Proteinuria (Protein in Urine) Treatment in Delhi, India

Patients with proteinuria are asymptomatic. However, when the kidneys begin to deteriorate, some symptoms may show up. These include:

• More frequent urination
• Foamy or bubbly urine
• Swelling in the face, stomach, feet or ankles
• Muscle cramping at night
• Lack of appetite
• Nausea and vomiting
• Shortness of breath
• Tiredness
• Morning puffiness around the eyes

Alternatively, it is essential to note that these symptoms also indicate chronic kidney disease. Therefore, if these symptoms are evident, seek immediate medical attention.

Normally, kidneys absorb from the blood what the body needs to function and eliminate toxins through urine. However, when kidneys fail to function efficiently or undergo morphological changes, they start excreting healthy substances from the blood, such as proteins. This issue indicates that the filters of the kidney are not working properly and require treatment before the overall condition worsens.

Some conditions cause a temporary leak, while others may be permanent causes. Some of these temporary conditions include:

• Dehydration
• Inflammation and low blood pressure
• Strenuous exercise
• Kidney stone
• Fever
• Exposure to extreme cold

Some of the causes that lead to permanent renal damage are:

• Chronic kidney disease
• Focal segmental glomerulosclerosis (FSGS)
• Glomerulonephritis
• IgA nephropathy or Berger's disease
• Preeclampsia
• Nephrotic syndrome
• Lupus
• Heart disease
• Heart failure
• Malaria
• Rheumatoid arthritis
• Hodgkin's lymphoma (Hodgkin's disease)
• Diabetic nephropathy (kidney disease)
• High blood pressure
• Orthostatic proteinuria
• Membranous nephropathy
• Multiple myeloma
• Amyloidosis
• Certain drugs, such as NSAIDs
• Kidney infection or pyelonephritis
• Benign conditions

Proteinuria is often caused by relatively benign (non-cancerous) or temporary medical conditions.

If a doctor suspects renal disease, patients are advised to get urine tests done three times over three months. If proteins are found in the urine, it indicates renal disease. The earlier the diagnosis, the better the disease can be managed and, as a result, have a better prognosis. Other tests that may be prescribed are:

Blood tests are advised to check the following:

• Creatinine levels: When the kidneys function properly, creatinine is eliminated through urine. However, only trace amounts remain. In a diseased state, creatinine remains in the blood, and levels appear elevated.
• Glomerular filtration rate (GFR): The GFR helps evaluate how much the kidney is functioning. A GFR lower than 15 indicated kidney failure.
• Protein levels in the serum: The serum is part of the blood that contains proteins. This test indicates if there has been a decline in the serum protein levels, which is suggestive of renal failure.
• Imaging tests like CT scans and ultrasounds: Imaging tests help detect renal issues such as kidney stones, urinary tract blockages or tumours.
• Urine protein electrophoresis: Specific types of proteins are looked for in a urine sample. For instance, Bence-Jones proteins in urine may suggest multiple myeloma, known as cancer of the plasma cells.
• Immunofixation blood test: Immunoglobulins, the antibodies that fight infection in the blood, are looked for. Having too many of them is suggestive of blood cancer.
• Renal biopsy: A small part of the kidney is taken for microscopic examination to study the cause of renal disease. Moreover, it also helps determine the extent of renal damage.

Proteinuria is not a disease but is a sign of another undetected disease. Hence, it is crucial to diagnose the underlying ailment before starting the treatment.

If proteinuria is due to a temporary cause, waiting for the cause to heal is one option. On the other hand, some temporary causes can be treated. This kind of proteinuria lasts for a short time. However, it is still important to check its progression to avoid major ailments.

Take medicines if the doctor prescribes them, especially for diabetes and hypertension. Some examples are:

• Metformin
• ACE inhibitors (angiotensin-converting enzyme inhibitors)
• ARBs (angiotensin receptor blockers)

If the cause is rather permanent, treating it may help lower the intensity of protein leakage. For instance, keeping blood pressure and blood sugar levels under control lowers the incidences of protein leaks.

Further, if end-stage renal disease or chronic kidney disease has been diagnosed, making lifestyle changes is imperative. Changing the diet pattern, avoiding smoking and drinking, exercising more frequently and focusing on weight loss if obese or overweight will help improve the condition.

Patients with diabetes, hypertension, and proteinuria must take blood pressure medication and control blood sugar levels. GFR tests should be followed on a six-monthly or annual basis. Consulting a nephrologist would be ideal for proper treatment. Pregnant women with preeclampsia should look after themselves well. This condition is often serious only during pregnancy and resolves later.

The risk factors associated with proteinuria are:

• A family history of renal disease
• Age over 65
• Obesity
• Orthostatic proteinuria
• Chronic kidney disease
• Diabetes
• Hypertension
• Current smoking
• Cardiovascular disease
• Family history of chronic kidney disease
• Aboriginal or Torres Strait Islander people

Proteinuria is associated with many life-threatening complications that include increased risks of the following conditions:

• Gastrointestinal haemorrhage
• Progression of kidney disease
• Coronary heart disease
• Hypercoagulability, Venous thromboembolism
• Pulmonary oedema due to fluid overload
• Bacterial infections
• Cerebrovascular disease
• Renal replacement therapy, including dialysis and transplant
• Death

The prognosis of proteinuria depends on the underlying reasons for the symptom. Therefore, early diagnosis and timely treatment play a major role in determining the prognosis of patients with proteinuria. Among other forms, proteinuria in IgA nephropathy and idiopathic membranous nephropathy has the worst patient outcome.

Similarly, higher proteinuria is correlated with a poor prognosis in patients with chronic kidney disease. Post-kidney transplant proteinuria, too, has a poor prognosis. Finally, proteinuria does not have a favourable outcome in a patient with preeclampsia.