Presence of protein in urine 0 2. Increased protein in urine (proteinuria). Norms of protein in urine in women and men
Hello, dear readers! Pathological processes that occur in the kidneys are primarily reflected in the composition of urine. Today I want to introduce you to another secret of laboratory research and tell you about increased protein in the urine, why it appears there, how much of it should be normal and what a deviation from the norm means.
This laboratory indicator is most important for the doctor to make a diagnosis. Normally, there should be no protein in the urine, but acceptable values can be up to 0.033 g/l. Anything above this value is called proteinuria.
The biological value of proteins in the human body is extremely important. After all, proteins are building materials for building cells, protect the body from infections, help absorb vitamins and microelements, etc. Proteins - enzymes that make up enzymes help in biological and chemical processes in the body.
The kidneys filter our blood, removing from the body not only excess water, but also metabolic end products, inorganic and organic substances and toxins. The appearance of protein in the urine is one of the signs of a wide range of diseases that can be divided into three groups:
- When the permeability of the glomerular filter is impaired, the renal glomeruli cannot filter high molecular weight proteins. Glomerular (glomerular) proteinuria is a mandatory sign of many kidney diseases, with hypertension, atherosclerotic nephrosclerosis, and congestive kidney.
- Reabsorption disorder, when, during normal filtration in the glomeruli, reabsorption of low molecular weight proteins does not occur. Tubular proteinuria is observed in glomerulonephritis, diabetic nephropathy, renal amyloidosis, and systemic diseases.
- Proteinuria “overflow” is much less common and most often it is one of the signs of neoplasms.
Protein in urine is normal
As I have already noted, a healthy person should not have protein in the urine, but its acceptable values are up to 0.033 g/l.
Increased protein in the urine (also called albuminuria) can be orthostatic in nature and can be observed after heavy physical work, in athletes, with increased sweating, in weakly physically developed schoolchildren and adolescents, in pregnant women.
Exceeding the norm may be due to improper collection of urine for research. Even improper toileting of the genitals before taking the test can affect the result. How to properly prepare for a urine test?
Increased protein in urine
The cause of increased protein in the urine can be various different diseases:
- viral and bacterial infections,
- prolonged fasting and
- burn disease,
- hormonal changes.
As a rule, after recovery from these diseases, the release of protein into the urine stops.
The main and most common cause is pathological processes in the kidneys and urinary tract themselves.
But albuminuria is possible not only with kidney diseases. This can be one of the signs of allergic reactions, leukemia, epilepsy and heart failure.
Depending on the amount of protein, there are 3 degrees of proteinuria:
- Initial – protein content in daily urine – 150-500 mg/l;
- Moderate – from 500 mg/l to 2 g/l;
- Macroproteinuria – more than 2 g/l, which occurs in severe kidney damage (glomerulonephritis, tuberculosis, tumors, amyloidosis, etc.). This level can lead to serious consequences, including kidney failure, when hemodialysis or an artificial kidney machine will be required to restore function.
If a slight increase in protein is observed for quite a long time, then this is also a reason for a more thorough examination by a doctor.
During pregnancy
As soon as a pregnant woman registers with antenatal clinic, she needs to regularly, right up to the birth itself, conduct a urine test before each visit to the gynecologist, including for protein. In the first half of pregnancy, urine is taken once a month, in the second half - once every 2 months. Why is this necessary?
Pregnancy is a special condition when, due to physiological characteristics, the functioning of some organs and the body as a whole changes. Thus, an increase in protein in the urine tells the gynecologist about possible pathologies that can negatively affect both the health of the woman herself and the growing fetus.
Exceeding normal protein levels may be due to physiological reasons (stress, use of certain medications, increased sweating, cold showers, etc.). Although experts say that a pregnant woman should not excrete more than 0.08 - 0.2 g/l per day. If exceeding the norm is observed once, then this does not cause concern. It is enough to regulate your diet and drinking regime. After eliminating the causes of protein in the urine, protein levels return to normal.
Pre-existing kidney disease, diabetes mellitus, and high blood pressure can provoke increased protein in pregnant women.
But the most dangerous condition during pregnancy, accompanied by excess of the norm, is gestosis. With gestosis, the placenta begins to function incorrectly, as a result of which the growing fetus does not receive enough oxygen and nutrients. A possible outcome is premature birth, arrest of fetal development and even death.
