What does protein in urine mean 0 066. Protein in urine what does it mean. The analysis speaks of the disease

The term "proteinuria" refers to the appearance of any type of protein in the urine in excess of physiological (normal) values.

The detection of an increased level of protein in the urine is the most studied and significant pathological symptom in the practice of a doctor, indicating a violation of the urinary system.

In different patients, the severity of proteinuria can vary significantly, depending on the disease underlying it. In addition, the detection of protein in the urine can be observed in isolation or in combination with other changes in TAM (hematuria, leukocyturia, bacteriuria).

The history of the discovery of the syndrome

The first information about changes in the chemical composition of urine in certain diseases was obtained as early as the 17th century. So, in 1694, the outstanding Leiden doctor F. Dekker first discovered protein in the urine of patients with proven kidney pathology.

In his research, he was able to demonstrate that urine contains a substance that coagulates and coagulates when heated, which in turn leads to the formation of "turbidity".

Based on the experiments, F. Dekker proposed specific methods for detecting this impurity using acetic acid.

As a pathological syndrome, proteinuria was described by D. Cotugno in 1764, identifying it in a patient with acute pyelonephritis. Finally connected proteinuria and renal pathology R. Bright.

To identify the protein, he used a fairly simple and specific technique - heating a small amount of urine in a spoon over a flame (the protein precipitated after denaturation). A number of experiments have used nitric acid to detect protein.

R. Bright reliably established the connection of proteinuria with chronic nephritis, which for some time was called "Bright's disease".

2. Limits of norm and pathology

Often, the question of the presence of protein in the urine of healthy individuals can be answered ambiguously. What is considered a normal range for diagnosing pathological proteinuria? There are conflicting data in the medical literature.

With the protein concentration in a single portion of urine, everything is quite simple, normally it should not exceed 0.03 g / l (in children up to a year up to 0.002 g / l, in children older than a year - 0.036 g / l).

The level of daily loss of protein in the urine should normally not exceed 0.15 g / day (up to 100 mg / day Pushkarev I.A. 1985; 150 mg / day Bergstein J., 1999; 200 mg / day B.M. Brenner, 2007) .

At the same time, the calculated concentrations of the level of daily proteinuria based on the given norms in a healthy person (taking into account diuresis up to 1.5 l / day) show the possibility of excreting up to 0.1 gram of protein.

Such discrepancies are explained by the individual and racial characteristics of protein excretion in the urine.

The vast majority of people are characterized by slight proteinuria (about 40-50 mg per day). In 10-15% of the population, the daily excretion of protein in the urine reaches 0.150 g / day without confirmation of the pathology of the urinary system.

The chosen diagnostic method is of great importance for assessing the degree of daily loss of protein in the urine.

Generally accepted methods, such as a test with sulfosalicylic acid or a biuret reaction, do not detect protein in the urine of a healthy population. When a single increase in the level of protein in the urine is detected, patients are often prescribed.

3. Protein composition of urine

To assess proteinuria correctly, you need to have an idea of ​​the qualitative and quantitative composition of normal urine.

In a portion of the urine of a healthy person, up to 200 different proteins can be detected, filtered from the blood or secreted by the epithelial cells of the urinary system.

Approximately 50-70% of urine protein is uroromucoid (uromodulin) - a product of renal tissue synthesis. In the lumen of the renal tubules, uromodulin forms a specific gel-like structure that is impermeable to water, but permeable to ions.

Uromodulin is found in the renal tissue from the 16th day of embryogenesis. In daily urine, it is detected in the amount of 20-100 mg, and its synthesis increases with high salt intake, taking loop diuretics (furasemide, torasemide).

The appearance of tissue proteins may be the result of normal renal excretion and continuous renewal of kidney tissues.

Plasma proteins are second in terms of specific gravity.. When using high-quality diagnostic systems, about 30 plasma proteins can be detected in urine, the leading position among which is albumin.

