Proteinuria

Question 1

You are working in a GP surgery and a middle aged man comes to see you. He is asymptomatic and has never come to the surgery before. He explains he has a new partner who encouraged him to attend for a well man check. You ask for a urine sample to dipstick and find 2+ protein.
Is this a significant finding?

Answer 1

This is the first positive sample therefore could be:
oTransient proteinuria
oPersistent proteinuria

Question 2

What is the difference between transient proteinuria and persistent proteinuria?

Answer 2

Transient proteinuria caused by: fever, UTI, Heavy physical exertion, cold exposure, orthostatic proteinuria (more likely children/adolescents)

Persistent proteinuria: The presence of dipstick-positive proteinuria on 2 urine samples separated by 1 to 2 weeks indicates persistent proteinuria and warrants quantification and further assessment.

Question 3

What is proteinuria a risk factor for?

Answer 3

oThe presence of proteinuria is an independent risk factor for cardiovascular disease, death, and end-stage renal disease in the general population, and in patients with chronic kidney disease.

Question 4

In which circumstance will proteinuria be thought of as linked to a renal cause?

Answer 4

o Proteinuria accompanied by haematuria is more likely to be of glomerular aetiology.

Question 5

How should proteinuria be investigated?

Answer 5

o Urine dip to detect but urine albumin-to-creatinine ratio, urine albumin, 24hr collection more sensitive

Question 6

Who needs routine testing for proteinuria?

Answer 6

o	hypertension 
o	diabetes mellitus 
o	obstructive uropathy 
o	pyelonephritis
o	polycystic kidneys 
o	vasculitis 
o	nephrotic syndrome
o	glomerulonephritis
o	chronic urinary retention 
Patients with metabolic syndrome