As a form of late toxicosis, a woman, combined with high blood pressure, can develop very life-threatening conditions: nephropathy, preeclampsia and eclamsia.
If during pregnancy you experience dizziness, headache, ringing in the ears, darkening of the eyes - these are serious symptoms that should never be ignored, you should immediately inform your gynecologist about the appearance of these symptoms.
In children
Normally healthy child There should be no protein in the urine. But its appearance should alert both parents and doctors. Because this may be one of the symptoms of a serious pathology.
In young children, exceeding the indicators can occur not only due to reasons that are also typical for adults. This is possible due to overheating, when the child is dressed very warmly, elevated temperature, during excessive physical activity, even in infants, when they move their arms and legs very actively, when using certain medications, allergies, injuries and burns.
Orthostatic proteinuria may occur in adolescents. With increased physical activity, the protein level can reach 1.0 g/l, this is observed more often in teenage boys.
To be sure of the correctness of the analysis result, a portion of urine is collected after a thorough morning toilet and it is best to take the middle portion of urine.
In men
It is necessary to separately note the deviation from the norm in urine analysis in men. In addition to the reasons described above for the appearance of protein in the urine, its appearance can be provoked by excessive consumption of protein foods and proteins.
Elevated levels can tell the doctor about the presence of prostatitis and urethritis in men. With a thorough examination, protein can be observed not only in kidney pathology, but it can be a symptom of hemolytic anemia, myocardial infarction, obliterating atherosclerosis with gangrene of the extremities, oncology, muscle injuries.
Symptoms of increased protein in urine
If the indicators in the analysis do not slightly exceed the norm, then people do not make any special complaints. However, a significant and long-term deviation from the norm may be accompanied by the following symptoms:
- pain and aches in joints and muscles, night cramps in the legs,
- general weakness, loss of appetite, pale skin,
- fever and chills,
- high blood pressure,
- the appearance of edema,
- bad dream,
- loss of consciousness.
Visually, you can see flakes and white deposits in the urine, but the urine itself becomes cloudy.
If elevated protein is detected for the first time, it is necessary to retake the test, paying careful attention to the toilet of the genital organs, since remaining discharge in women or lubricant under the foreskin in men can get into the urine and the result will again be unreliable.
Dear readers, increased protein in the urine is a serious sign. In the presence of characteristic symptoms and changes appearance urine, you must tell your doctor about this in order to begin timely treatment.
Protein in urine (proteinuria) is a condition of the body characterized by increased protein excretion in the urine.
Until 1997, the term albuminuria was synonymous with proteinuria.
After establishing the fact that not only proteins - albumins, but also globulins are excreted in the urine.
The term “albuminuria” has fallen out of widespread use as the definition of “protein in the urine.”
The extent of proteinuria (the amount of protein excreted in the urine) depends on three factors:
Fine almost all the protein is reabsorbed in the proximal tubules of the kidneys and only a small part of it excreted in urine. In case of violation any From the three mechanisms mentioned above, proteinuria of various genesis (origin) occurs.
At rest in a healthy person, during general analysis urine, protein is not detected. In morning urine, the protein concentration also does not exceed 0.033 grams/liter.
0.033 grams/liter – minimum the concentration of protein in the urine, detected by standard laboratory tests during analysis. There is protein in the urine Always, and if its concentration does not exceed 0.033 grams/liter - we can say that the protein in the urine is “normal”, “absent”, “not detectable” or “not detectable”.
Proteinuria is the detection of protein in the urine in concentrations exceeding mark 0.033 grams/liter. Taking into account daily fluctuations in the excretion (excretion) of protein in the urine (the maximum amount occurs during the daytime), to assess the extent of proteinuria, a 24-hour urine analysis is performed, which makes it possible to determine daily proteinuria.
The appearance of protein in the urine is not always an alarming signal, but it can be a companion to serious diseases, including character.
A slight increase in protein in the urine of a healthy person may appear after prolonged physical activity. Proteinuria in a healthy person can also be observed after consuming foods rich in whole (undenatured) proteins (milk, raw egg); when the body is hypothermic (including after taking a cold shower); as a result of long walking; with emotional (nervous) stress; profuse sweating; due to allergic diseases.
The appearance of protein in the urine can also be a consequence of an increase in body temperature or an infectious disease.
Minor physiological (nutritional) proteinuria is observed in 92% of newborns in the first 3-7 days of life and is explained by excessive breastfeeding. This proteinuria, being short-term, does not require treatment; to eliminate it, in most cases, it is necessary to stop overfeeding the child.