In the urine, proteins of the tissues of the heart, pancreas, liver, and transplantation antigens can be detected. Damage to the heart tissue in patients is accompanied by myoglobinuria, and some tumors lead to increased excretion of low molecular weight proteins.

Almost all known human hormones are excreted in the urine. In pregnant women, proteins secreted by placental tissues can be detected in the urine.

4. Mechanism of appearance of protein in urine

Urine formation occurs in the main structural element of the kidney - the renal glomerulus (a network of arterial capillaries enclosed in a capsule).

Blood entering the capillaries of the glomerulus is filtered through a special glomerular membrane with the formation of primary urine. The glomerular filtration membrane has a rather complex structure and includes:

1. 1 The inner layer, represented by the endothelium, most of which is covered with pores with a diameter of 40 nm. The pores are covered by a diaphragm, so protein filtration at this stage is determined by both the pore size and the state of this diaphragm;
2. 2 Three-layer membrane (basal), located outside of the inner layer. Its permeability to protein molecules is determined by its electrical charge and the arrangement of collagen filaments;
3. 3 Epithelial lining (podocyte apparatus) located on the urinary side of the basement membrane. This layer is responsible for the process of active filtration using microfilaments.

In a healthy person, the glomerular filter can pass proteins of a certain size (no more than 4 nm, weighing no more than 70 kDa). Proteins such as serum albumin, myoglobin, prealbumins, lysozyme, microglobulins, etc. are freely filtered.

In addition to size, the charge of the protein molecule plays an important role in the filtration process. The basement membrane is normally negatively charged and does not allow active filtration of plasma proteins that have the same charge.

Figure 1 - The structure of the nephron

If small plasma proteins manage to pass the renal filter, they are almost completely absorbed in the renal tubules.

Summarizing the above, physiological protein excretion is the result of the interaction of glomerular and tubular mechanisms, and damage to any of the departments of the nephron can lead to proteinuria.

Identification of transient or permanent proteinuria in a person requires a thorough examination. Next, we turn to the study of the main reasons for the increase in the level of protein in the urine.

5. Functional proteinuria

Functional proteinuria is not associated with renal tissue damage. It is based on a transient violation of protein filtration. This condition may occur when:

1. 1 Severe psycho-emotional stress;
2. 2 Eating a lot of protein;
3. 3 Dehydration, electrolyte disturbances;
4. 4 Chronic heart failure, hypertension;
5. 5 fever;
6. 6 Against the background of exhausting physical exercises (marching proteinuria);
7. 7 Against the background of hypothermia.

In infants, dehydration proteinuria is often found, which is based on violations of the feeding regimen, toxicosis, diarrhea, and vomiting. After removal of the provoking factor, such proteinuria stops.

In adolescents, the so-called orthostatic proteinuria can be detected - an increase in the excretion of protein in the urine during the transition to a standing position. Children predisposed to orthostatic proteinuria are diagnosed with active growth, low muscle mass, kyphosis, lumbar lordosis, low blood pressure, and absolutely normal renal function.

Proteinuria occurs when a teenager is standing. Lordosis of the spine leads to the fact that the anterior surface of the liver goes down and slightly presses the inferior vena cava. Stagnation of blood in the renal veins and provokes the release of protein in the urine.

In physiological proteinuria, the largest proportion is low molecular weight proteins (up to 20 kDa), for example, Ig, 40% proteins with a high mass (65 kDa), 40% are uromodulin.

6. Pathological proteinuria

Pathological proteinuria develops when the renal glomeruli, where filtration occurs, or the renal tubules, where reabsorption of protein molecules occurs, are damaged.

Depending on the level of damage, three types of pathological proteinuria can be distinguished:

1. 1 Prerenal, or overload, associated with increased protein breakdown and the appearance of an increased concentration of low molecular weight proteins in the blood plasma.
2. 2 Renal, associated with damage to the filtration apparatus of the renal glomerulus and / or tubules of the kidneys, where protein molecules are reabsorbed.
3. 3 Postrenal, due to the pathology of the underlying urinary tract. Often due to inflammatory exudation.

