Proteinuria Clinical Presentation

Updated: Mar 25, 2020
  • Author: Beje Thomas, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Presentation

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 llevel 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 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) infection 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

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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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Complications

Complications of proteinuria include the following:

  • Pulmonary edema due to fluid overload
  • Acute kidney injury due to intravascular depletion and progressive kidney disease
  • Increased risk of bacterial infection, including spontaneous bacterial peritonitis
  • Increased risk of arterial and venous thrombosis, including renal vein thrombosis
  • Increased risk of cardiovascular disease
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