Lasting loss minor volume of albumin protein (microalbuminuria) may not cause symptoms, but microalbuminuria increases the risk of developing coronary heart disease (myocardial infarction).
Pathological causes of an increase in the volume of protein in the urine may be infectious diseases of the urinary system (urethritis, cystitis), renal cell carcinoma.
The clinical and laboratory sign of kidney disease is precisely systematic detection of protein in the urine that cannot be explained by natural causes.
In the first days of life, in 92% of children, the level of protein in the urine exceeds normal values due to an increase in the permeability of the epithelium of the glomeruli and tubules of the kidneys against the background of the hemodynamic characteristics of the newborn. This proteinuria in newborns is physiological. If elevated levels of protein in the urine persist after first week of life in infants, this proteinuria should almost always be considered as pathological.
A urine test for total protein (Urinalysis, Protein total) is used in the diagnosis of diseases of the urinary system of the human body, prescribed by a doctor to identify kidney diseases and control the treatment process.
A test for total protein in urine is prescribed by a doctor for the following diseases:
- IgA-glomerulonephritis;
- acute tubulointerstitial glomerulonephritis;
- focal segmental glomerular sclerosis;
- idiopathic membranous glomerulonephritis;
- lipoid nephrosis;
- other primary glomerulopathies;
- systemic connective tissue diseases (systemic lupus erythematosus, SLE);
- amyloidosis;
- kidney damage due to diabetes mellitus;
- preeclampsia;
- other multiorgan diseases with possible involvement of the kidneys;
- sickle cell anemia;
- malignant neoplasms of the gastrointestinal tract, lungs, blood.
In patients at risk of chronic renal failure (smoking, heredity, age over 50 years, obesity), a urine protein test is prescribed without fail. The analysis should also be carried out for symptoms of nephropathy (weight gain, microscopic hematuria, gross hematuria, etc. Indicator test strips are used for visual rapid diagnosis, measurement of protein concentration in urine, timely detection of albuminuria (proteinuria) both at home and in medical settings centers, clinical diagnostic laboratories, hospitals (clinics), medical institutions For independent urine analysis for protein and subsequent interpretation of the test result, special knowledge. not required.
The procedure for determining the extent of proteinuria is quite simple:
- Remove the test strip from the pencil case (tube), after which it should be immediately sealed with a lid;
- Immerse the test strip indicator in urine for 2-3 seconds;
- After removing the test strip, remove excess urine by touching the edge of the strip to the container with the test sample;
- Place the test strip on a flat, clean, dry surface so that the indicator element is at the top;
- Within 60 seconds, the indicator element of the test strip is colored when protein is detected in the urine. Or doesn't change coloring if no traces of protein were found.
Instructions for using test strips from different manufacturers may differ in the recommendations and procedure for conducting the test. Detailed instructions for using certain products can be studied using the links below.
When performing a urine test yourself with test strips, it should be taken into account that sedimentary (if sediment is present) protein samples can be false positive if the test sample contains certain antibiotics, sulfonamides, or iodide contrast agents.
Test strips for determining protein in urine on the medical market today are represented by the following manufacturers:
- Analyticon Biotechnologies AG, Germany (“Analyticon”);
- Bayer, Germany (Stix series strips, as well as Microbumintest test tablets);
- Beijing Condor-Teco Mediacl Technology, China (ordered by Tespro, Ukraine, trademark “Samotest”);
- DAC-SpectroMed, Moldova;
- Dirui Industrial, China (“Uristik”);
- Erba, Czech Republic;
- IND Diagnostic Inc, Canada (“Multicheck”);
- HTI Medical, USA (“UrineRS”);
- Roche, Switzerland (“Micral-Test”);
- YD Diagnostics, Korea (“URiSCAN”);
- Biosensor AN, Russia (“Uribel”, “Uripolian”);
- Bioscan, Russia (“Bioscan”);
- Norma, Ukraine (“Protest”);
- Farmasco, Ukraine (“Citolab/Tsitolab”).
The portal contains descriptions of the following products for detecting proteinuria.
Single indicator strips (exclusively total protein in urine):
- Bioscan Belok (Bioscan Belok No. 50) Russian strips for analyzing urine for protein from Bioscan;
- Uribel (Uribel No. 50) test strips from the Russian company Biosensor AN.