6.1. prerenal

Prerenal proteinuria is based on the appearance in the patient's blood plasma of proteins with a small molecule size, which can pass through a healthy renal filter and enter the urine in large quantities.

The appearance of such proteins in the plasma is associated either with their increased synthesis or with the breakdown of tissue structures and cells. This condition may occur when:

1. 1 plasmablastic leukemia;
2. 2 multiple myeloma;
3. 3 Connective tissue diseases;
4. 4 Rhabdomyolysis;
5. 5 Lymphoma with paraproteinemia;
6. 6 Hemolytic anemia;
7. 7 Macroglobulinemia.

Most often, this type of proteinuria is due to an increase in the blood of light chains of Ig (Bence-Jones protein), myoglobin, hemoglobin, lysozyme.

Congestive forms of prerenal proteinuria are possible, which occur in decompensated heart disease, metastases, and tumors of the abdominal cavity.

In a separate category, neurogenic prerenal proteinuria can be distinguished, which can be triggered by an epileptic seizure, traumatic brain injury, hemorrhage, autonomic crisis.

6.2. Renal

In this case, an increase in the level of protein in the urine is associated with damage to the renal parenchyma or renal interstitium. This is typical for the following conditions:

1. 1 Glomerulonephritis (acute or chronic);
2. 2 Nephropathy in diabetes;
3. 3 Nephropathy of pregnancy;
4. 4 Amyloidosis;
5. 5 Tumors of the kidneys;
6. 6 Hypertensive nephrosclerosis;
7. 7 Gout.

Depending on the location of the damage, the composition and volume of proteins excreted in the urine changes, which makes it possible to distinguish between:

1. 1 Renal glomerular (glomerular) proteinuria, which develops when the cortical substance of the kidney, in which the nephrons are located, is damaged.
2. 2 Renal tubular proteinuria, which develops against the background of problems with reabsorption of proteins in the proximal tubules.

6.2.1. Glomerular injury

With damage to the renal glomeruli, changes in the glomerular type are recorded in the urine:

1. 1 With the loss of the negative charge of the basement membrane, low molecular weight protein molecules (albumin and transferrin) begin to predominate in the urine.
2. 2 In case of violation of the integrity of the pores in the membranes, large molecular weight (immunoglobulin G) are determined in the urine.

Thus, the nature of damage to the renal filter affects the ability to pass protein molecules of different sizes and masses.

That is why, according to the composition of uroproteins, proteinuria is distinguished:

1. 1 Highly selective - excretion of low molecular weight proteins with a mass of up to 70 kDa (mainly albumin);
2. 2 Selective - excretion of both low molecular weight and proteins weighing up to 150 kDa;
3. 3 Non-selective - isolation of a protein with a mass of 830 to 930 kDa.

To determine the degree of selectivity, a special index is used, which is the ratio of isolation of proteins with high mass to low molecular weight (usually the ratio of IgG/albumin).

A ratio of up to 0.1 (selective) indicates a filtration defect associated with a violation of the ability to retain negatively charged molecules. An increase in the index of more than 0.1 indicates the non-selectivity and permeability of the filter pores for macromolecules.

Determination of the degree of selectivity of glomerular proteinuria is important for the development of patient management tactics.

The selective nature of protein loss in the urine indicates minimal damage, therefore, in such patients, the effectiveness of glucocorticosteroids is high.

Non-selectivity is associated with more severe changes in the renal filter (membranous nephropathy, glomerulosclerosis, proliferative glomerulonephritis), in the treatment, as a rule, resistance to steroids is observed.

An increase in glomerular hydrostatic pressure can also lead to increased protein filtration, which is a variant of glomerular proteinuria.

6.2.2. tubular protein loss

It develops against the background of impaired protein reabsorption in the renal tubules and is manifested by the release of low molecular weight proteins (weight below 40 kDa), which are normally completely reabsorbed.

