proteinuria Proteinuria describes a condition in which urine contains an abnormal amount of protein.

Healthy Kidneys

Healthy kidneys contain roughly a million functioning units which are called nephrons. Each nephron consists of a specialised filter which is called the glomerulus and some highly specialised tubing. As blood passes through healthy kidneys the waste products in the blood are filtered out along with water. The things the body wants to keep are left behind in the blood, such as proteins and blood cells.

Why is proteinuria important?

We all leak tiny amounts of albumin (a protein which has a small molecular size and is water-soluble) into our urine. If the filters in our kidneys are damaged, increased amounts of albumin and other larger proteins from our blood can pass through and escape into the urine. This abnormal amount of protein in the urine is known as proteinuria.

Research shows that the level and type of proteinuria are a good indicator of the extent of kidney damage.Proteinuria is also a sign that someone is at risk of developing progressive deterioration of kidney function.

What can cause protein leaks from kidneys?

Many diseases can cause inflammation of the kidney filters, a condition which is also known as 'glomerular nephritis', 'nephritis' or 'nephropathy'. Other processes that can damage the kidney filters and cause proteinuria include diabetes, high blood pressure (hypertension), and some other forms of kidney diseases.

Tests to determine proteinuria

To test for kidney problems, your doctor may do an initial test on a sample of your urine with an indicator strip or 'dipstick'.

If your doctor suspects you may have CKD or reduced kidney function, he/she will send a urine sample (preferably the first urine specimen of the day) to the local laboratory to be tested. This is the only way to identify small quantities of albumin and to measure the amount of protein present.

What are the signs of proteinuria?

Large amounts of protein in your urine may cause it to look foamy in the toilet. Also, the loss of protein from your body means your blood can no longer soak up enough fluid, and you may notice swelling in your hands, feet, abdomen, or face.

Who should have their urine routinely tested for proteinuria?
  1. people with kidney function known to be less than 60% of normal
  2. people with diabetes
  3. people with high blood pressure (hypertension)
  4. people with heart and blood vessel (cardiovascular) disease (ischaemic heart disease, chronic heart failure, peripheral vascular disease and cerebral vascular disease)
  5. people with complex diseases which may involve the kidneys - for example, systemic lupus erythematosus
  6. people with a family history of kidney failure or a family history of inherited kidney disease
  7. people found to have blood in their urine.
Proteinuria and Diabetes

Diabetes is a very common cause of kidney damage. This applies to people with any form of diabetes whether Type 1 (insulin required) or Type 2 (which is treated with diet and tablets but may require insulin).In people with diabetes, the first sign of deteriorating kidney function is the presence of small amounts of albumin in the urine, a condition called microalbuminuria.

How often do I need to have a test for proteinuria?

People who are at increased risk of developing kidney disease should have this test annually as a minimum or as part of their routine checkups by the doctor.

If I have proteinuria, will I need specific treatment?

If proteinuria is confirmed, your doctor will do other tests and examinations to find out the cause. This may include referral to a specialist kidney doctor (nephrologist) who will help to develop your kidney care plan. Your treatment may include medicines; lifestyle changes such as losing excess weight, exercising and stopping smoking, and sometimes changes in your diet.

Managing diabetes and high blood pressure with proteinuria

If you have diabetes you should test your blood glucose often, follow a healthy eating plan, take your medicines, and get plenty of exercise.

If you have diabetes or high blood pressure, then your doctor may prescribe a medicine from a class of drugs called ACE inhibitors. Alternatively your doctor may prescribe a similar class of drugs called ARBs. These drugs have been found to protect kidney function even more than other drugs that provide the same level of blood pressure control.

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