Strips with two or more indicators:
- Albufan (Albufan No. 50, AlbuPhan) - indicator test strips for determining total protein and pH (acidity) of urine.
Strips with three or more indicators:
- Bioscan Penta (Bioscan Penta No. 50/No. 100) with five indicators from the Russian company Bioscan, allowing urine tests not only for total protein, but also for ketones, glucose (sugar), occult blood (red blood cells and hemoglobin), pH (acidity );
- Pentaphan / Pentaphan Laura for total protein, ketones, occult blood (red blood cells and hemoglobin), glucose and urine pH (acidity) from Erb Lachem, Czech Republic.
You can buy test strips for determining proteins (albumin) in urine at a pharmacy, pharmacy, using the drug booking service, among other things. Before purchasing test strips, you should check the expiration dates. You can order test strips at any available online pharmacy; they are sold with delivery, without a doctor’s prescription.
The price of test strips (in package No. 50, with a single indicator) usually does not exceed 150-200 rubles as of May 2017.
Self-diagnosis with test strips is not a substitute for regular assessment of your health status by a qualified medical specialist, doctor.
Treatment of proteinuria
Treatment of proteinuria (protein in the urine) comes down to restoring kidney function. If proteinuria is physiological in nature, its appearance is not associated with pathological causes - no treatment is required.
Treatment of protein in urine with remedies traditional medicine aimed at normalizing kidney function involves taking berries, decoctions, and tinctures.
The most common methods of treating proteinuria with folk remedies:
- Grind 20 grams of parsley seeds thoroughly, then pour 200 milliliters of boiling water. The liquid is infused for 2 hours, used to treat proteinuria during the day in small portions;
- Squeeze the juice from the cranberries and cook the skins of the berries for 15 minutes. After cooling the broth, mix it with cranberry juice. Drink this fruit drink throughout the day;
- Pour 20 grams of chopped parsley root into 200 milliliters of boiling water. Allow the broth to brew for 90 minutes. Should be taken 30 milliliters 4 times a day;
- Pour 40 grams of birch buds with 200 milliliters of water, bring to a boil, then allow the broth to sit in a thermos for 90 minutes. Take 50 milliliters three times a day. When using this method of treating protein in the urine, the level of proteinuria should be constantly monitored. If protein in the urine decreases, stop treatment with this method;
- Pour boiling water over 350 grams of fir bark, seal the container with the tincture hermetically, and let it brew for 60 minutes. The tincture is taken 30 minutes before meals, 50 milliliters. When preparing the tincture, fir bark can be replaced with fir oil. 2-3 grams of oil are diluted in 60 milliliters of water. Admission rules are the same.
Before you begin treating proteinuria with traditional medicine, you should consult with a qualified medical specialist or doctor.
Denial of responsibility
The article about protein in the urine (proteinuria), diagnostic and preventive means, and treatment methods on the medical portal is a compilation of materials obtained from authoritative sources, a list of which is posted in the “Notes” section. Despite the fact that the reliability of the information presented in the article “ Protein in urine (proteinuria)» checked by qualified medical specialists, the contents of the article are for reference purposes only, is not guidance for independent(without contacting a qualified medical specialist, doctor) diagnostics, diagnosis, choice of means and methods of treatment.
- highly specialized glomerular cells, the main function of which is to provide glomerular filtration. Endocrinology(from the Greek ἔνδον - “inside”, κρίνω - “I highlight” and λόγος - “science, word”) - the science of the functions and structure of the endocrine glands (endocrine glands), the hormones (products) they produce, the ways of their formation and effects on the human body. Endocrinology also studies diseases caused by dysfunction of the endocrine glands and seeks ways to treat diseases associated with disorders of the endocrine system. The most common endocrine disease is diabetes mellitus.
The presence of protein in urine - what does this mean? Protein in the urine, or so-called proteinuria, occurs due to various factors. Some amount of the substance may occasionally be present in the urine. However, there is a certain limit, after exceeding which we can talk about kidney dysfunction.
Temporary promotion
The kidneys are responsible for urine formation in the human body. Temporary high protein levels can be due to a number of factors. As a result of observation, the reasons that influenced the change in kidney function are determined - the presence of diseases, hypothermia, and the effect of certain medications.
Increased protein in the urine indicates the presence of inflammation. Intestinal infections easily spread to the kidneys, since the lymphatic vessels of these organs and the intestines are closely interconnected.