Tubular proteinuria, as a rule, does not exceed 2 g / 1.73 mx2 / day.

Pathologies associated with tubular protein loss include:

1. 1 Interstitial nephritis;
2. 2 Urinary infections;
3. 3 Urolithiasis;
4. 4 Toxic effects;
5. 5 Wilson's disease;
6. 6 Fanconi syndrome.

Indicators of tubular proteinuria are B2-microglobulin, retinol-binding protein and/or alpha1-microglobulin.

The level of excretion of B2-microglobulin has the greatest diagnostic value. An increase in the level of albumin in the urine with a normal content of B2-microglobulin indicates damage to the glomeruli, while the predominance of B2-microglobulin indicates tubular pathology. However, one should not forget about the possibility of an erroneous result of the analysis.

6.3. Postrenal

Postrenal proteinuria is caused by the ingestion of an inflammatory protein-rich exudate into the urine and is associated with damage to the underlying urinary tract. This condition may occur when:

1. 1 Inflammatory pathology of the urinary tract (cystitis, urethritis, prostatitis);
2. 2 Bleeding from the urinary tract;
3. 3 Polyps of the bladder;
4. 4 Tumors of the urinary tract.

Figure 1 - Differential diagnosis of proteinuria. Source -V.L. Emanuel. Problems of the pathology of the urogenital system // Journal of laboratory medicine. No. 7, 2015.

7. Gradations of proteinuria

By the amount of protein excretion, it is advisable to distinguish between the variability of proteinuria, which ranges from microproteinuria to a high, nephrotic degree (above 3 g / day).

The term MAU (microalbuminuria) means the excretion of albumin in the urine in an amount above the physiological norm, but below the sensitivity of standard test systems.

It is customary to talk about MAU with a daily loss of 10 mg to 300 mg of albumin. MAU may be the only early sign of glomerular involvement, such as in diabetic nephropathy.

MAU appears long before the start of a decrease in the level of GFR (glomerular filtration rate). Microalbuminuria also occurs in hypertension, kidney transplant rejection.

Low grade proteinuria (300 mg -1 g/day) can be detected in acute urinary tract infections, urinary tract obstruction, urolithiasis, and nonspecific nephritis.

Moderate loss of proteins (1 g - 3 g / s) develops with acute tubular necrosis, glomerulonephritis, hepatorenal syndrome, amyloidosis.

A large loss of protein in the urine (more than 3 g / s) is actually always associated with a violation of the glomerular filter and a change in the "size-charge ratio" of proteins and membranes.

8. Clinical manifestations

Proteinuria, which occurs in a mild form, usually has no clinical manifestations or is masked by symptoms of the underlying pathology.

With a significant increase in the concentration of protein in the urine, foaming during urination is observed. Such "foam" remains long enough.

A constant and significant loss of proteins in the urine can lead to the development of edema of the face, limbs, and abdomen.

9. Kidney failure

Proteinuria is one of the most significant risk factors for the formation and progression of CKD (chronic kidney disease). The relationship between the increase in protein loss in the urine and the rate of decline in kidney function has been proven.

In one of the latest meta-analyses (Stoycheff, 2011), the role of proteinuria as an independent risk factor for CKD progression was once again proven.

Proteinuria (including MAU) are risk factors for the development of complications from the cardiovascular system.

In international expert recommendations, a normogram is used to determine the risk of an unfavorable prognosis for the development of CKD and renal failure (Figure 2). The higher the level of proteinuria, the higher the risk of fatal outcomes.

Fig. 2. Nomogram of risk of poor prognosis KDIGO-2012, 2013: green - low risk (if there are no other markers of renal pathology or the pathology itself), yellow - moderate risk, orange - high risk, red - very high risk

10. Treatment tactics

The tactics of managing a patient with proteinuria directly depend on the cause, the risk of an unfavorable outcome, the prognosis, which determines the need for dynamic monitoring by a therapist or a nephrologist.

