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Proteinuria Clinical Presentation

  • Author: Edgar V Lerma, MD, FACP, FASN, FAHA, FASH, FNLA, FNKF; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Dec 10, 2015
 

History

Mild to moderate proteinuria may be asymptomatic. The majority of patients will not report any symptoms, and proteinuria will be detected in the course of routine laboratory testing conducted to evaluate systemic disease, such as hypertension or diabetes, or as part of a well-person examination.

Because proteinuria occurs frequently in the absence of serious underlying renal disease, considering the more common and benign causes of proteinuria first is important. Questions to ask include the following:

  • Is this transient proteinuria - This may be associated with physical exertion and fever
  • Is this orthostatic proteinuria - It typically is observed in tall, thin adolescents or adults younger than 30 years; it may be associated with severe lordosis; renal function is normal, and albuminuria usually is less than 1 g/day
  • Is this due to a nonrenal disease (eg, severe cardiac failure, sleep apnea) - Renal function is normal and proteinuria usually is less than 1 g/day; microalbuminuria frequently is observed in association with hypertension and the early stages of diabetic nephropathy
  • Are symptoms present that suggest nephrotic syndrome or significant glomerular disease
  • Have changes occurred in the urine’s appearance (eg, red/smoky, frothy); did this occur in relation to an upper respiratory tract infection
  • Is edema (eg, ankle, periorbital, labial, scrotal) present
  • Has the patient ever been told that his or her blood pressure is elevated
  • Has the patient ever been told that his or her cholesterol is elevated
  • Is a history of multisystem disease or of another cause of glomerular disease present
  • Is a past or family history of kidney disease (including pregnancy related) present
  • Does the patient have diabetes mellitus - If so, for how long; are eye diseases or other complications present
  • Is a family history of diabetes mellitus present; does it include kidney disease
  • Is any chronic inflammatory disease (eg, systemic lupus erythematosus [SLE]) or rheumatoid arthritis present
  • Does the patient have any joint discomfort, a skin rash, eye symptoms, or symptoms of Raynaud syndrome
  • Is the patient taking any medication, including over-the-counter or herbal remedies
  • Are any past health problems, such as jaundice, tuberculosis, malaria, syphilis, or endocarditis, present?
  • Are any other systemic symptoms, such as fever, night sweats, weight loss, or bone pain, present
  • Does the patient have any risk factors for human immunodeficiency virus (HIV) or hepatitis
  • Are symptoms present that suggest complication(s) of nephrotic syndrome
  • Does the patient have any loin pain, abdominal pain, breathlessness, pleuritic chest pain, or rigors
Next

Physical Examination

The physical examination should include the following:

  • Assess intravascular volume status - Examine the jugular venous pulse (JVP), erect and supine pulse and blood pressure, and heart sounds
  • Assess extravascular volume status - Look for edema (eg, ankle, leg, scrotal, labial, pulmonary, periorbital), which may or may not be pitting, depending on the duration of edema; massive weight gain due to fluid is very common, especially in patients with nephrotic syndrome; patients may also have decreased breath sounds due to pleural effusions
  • Examine the patient for signs of systemic disease - Eg, retinopathy, rash, joint swelling or deformity, stigmata of chronic liver disease, organomegaly, lymphadenopathy, and cardiac murmurs
  • Examine the patient for complications such as venous thrombosis and peritonitis
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Contributor Information and Disclosures
Author

Edgar V Lerma, MD, FACP, FASN, FAHA, FASH, FNLA, FNKF Clinical Professor of Medicine, Section of Nephrology, Department of Medicine, University of Illinois at Chicago College of Medicine; Research Director, Internal Medicine Training Program, Advocate Christ Medical Center; Consulting Staff, Associates in Nephrology, SC

Edgar V Lerma, MD, FACP, FASN, FAHA, FASH, FNLA, FNKF is a member of the following medical societies: American Heart Association, American Medical Association, American Society of Hypertension, American Society of Nephrology, Chicago Medical Society, Illinois State Medical Society, National Kidney Foundation, Society of General Internal Medicine

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Otsuka, Mallinckrodt, ZS Pharma<br/>Author for: UpToDate, ACP Smart Medicine.

Coauthor(s)

Tejas Desai, MD Staff Nephrologist, WG (Bill) Hefner VA Medical Center

Tejas Desai, MD is a member of the following medical societies: American College of Physicians, American Society of Nephrology

Disclosure: Nothing to disclose.

Pankaj Jawa, MD Assistant Professor of Medicine, Division of Nephrology and Hypertension, The Brody School of Medicine at East Carolina University

Pankaj Jawa, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Transplantation, National Kidney Foundation

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology

Disclosure: Nothing to disclose.

Acknowledgements

George R Aronoff, MD Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine

George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, and National Kidney Foundation

Disclosure: Nothing to disclose.

Kevin McLaughlin, MBChB, PhD, MSc Associate Professor, Assistant Dean, Department of Medicine, University of Calgary Faculty of Medicine, Calgary Health Region

Kevin McLaughlin, MBChB, PhD, MSc is a member of the following medical societies: American Society of Nephrology, American Society of Transplantation, and College of Physicians and Surgeons of Alberta

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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