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.