The presence of inflammation is determined by examining:
- general urinalysis;
- general blood test;
- urine analysis using the Zimnitsky method.
A commonly available and inexpensive method for examining the kidneys is ultrasound. With its help, various pathologies and neoplasms are identified. The norm for protein in urine in women is its absence. But the presence of no more than 0.0025 g per 1 liter of daily liquid is allowed. Elevated protein in the urine is determined if the amount of protein more than 50 mg is detected in the daily volume.
Protein may temporarily increase after:
- long stay in the cold;
- regular emotional stress;
- transferred viral diseases;
- intense physical activity;
- excess protein products in the diet.
After the cessation of the provoking causes, the indicators return to normal. Increased protein in the urine should not be ignored. The load and vulnerability of the genitourinary system doubles during pregnancy. The increase in protein in the urine in women carrying a baby is especially carefully monitored.
If the rules for selecting tests are violated, false or physiological albuminuria may be detected. Protein molecules are quite large and may not pass through the kidney filter. Only a small part is excreted in the urine - no more than 1%. In men, protein in urine should not exceed 0.3 g. Reasons for exceeding the norm: stress, intense training, professional activity. Urine in men always contains more protein than in women.
Manifestations and degrees
If, over time, protein molecules return to normal levels, then physiological proteinuria has occurred. It is necessary to consider the causes of pathological deviations from the norm. Acceptable levels of protein in urine in women are different from those in men. There are 3 degrees of pathological albuminuria in men.
Light - characterized by the release of up to 1 g of protein per day. Such an excess is observed in urethritis, inflammation of the bladder, urolithiasis, and renal polycystic disease. The average degree is determined in the range from 1 to 3 g per day. Such values indicate pathologies of the renal tubules, glomerulonephritis. In severe cases, a urine test shows a level above 3.5 g. The protein concentration in a urine test in the morning is normal if it is less than 0.033 g/l.
Symptoms of high protein levels:
- increased body temperature;
- progressive anemia, weakness, fatigue;
- dizziness, drowsiness;
- lack of appetite.
If the indicators are elevated, additional examinations are prescribed to determine the characteristics of the disorders and causes. Blood and urine are carefully examined. This measure allows us to exclude the physiological factor.
Pathological albuminuria can be renal or extrarenal. The second is caused by an admixture of protein in cystitis, prostatitis, vulvovaginitis and is not associated with kidney diseases. A urine test shows protein in the urine of 0.1 g per day. The renal form is provoked by acute and chronic diseases. Main pathologies: kidney tuberculosis, chronic heart failure, nephritis, nephrosis, congenital pathologies.
The norm of protein in urine for women is no more than 0.1 g/l; the presence of traces of it up to 0.14 g/l is not a pathology.
Normal values for pregnant women with daily urine collection are no more than 0.3 g/l. When the indicator is higher than 0.3 g/l, problems in the genitourinary system and kidneys are determined.
The higher the indicator, the more significant the problem. To determine the correct diagnosis, it is necessary to repeat the tests after 1-2 weeks. Pathologies characterized by increased rates are pyelonephritis, urolithiasis, infections, chemotherapy, tumors, leukemia, kidney or brain injuries.
For precise definition quantities carried out daily analysis. It is done both on an outpatient basis and in hospitals. The start time of collection is fixed, for example at 6 am. Urine collection occurs throughout the day. Be sure to follow the rules of personal hygiene, avoid physical overload, exclude certain foods from the diet, and stop taking medical supplies. After this, the total volume of urine is calculated, and 50 ml is taken for laboratory testing.
Forms and methods of treatment
A mild form of proteinuria does not have pronounced symptoms in the early stages of the disease. Sometimes the normal state of urine or its simply too foamy texture can cause alarm. Doctors recommend regularly taking tests once a year to promptly identify deviations from the norm.
The first symptom - the appearance of swelling - indicates that there is not enough protein in the blood. Depending on the etiology, prerenal, renal and postrenal proteinuria are determined. At the initial stage of urine formation, an increased amount of albumin is observed. Then reabsorption occurs into the renal tubules, so the protein in the urine is normal. The presence of deviations may not be determined by conventional methods.
Kidney diseases lead to dysfunction of the tubules, so protein substances are not fully reabsorbed into the blood plasma. Kidney diseases associated with increased secretion of albumin and other protein compounds are:
- glomerulonephritis;
- polycystic disease;
- pyelonephritis;
- tuberculosis.