In the general analysis of urine, there is always an item - protein. A person begins to worry when he receives results with an increased content of it. Why is protein present, what does it mean, what norms of protein in urine are acceptable? In order to deal with this issue, you will have to go to the doctor.

Where does it come from?

This component is constituent of enzymes, and takes part in almost all cellular processes occurring in the body. Therefore, in some quantities, its formation in urine is quite acceptable, as well as its absence.

Even eating a large amount of protein foods can affect. But the concentration of protein at the same time quickly disappears.

Important! Despite the fact that approximately 15 percent of healthy people sometimes have protein in the urine, a negative test result is still considered the absolute norm.

The body is protected from protein entering the urethra by the so-called renal pelvis, which serve as a "wall". Therefore, damage to this protection can serve as a reason for protein formation.

In medicine, the increase in concentration is called proteinuria.

How much protein should be in the urine - acceptable norms

This is the first indicator that the doctor turns to when interpreting the results of the patient's examination. It is impossible to visually determine the presence of protein in the urine. One can only guess from the presence of whitish impurities.

The analysis is carried out by various methods: a sample with boiling, test strips, the Brandberg-Roberts-Stolnikov study, as well as quantitative methods. Take the morning portion of the material or daily.

If a protein is detected, a second screening is carried out. in two weeks, due to existing provoking factors such as nervous strain, protein foods in the diet, hypothermia.

The norms of protein in the urine in women and men:

morning analysis - 0.033 g / l
daily analysis - 0.06 g / l

Norms of protein in the urine in children:

morning analysis - 0.037 g / l
daily analysis - 0.07 g / l

The norms of protein in the urine in pregnant women:

morning analysis - 0.033 g / l
daily analysis - 0.3 g / l

How to lower the level of protein in the urine, read our article.

Why the norm is increased - the causes of proteinuria

The reasons for the increase in protein are varied. In addition to physiological reasons, including just transferred SARS, pregnancy, prolonged exposure to the sun, improper hygiene, etc., if there is a lot of protein in the urine, then this may be due to diseases:

• urinary system;
• Complications of SARS: influenza, pneumonia;
• Allergy;
• Pyelonephritis;
• Diabetes;
• Systemic diseases;
• Nephropathy;
• Malignant neoplasms.

In newborns, immediately after birth, there is a slight increase in protein in the urine. And it's completely Fine.

Even protein addiction, lack of water in the body, taking high doses of vitamin C leads to the fact that the protein can “jump” to significant numbers.

Symptoms of pathology

Proteinuria is divided according to severity: traces of protein - up to 0.033; light - up to 1; moderate - up to 2 and severe - more than 3.

If the excess is insignificant, then an adult does not notice any signs. But the following symptoms may appear:

Among the symptoms of severe proteinuria: increased pressure, migraines, sweating. If arose bad smell in urine, then this indicates the progression of pathology, for example, urethritis.

Protein in the urine 0,066 - such indicators are a frequent occurrence during pregnancy, and is called gestational proteinuria. If there are no others, and the rest of the values ​​​​in the analyzes are normal, then you should not worry.

Protein in the urine 0,033 - experts mark in the analysis - traces of protein in the urine, or trace proteinuria. A failure can also occur in healthy people and does not mean kidney disease at all, especially if there are no additional signs of the disease. Causes:

• Improper nutrition;
• Stress;
• The use of certain types of antibiotics.

The result is distorted by incorrect collection of urine, that is, a violation of hygiene and so on.

It is necessary to retake the analysis again.

Protein in the urine 0,1 - shows that there is a moderate proteinuria. For pregnant women, it can be regarded as the norm.

But the doctor must evaluate all indicators and prescribe additional studies in order to early detection of kidney problems: complete blood count (in it, elevated leukocytes and ESR will “show themselves”), creatinine, urea, C-reactive protein. If necessary, ultrasound of the kidneys, in women additional ultrasound of the pelvic organs.

