Proteinuria Workup

  • Author: Edgar V Lerma, MD, FACP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: Jan 31, 2012
 

Laboratory Studies

  • To determine whether patients have transient proteinuria, perform the following:
    • Urinalysis and microscopic examination on at least 3 separate occasions
    • Albumin-to-creatinine or protein-to-creatinine ratio in random urine sample[7, 8]
    • Urinalysis on early morning sample, before patients are involved in physical activity
  • To determine whether patients have orthostatic proteinuria, perform the following:
    • Urine microscopy
    • Split urine collection, daytime (7 am to 11 pm) and overnight (11 pm to 7 am)
  • To determine whether proteinuria may be glomerular in origin, perform the following:
    • Urine microscopy
    • Urine collection (24 h) for quantification of albumin (or protein) excretion and creatinine clearance
    • Serum creatinine, albumin, cholesterol, and blood glucose determinations
    • If indicated, autoantibodies determinations, including antinuclear (ANA), anti-DNA, complement levels, and cryoglobulins
    • If indicated, hepatitis B, hepatitis C, and HIV serologies
    • If indicated, urine and plasma protein electrophoresis
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Imaging Studies

  • Renal ultrasound scan, if glomerular disease is being considered
  • Chest x-ray, if indicated
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Other Tests

  • Renal biopsy should be considered in adult patients with persistent proteinuria because the diagnostic and prognostic information yielded is likely to guide the choice of specific therapy (see Medical Care).
    • In children, most cases of nephrotic syndrome are due to steroid-sensitive minimal-change disease. In such cases, this is a reasonable assumption, and a trial of therapy should be given, reserving biopsy for unresponsive cases.
    • In adult patients who have isolated proteinuria of less than 1 g/d with no other indicators of renal disease, the renal prognosis is good and the need for specific treatment is unlikely. Most nephrologists would treat these patients with the nonspecific measures detailed in Medical Care and only proceed to biopsy if the degree of proteinuria increased or if the patient developed progressive renal decline.
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Contributor Information and Disclosures
Author

Edgar V Lerma, MD, FACP, FASN, FAHA  Clinical Associate 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 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, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

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

Kevin McLaughlin 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.

Specialty Editor Board

Frank C Brosius III, MD  Nephrology Program Director, Professor of Internal Medicine and Physiology, Department of Internal Medicine, Division of Nephrology, University of Michigan School of Medicine

Frank C Brosius III, MD is a member of the following medical societies: Alpha Omega Alpha, American Diabetes Association, American Society of Nephrology, and Phi Beta Kappa

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

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.

Rebecca J Schmidt, DO, FACP, FASN  Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine

Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association

Disclosure: Renal Ventures Ownership interest Other

Chief Editor

Vecihi Batuman, MD, FACP, FASN  Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, 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, and International Society of Nephrology

Disclosure: Nothing to disclose.

References

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  2. Wu Y, Chen Y, Chen D, et al. Presence of foam cells in kidney interstitium is associated with progression of renal injury in patients with glomerular diseases. Nephron Clin Pract. Aug 12 2009;113(3):c155-c161. [Medline].

  3. Jackson CE, Solomon SD, Gerstein HC, et al. Albuminuria in chronic heart failure: prevalence and prognostic importance. Lancet. Aug 15 2009;374(9689):543-50. [Medline].

  4. Friedman DJ, Kozlitina J, Genovese G, Jog P, Pollak MR. Population-Based Risk Assessment of APOL1 on Renal Disease. J Am Soc Nephrol. Nov 2011;22(11):2098-105. [Medline].

  5. Hladunewich MA, Troyanov S, Calafati J, et al. The natural history of the non-nephrotic membranous nephropathy patient. Clin J Am Soc Nephrol. Aug 6 2009;[Medline].

  6. Hebert LA, Birmingham DJ, Shidham G, et al. Random spot urine protein/creatinine ratio is unreliable for estimating 24-Hour proteinuria in individual systemic lupus erythematosus nephritis patients. Nephron Clin Pract. Aug 12 2009;113(3):c177-c182. [Medline].

  7. Methven S, Macgregor MS, Traynor JP, et al. Assessing proteinuria in chronic kidney disease: protein-creatinine ratio versus albumin-creatinine ratio. Nephrol Dial Transplant. Mar 17 2010;[Medline].

  8. Cirillo M. Evaluation of glomerular filtration rate and of albuminuria/proteinuria. J Nephrol. Mar-Apr 2010;23(2):125-32. [Medline].

  9. Roozbeh J, Banihashemi MA, Ghezlou M, et al. Captopril and combination therapy of captopril and pentoxifylline in reducing proteinuria in diabetic nephropathy. Ren Fail. Jan 2010;32(2):172-8. [Medline].

  10. Nakamura T, Sato E, Fujiwara N, et al. Co-administration of ezetimibe enhances proteinuria-lowering effects of pitavastatin in chronic kidney disease patients partly via a cholesterol-independent manner. Pharmacol Res. Aug 7 2009;[Medline].

  11. Vegter S, Perna A, Postma MJ, et al. Sodium Intake, ACE Inhibition, and Progression to ESRD. J Am Soc Nephrol. Jan 2012;23(1):165-73. [Medline].

  12. Robles NR, Romero B, de Vinuesa EG, et al. Treatment of proteinuria with lercanidipine associated with renin-angiotensin axis-blocking drugs. Ren Fail. Jan 2010;32(2):192-7. [Medline].

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  14. Giatras I, Lau J, Levey AS. Effect of angiotensin-converting enzyme inhibitors on the progression of nondiabetic renal disease: a meta-analysis of randomized trials. Angiotensin-Converting-Enzyme Inhibition and Progressive Renal Disease Study Group. ALYSIS. Sep 1 1997;127(5):337-45. [Medline].

  15. Klahr S, Levey AS, Beck GJ. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med. Mar 31 1994;330(13):877-84. [Medline].

  16. Lewis EJ, Hunsicker LG, Bain RP. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group [published erratum appears in N Engl J Med 1993 Jan 13;330(2):152]. N Engl J Med. Nov 11 1993;329(20):1456-62. [Medline].

  17. Robinson RR. Isolated proteinuria in asymptomatic patients. Kidney Int. Sep 1980;18(3):395-406. [Medline].

  18. Ruggenenti P, Perna A, Mosconi L. Proteinuria predicts end-stage renal failure in non-diabetic chronic nephropathies. The "Gruppo Italiano di Studi Epidemiologici in Nefrologia" (GISEN). Kidney Int Suppl. Dec 1997;63:S54-7. [Medline].

  19. Springberg PD, Garrett LE Jr, Thompson AL Jr. Fixed and reproducible orthostatic proteinuria: results of a 20-year follow-up study. Ann Intern Med. Oct 1982;97(4):516-9. [Medline].

  20. Waugh NR, Robertson AM. Protein restriction in diabetic renal disease. In: The Cochrane Database of Systematic Reviews [serial CD-ROM]. Issue 4. 1999.

 
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