Glomerulonephritis is characterized by an increased content of proteins and red blood cells in the urine. Pyelonephritis is characterized by the presence of protein substances, leukocytes, bacteria and epithelial cells. The kidneys subsequently suffer from pathologies in other organs. Why are their functions disrupted? Mostly, failure occurs with hypertension, nephropathy, vascular atherosclerosis, and diabetes.
With adrenal proteinuria, the body has increased production of normal or pathological proteins. Which means additional stress on the kidneys, which do not have time to process such a number of compounds. Increased release of hemoglobin, fever, heart attack are the reasons for the increase in protein substances.
Proteinuria is not an independent disease, but a consequence of the pathology of other organs. Inflammatory processes of the kidneys and other genitourinary organs are treated with antibiotics, uroseptics, and anti-inflammatory drugs. Diabetes mellitus requires constant use of insulin-containing medications. Hypertension requires constant monitoring and lifelong use of antihypertensive drugs.
Treatment is prescribed depending on the underlying disease, and the presence of protein is only a consequence. Monitor this indicator regularly, especially if these pathologies are present. Do not self-medicate, seek help from specialists.
General information about the study
Total protein in urine is an early and sensitive sign of primary kidney diseases and secondary nephropathies in systemic diseases. Normally, only a small amount of protein is lost in the urine due to the filtration mechanism of the renal glomerulus - a filter that prevents the penetration of large charged proteins into the primary filtrate. While low molecular weight proteins (less than 20,000 daltons) freely pass through the glomerular filter, the supply of high molecular weight albumin (65,000 daltons) is limited. Most of the protein is reabsorbed into the bloodstream in the proximal tubules of the kidney, with the result that only a small amount is ultimately excreted in the urine. About 20% of the protein secreted normally is low molecular weight immunoglobulins, and 40% each is albumin and mucoproteins secreted in the distal renal tubules. Normal protein loss is 40-80 mg per day, the release of more than 150 mg per day is called proteinuria. In this case, the main amount of protein is albumin.
It should be noted that in most cases, proteinuria is not a pathological sign. Protein in the urine is detected in 17% of the population and only 2% of them cause serious illness. In other cases, proteinuria is considered functional (or benign); it is observed in many conditions, such as fever, increased physical activity, stress, acute infectious disease, and dehydration. Such proteinuria is not associated with kidney disease, and protein loss is insignificant (less than 2 g/day). One of the types of functional proteinuria is orthostatic (postural) proteinuria, when protein in the urine is detected only after prolonged standing or walking and is absent in a horizontal position. Therefore, with orthostatic proteinuria, an analysis of total protein in the morning urine will be negative, and an analysis of 24-hour urine will reveal the presence of protein. Orthostatic proteinuria occurs in 3-5% of people under 30 years of age.
Protein in the urine also appears as a result of its excess production in the body and increased filtration in the kidneys. In this case, the amount of protein entering the filtrate exceeds the possibilities of reabsorption in the renal tubules and is ultimately excreted in the urine. This “overflow” proteinuria is also not associated with kidney disease. It can accompany hemoglobinuria with intravascular hemolysis, myoglobinuria with muscle tissue damage, multiple myeloma and other plasma cell diseases. With this type of proteinuria, it is not albumin that is present in the urine, but some specific protein (hemoglobin in hemolysis, Bence Jones protein in myeloma). In order to identify specific proteins in urine, a 24-hour urine test is used.
Proteinuria is characteristic of many kidney diseases and constant sign. According to the mechanism of occurrence, renal proteinuria is divided into glomerular and tubular. Proteinuria, in which protein in the urine appears as a result of damage to the basement membrane, is called glomerular. The glomerular basement membrane is the main anatomical and functional barrier to large and charged molecules; therefore, when it is damaged, proteins freely enter the primary filtrate and are excreted in the urine. Damage to the basement membrane can occur primarily (in idiopathic membranous glomerulonephritis) or secondary, as a complication of a disease (in diabetic nephropathy due to diabetes mellitus). The most common is glomerular proteinuria. Diseases accompanied by damage to the basement membrane and glomerular proteinuria include lipoid nephrosis, idiopathic membranous glomerulonephritis, focal segmental glomerular sclerosis and other primary glomerulopathies, as well as diabetes mellitus, connective tissue diseases, post-streptococcal glomerulonephritis and other secondary glomerulopathies. Glomerular proteinuria is also characteristic of kidney damage associated with certain medications (non-steroidal anti-inflammatory drugs, penicillamine, lithium, opiates). Most common cause glomerular proteinuria is diabetes mellitus and its complication – diabetic nephropathy. The early stage of diabetic nephropathy is characterized by the secretion of a small amount of protein (30-300 mg/day), the so-called microalbuminuria. As diabetic nephropathy progresses, protein loss increases (macroalbuminemia). The degree of glomerular proteinuria varies, often exceeding 2 g per day and can reach more than 5 g of protein per day.
