Proteinurea

 

Asalam-Alaikum My name is dr Shoukat Memon and I am working as a consultant Nephrologist in this Indus Hospital and Health Network Karachi. Today we are going to discuss Proteinuria which means protein in urine. Many people ask the question that Is it normal to have protein in urine? And if this is not normal then how much worrisome it is? does it run in the family? What are the symptoms of this disease? We are going to answer (discuss) all of these questions. Normally a person can produce protein in urine up to the level of 150 mg in a day which includes albumin protein along with other proteins. Once this exceeds 150 mg in 24 hour period the doctor tells you this is not normal and condition known as Proteinuria. If protein in urine is more than 150 mg but less than 1 gram ( or 1000 mg) then it is not as worrisome as we find more than 1 gm in some of the people and usually 2gm or more than 2gm where the doctor (nephrologist) often advise kidney biopsy. Kidney/renal biopsy is a procedure in which the patient is supposed to lie down on the abdomen and the doctor inserts an injection after anesthetizing the back (kidney area). This is done under the guidance of an ultrasound machine in which the doctor keeps looking patient’s kidney in real time while doing a kidney biopsy. The kidney tissue which is removed in this procedure is hair-likeand generally, this procedure is very safe and rarely complication occurs. This condition of significant proteinuria (usually equal to 3 gm in 24 hour period) is also called Nephrotic syndrome. Regarding the manifestation of this disease, patient notices froth in urine, swelling in legs and feet which produce dip on pressure and there is periorbital puffiness around the eyes especially when patient wakes up in the morning. Swelling of body may be seen in other condition too but here we are talking about swelling related to an inflammation of natural filters (glomeruli). If proteinuria is associated with diabetes then kidney biopsy and other medicine are not useful and only the needful is to maintain blood sugar and blood pressures targets as follows: Fasting Blood Sugar <150 mg/dl Random Blood Sugar <200 mg/dl HBA1C <7.5% BP <140/90 mmHg Then if a kidney biopsy is done and certain medicines are advised i.e. deltacortil and anotherconditions immunosuppressive in those patients who are not suffering from diabetic kidney disease and proteinuria is significant with or without renal function (serum creatinine) derangement. The question is often asked how worrisome this disease is? the answer is yes if proteinuria is significant then it may take some time and roughly it responds in 2/3 of cases and the rest of the people may lead to end-stage renal disease which means they would survive on dialysis therapy. Other questions often asked by nephrologists are whether these diseases run in families? The answer is not many; very few run in the family; one of them is familial FSGS, some cystic diseases, etc. The final and take-home message is that one should discuss with the doctor regarding proteinuria if someone is suffering. Discuss with the doctor how much protein is leaking and let the doctor do some more tests and discuss treatment options so that a rational approach can be devised. Thank you very much and take care.