PROTEINURIA

Definitions of Proteinuria
Urinalysis sticks for ward testing are quite sensitive for proteinuria. They
are impregnated with bromocresol green that changes colour in the
presence of protein and is used as an indicator dye. They are intended
to correlate as follows:
+ with 0.3 g/l,
++ with 1 g/l,
+++ with 3 g/l and
++++ with X20 g/l.
False-positive results may be obtained with concentrated or alkaline
urine, and false-negative results may be obtained with dilute or
markedly acidic urine.
Causes of proteinuria

The protein that is excreted in urine under physiological conditions is not

usually detected on urinalysis or dipstick testing. Pathological
proteinuria has been classified into four groups: glomerular, tubular,
overflow and benign.1
Glomerular proteinuria occurs because of increased
glomerular permeability to proteins.
Tubular proteinuria is due to decreased tubular resorption of
proteins contained in glomerular filtrate and is seen in tubulointerstitial diseases.

Overload proteinuria is secondary to increased production, or

release, of low-molecular-weight proteins. The myeloproliferative
conditions that cause this form of proteinuria are rare in children.

Benign proteinuria implies proteinuria that is detected on urinalysis but

which has no serious underlying pathology. It includes proteinuria seen
in fever or after exercise, idiopathic transient proteinuria, and orthostatic
or postural proteinuria.

Another Classification

Transient proteinuria
normal renal function, bland urine sediment, normal blood
pressure, absence of significant edema, quantitative protein
excretion of usually less than 1g/day; this is not indicative of
significant underlying renal disease, and the proteinuria
disappears upon repeat testing
Orthostatic proteinuria
tall, thin adolescents or adults younger than 30 years (may be
associated with severe lordosis); renal function is normal and
proteinuria usually is less than 1 g/day; overnight urine collection
shows normal protein excretion (ie, < 50 mg during 8-h period)
Persistent proteinuria due to extrarenal disease
Renal function is normal, urine sediment is bland, blood pressure
is normal, significant edema is absent, and quantitative albumin
excretion usually is less than 500 mg/day; this is not usually
indicative of clinically progressive, underlying renal disease
Persistent proteinuria in excess of 500 mg/day
Is more likely the result of significant glomerular disease
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FUNCTIONAL PROTEINURIA
Functional proteinuria describes a transient increase in urinary protein
excretion. The mechanisms responsible for this type of proteinemia are
unknown but are probably caused by the changes in glomerular
hemodynamics, such as can occur with vigourous excercise or fever.
Occurs in the absence of any clear-cut renal or systemic disorder.

 http://www.hkmacme.org/course/2009BW09-0100/Spotlight

Common causes of Functional Proteinuria :

Dehydration
Emotional Stress
Fever
Intense Physical Activity
Most Acute Illness
Orthostatic (postural) disorder
Organic disease causing functional proteinuria
o Congestive Heart Failure
o Hypertension
o Extensive skin lesion (e.g. burns)
o High blood concentration of protein
administration of albumin or plasma)

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http://emedicine.medscape.com/article/238158-overview
Adult and pediatric urology
Decision Making in Medicine

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Postural or orthostatic proteinuria is a type of functional proteinuria

typically seen in <30 years of age. Proteinuria is absent after period of
being recumbent, such as after a night sleep, and develops upon rising.
Patients with orthostatic proteinuria usually <30 years of age, have
moderate proteinemia (excrete < 2g/day of protein), and have normal
kidney function.
To diagnose orthostatic proteinuria, split urine specimens are obtained
for comparison. The first morning void is discarded. A 16-hour daytime
specimen is obtained with the patient performing normal activities and
finishing the collection by voiding just before bedtime. An eight-hour
overnight specimen is then collected.
The daytime specimen typically has an increased concentration of
protein, with the nighttime specimen having a normal concentration.
Patients with true glomerular disease have reduced protein excretion in
the supine position, but it will not return to normal (less than 50 mg
per eight hours), as it will with orthostatic proteinuria.
Source :