When protein reabsorption function in the renal tubules is impaired, tubular proteinuria occurs. As a rule, protein loss with this option does not reach such high values as with glomerular proteinuria, and amounts to up to 2 g per day. Impaired protein reabsorption and tubular proteinuria are accompanied by hypertensive nephroangiosclerosis, urate nephropathy, intoxication with lead and mercury salts, Fanconi syndrome, as well as drug-induced nephropathy when using non-steroidal anti-inflammatory drugs and some antibiotics. The most common cause of tubular proteinuria is hypertension and its complication – hypertensive nephroangiosclerosis.
An increase in protein in the urine is observed in infectious diseases of the urinary system (cystitis, urethritis), as well as in renal cell carcinoma and bladder cancer.
The loss of a significant amount of protein in the urine (more than 3-3.5 g/l) leads to hypoalbuminemia, a decrease in blood oncotic pressure and both external and internal edema (edema of the lower extremities, ascites). Significant proteinuria provides an unfavorable prognosis for chronic renal failure. Persistent loss of small amounts of albumin does not cause any symptoms. The danger of microalbuminuria is the increased risk of coronary heart disease (especially myocardial infarction).
Quite often as a result of the most various reasons analysis of morning urine for total protein can be false positive. Therefore, proteinuria is diagnosed only after repeated testing. If two or more tests of the morning urine sample are positive for total protein, proteinuria is considered persistent, and the examination is supplemented by an analysis of 24-hour urine for total protein.
Testing morning urine for total protein is a screening method for detecting proteinuria. It does not allow assessment of the degree of proteinuria. In addition, the method is sensitive to albumin, but does not detect low molecular weight proteins (for example, Bence Jones protein in myeloma). In order to determine the degree of proteinuria in a patient with a positive morning urine sample for total protein, 24-hour urine is also tested for total protein. If multiple myeloma is suspected, 24-hour urine is also analyzed, and it is necessary to conduct additional research for specific proteins - electrophoresis. It should be noted that analysis of 24-hour urine for total protein does not differentiate the variants of proteinuria and does not reveal the exact cause of the disease, so it must be supplemented with some other laboratory and instrumental methods.
What is the research used for?
- For the diagnosis of lipoid nephrosis, idiopathic membranous glomerulonephritis, focal segmental glomerular sclerosis and other primary glomerulopathies.
- For the diagnosis of kidney damage in diabetes mellitus, systemic connective tissue diseases (systemic lupus erythematosus), amyloidosis and other multiorgan diseases with possible kidney involvement.
- For the diagnosis of kidney damage in patients at increased risk of chronic renal failure.
- To assess the risk of developing chronic renal failure and coronary heart disease in patients with kidney disease.
- To assess renal function during treatment with nephrotoxic drugs: aminoglycosides (gentamicin), amphotericin B, cisplatin, cyclosporine, non-steroidal anti-inflammatory drugs (aspirin, diclofenac), ACE inhibitors (enalapril, ramipril), sulfonamides, penicillin, thiazide, furosemide and some others.
When is the study scheduled?
- For symptoms of nephropathy: edema of the lower extremities and periorbital region, ascites, weight gain, arterial hypertension, micro- and gross hematuria, oliguria, increased fatigue.
- For diabetes mellitus, systemic connective tissue diseases, amyloidosis and other multi-organ diseases with possible kidney involvement.
- With existing risk factors for chronic renal failure: arterial hypertension, smoking, heredity, age over 50 years, obesity.
- When assessing the risk of developing chronic renal failure and coronary heart disease in patients with kidney disease.
- When prescribing nephrotoxic drugs: aminoglycosides, amphotericin B, cisplatin, cyclosporine, non-steroidal anti-inflammatory drugs, ACE inhibitors, sulfonamides, penicillins, thiazide diuretics, furosemide and some others.
