence of an excess of serum proteins in the urine. The protein in the urine often causes the urine to become foamy, although foamy urine may also be caused by bilirubin in the urine bilirubinuria,1 retrograde ejaculation,2 pneumaturia air bubbles in the urine due to a fistula,3 or drugs such as pyridium.4 Contents 1 Measurement 2 Associated conditions 2.1 Conditions with proteinuria as a sign 2.2 Conditions with proteinuria consisting mainly of Bence-Jones proteins as a sign 3 See also 4 Footnotes Measurement Proteinuria is often diagnosed by a simple dipstick test although it is possible for the test to give a false negative even with nephrotic range proteinuria if the urine is dilute. False negatives may also occur if the protein in the urine is composed mainly globulins or Bence-Jones Proteins because the reagent on the test strips, Bromphenol blue, is highly specific for albumin. 56 Traditionally dipstick protein tests would be quantified by measuring the total quantity of protein in a 24-hour urine collection test, and abnormal globulins by specific requests for Protein electrophoresis.78 Alternatively the concentration of protein in the urine may be compared to the creatinine level in a spot urine sample. This is termed Protein/Creatinine Ratio PCR. The 2005 UK Chronic Kidney Disease guidelines states that PCR is a better test than 24 hour urinary protein measurement. Proteinuria is defined as a Protein:creatinine ratio 45 mg/mmol which is equivalent to Albumin:creatinine ratio of 30 mg/mmol with very high levels of nephrotic syndrome being for PCR 100 mg/mmol.9 Associated conditions Proteinuria may be a sign of renal kidney damage. Since serum proteins are readily reabsorbed from urine, the presence of excess protein indicates either an insufficiency of absorption or impaired filtration. Diabetics may suffer from damaged nephrons and develop proteinuria. The most common cause of proteinuria is diabetes and in any person with proteinuria and diabetes the etiology of the underlying proteinuria should be separated into two categories: diabetic proteinuria versus the field. With severe proteinuria, general hypoproteinemia can develop which results in diminished oncotic pressure. Symptoms of diminished oncotic pressure may include ascites, edema, and hydrothorax. Conditions with proteinuria as a sign Proteinuria may be a feature of the following conditions:6 Nephrotic syndromes i.e. intrinsic renal failure Pre-eclampsia Eclampsia toxic lesions of kidneys Collagen vascular diseasese.g., systemic lupus erythematosus Dehydration Glomerular diseases, such as membranous glomerulonephritis, focal segmental glomerulonephritis, minimal change disease lipoid nephrosis Strenuous exercise Stress Obsessive Compulsive Disorder Benign Orthostatic postural proteinuria Focal segmental glomerulosclerosis FSGS IgA nephropathy i.e., Berger's disease IgM nephropathy Membranoproliferative glomerulonephritis Membranous nephropathy Minimal change disease Sarcoidosis Alport's syndrome Diabetes mellitus Drugs e.g., NSAIDs, nicotine, penicillamine,gold, ACE inhibitors, antibiotics, opiates especially heroin.10 Fabry's disease Infections e.g., HIV, syphilis, hepatitis,post-streptococcal infection Aminoaciduria Fanconi syndrome Heavy metal ingestion Hypertensive nephrosclerosis Interstitial nephritis Sickle cell disease Hemoglobinuria Multiple myeloma Myoglobinuria Organ rejection- kidney transplant patients may have gamma-globulins in their urine if the kidneys start to reject.11 Ebola hemorrhagic fever Nail Patella Syndrome Familial Merranean fever HELLP Syndrome This list is incomplete; you can help by expanding it. Conditions with proteinuria consisting mainly of Bence-Jones proteins as a sign Waldenstrom's macroglobulinemia Chronic lymphocytic leukemia Amyloidosis Malignancies e.g., lymphoma, other cancers multiple myeloma See also Albuminuria Microalbuminuria List of terms associated with diabetes Footnotes ^ http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20 ^ http://www.medhelp.org/forums/urology/archive/195.html Retrieved 2007-01-20 ^ Retrieved 2007-01-20 ^ http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20 ^ http://medlib.med.utah.edu/WebPath/TUTORIAL/URINE/URINE.html Retrieved 2007-01-20 ^ a b Simerville JA, Maxted WC, Pahira JJ 2005. Urinalysis: a comprehensive review. American family physician 71 6: 1153-62. PMID 15791892. ^ http://www.pathguy.com/lectures/urine.htm Retrieved 2007-01-20 ^ http://www.answers.com/topic/protein-electrophoresis Retrieved 2007-01-20 ^ Identification, management and referral of adults with chronic kidney disease: concise guidelines PDF. UK Renal Association 2005-09-27. - see Guideline 4 Confirmation of proteinuria, on page 9 ^ Dettmeyer RB, Preuss J, Wollersen H, Madea B 2005. Heroin-associated nephropathy. Expert opinion on drug safety 4 1: 19-28. doi:10.1517/14740338.4.1.19. PMID 15709895. ^ Hermann G, Zühlke V, Faul P 1970. Gamma globulin fragments in urine of kidney transplant patients in relation to rejection crisis. European surgical research. Europäische chirurgische Forschung. Recherches chirurgicales européennes 2 1: 55-63. PMID 4131420. v d e Abnormal clinical and laboratory findings R70-R94, 790-796 Blood test Red blood cells Elevated ESR - Anisocytosis - Poikilocytosis - Reticulocytosis - Inclusion bodies Howell-Jolly body, Heinz body Small molecules blood sugar: Abnormal glucose tolerance test - Hyperglycemia - Impaired glucose tolerance - Prediabetes other small molecules: Azotemia - Hyperuricemia Enzymes/other proteins Elevated transaminases - Cardiac marker - Elevated alpha-fetoprotein Minerals Iron overload disorder Pathogens/sepsis Bacteremia - Viremia - Fungemia - Parasitemia Urine test Proteinuria Albuminuria/Microalbuminuria - Myoglobinuria - Hemoglobinuria Small molecules Glycosuria - Ketonuria - Bilirubinuria Red blood cells Hematuria Other Chyluria - Crystalluria Other Abnormal basal metabolic rate - Latent tuberculosis Retrieved from http://en..org/wiki/Proteinuria Categories: Nephrology | Medical signs | UrologyHidden category: Incomplete lists Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Eesti Español Français Italiano עברית Nederlands 日本語 Polski Suomi This page was last modified on 19 August 2008, at 08:11
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