The presence of protein in urine is determined using a biochemical analysis of urine. Normally, the protein should either be completely absent or present in trace amounts, and temporarily.
The filtration system of the kidneys physiologically filters out high molecular weight particles, while small structures can be absorbed into the blood from urine while still in the renal tubules.
Normal protein in urine
For men
The maximum norm for protein content in urine for representatives of the stronger sex is considered to be up to 0.3 grams per liter - this concentration can be explained by powerful physical shock loads on the body, stress, and hypothermia. Anything above this value is pathological.
For children
For most cases, no protein should be detected normally in children. The maximum value of this parameter should not exceed 0.025 grams per liter of urine. A deviation from the norm of up to 0.7-0.9 grams per liter of urine is sometimes observed for periods in boys aged from six to fourteen years - this is the so-called orthostatic or postural protein. It appears, as a rule, in daytime urine and is a feature of the kidneys during the period of teenage puberty of the stronger sex, most often due to increased physiological activity, against the background of a long stay of the body in an upright state. Moreover, the phenomenon is not periodic, i.e. in a repeated sample, the protein is often not identified.
For women
For pregnant women, up to thirty milligrams is considered normal, from thirty to three hundred milligrams is microalbuminuria. At the same time, a number of studies show that the concentration of up to three hundred milligrams of protein per liter of liquid in a classic daily biochemical analysis on later does not cause complications for the mother and fetus, so this indicator can be attributed to physiological proteinuria.
Causes of high protein
Increased protein in urine can be caused by a number of reasons.
Physiology
- Powerful physical activity.
- Excessive consumption of foods rich in protein.
- Prolonged stay in an upright position with corresponding disruption of blood flow.
- Late pregnancy.
- Prolonged exposure to the sun.
- Hypothermia of the body.
- Active palpation of the kidney area.
- Severe stress, concussions, epileptic seizures.
Pathology
- Congestion in the kidneys.
- Hypertension.
- Nephropathies of various etiologies.
- Amyloidosis of the kidneys.
- Pyelonephritis, genetic tubulopathies.
- Tubular necrosis.
- Rejection of transplanted kidneys.
- Multiple myeloma.
- Hemolysis.
- Leukemia.
- Myopathies.
- Feverish conditions.
- Tuberculosis and kidney tumors.
- Urolithiasis, cystitis, prostatitis, urethritis, bladder tumors.
What does increased protein in urine mean?
In adults and children
Exceeding normal values in adults and children usually means the presence in the body of physiological or pathological problems that require identification, correct diagnosis and appropriate treatment.
Exceptions, as mentioned above, are made for representatives of the stronger sex in adolescence, if the increase in protein concentration is of an irregular, non-systemic nature.
Mild degrees of proteinuria (up to one gram of protein per liter of urine) are usually eliminated quite quickly, moderate (up to 3 g/l) and severe (over 3 g/l) require not only the highest quality diagnosis, but also quite long-term complex treatment, since they are usually caused by serious pathologies.
In pregnant women
Modern research shows that physiological changes in the body in pregnant women, especially in the later stages, with a protein concentration of up to 0.5 grams per liter of urine do not have a negative effect on the fetus and the woman, however, if the above parameters exceed the specified limit of 500 milligrams/liter of urine, then A representative of the fair sex in an interesting position will need comprehensive diagnostics and treatment, naturally taking into account her physiological state, as well as a competent assessment of the risks for the unborn child.
Treatment
Specific treatment of proteinuria, regardless of the gender and age of the patient, is aimed at eliminating the causes of the pathological condition, as well as neutralizing negative symptomatic manifestations.
Since increased protein in the urine can be caused by a number of factors, specific therapy is prescribed by a qualified doctor only after a thorough diagnosis of the patient and an accurate determination of the disease or physiological condition.
With moderate and severe manifestations of proteinuria with the manifestation of nephrotic syndromes of various etiologies, a person requires hospitalization, bed rest, and a special diet with maximum restrictions on salt and liquids. The groups of drugs used (depending on the cause of the condition) are immunosuppressants, corticosteroids, cytostatics, anti-inflammatory/antirheumatic, antihypertensive drugs, ACE inhibitors, as well as blood purification by hemosorption or plasmaformesis.
If a person has a weak form of proteinuria caused by an orthostatic or functional factor, then medications, as a rule, are not used: normalization of circadian rhythms is relevant, correct selection diet, as well as giving up a number of bad habits.
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