Protein in various diseases

Increased protein in the urine is a constant companion of pathologies such as cystitis, diabetes mellitus and pyelonephritis.

Acute cystitis affects people of almost all ages, but most often "loves" the fair sex. Diagnosis is based on proteinuria above 1 g/l and detection of elevated leukocytes in the urine.

Plus, the patient's complaints about the pungent smell of urine, painful urination and general symptoms of malaise. The patient is prescribed antibiotics and a diet. Do not consume foods that may induce more protein: it is meat, oily fish, foods excessively rich in vitamin C.

Diabetics are at high risk of getting a complication of their underlying disease: kidney dysfunction. Therefore, they need to control the protein in the urine at least once every six months. Experts sound the alarm already at the indicator above 0.3 g/l. Albumin protein is determined. Its norms for patients with diabetes mellitus:

• Less than 20 mg/l is normal;
• 20-200 mg / l - a slight excess;
• Above 200 - proteinuria.

For the diagnosis of pyelonephritis, each analysis value is not evaluated separately. But the characteristic picture of urine: a pale shade, and if pus appears, then it looks cloudy. Leukocytes are high - more than 6 (in children, the norm is up to 6). Protein is usually above 1 g/l. But the density and acidity can be within the normal range.

The clinical picture of the patient's complaints: high fever, back pain, urination, weakness.

Why is proteinuria dangerous?

This pathology is fraught with the loss by the body of various types of proteins that are important for its life. As a result, for a person, this will be expressed in constant edema, problems in blood clotting, which means that the risk of bleeding is high. In addition, there may be problems with the thyroid gland and, in fact, with any organ or body system.

Find out what the unpleasant smell of urine says from the video:

The presence of protein in the urine - what does it mean? Protein in the urine, or the so-called proteinuria, is manifested due to various factors. Some of the substance may be present in the urine from time to time. However, there is a certain limit, after exceeding which we can talk about a violation of the kidneys.

Temporary Boost

The kidneys are responsible for the formation of urine in the human body. Temporary high protein levels may be due to a number of factors. As a result of the observation, the reasons that influenced the change in the work of the kidneys are determined - this is the presence of diseases, hypothermia, the action of certain drugs.

Elevated protein in the urine indicates the presence of inflammation. Intestinal infections easily spread to the kidneys, since the lymphatic vessels of these organs and the intestines are closely interconnected.

The presence of inflammation is determined by the study:

• general urine analysis;
• general blood test;
• urinalysis according to the Zimnitsky method.

A commonly available and inexpensive method for examining the kidneys is ultrasound. With its help, various pathologies, neoplasms are detected. The norm of protein in the urine in women is its absence. But the presence of no more than 0.0025 g per 1 liter of daily liquid is allowed. Elevated protein in the urine is determined if more than 50 mg of protein is found in the daily volume.

Protein may temporarily increase after:

• long stay in the cold;
• regular emotional stress;
• transferred viral diseases;
• intense physical activity;
• excess protein in the diet.

After the termination of the provoking causes, the indicators return to normal. Increased protein in the urine should not be ignored. The load and vulnerability of the genitourinary system doubles during pregnancy. Especially carefully control the increase in protein in the urine in women who are carrying a baby.

If the rules for selecting tests are violated, false or physiological albuminuria may be detected. Protein molecules are large enough and may not pass through the kidney filter. Only a small part is excreted in the urine - no more than 1%. In men, protein in the composition of urine should not exceed 0.3 g. Reasons for exceeding the norm: stress, increased training, professional activity. Urine in men always contains more protein than in women.

Manifestations and degrees

If, over time, protein molecules return to normal levels, then physiological proteinuria has occurred. It is necessary to consider the causes of pathological deviations from the norm. Permissible levels of protein in the urine in women are different from those in men. There are 3 degrees of pathological albuminuria in men.

Light - characterized by the release of up to 1 g of protein per day. Such an excess is observed with urethritis, inflammation of the bladder, urolithiasis, and renal polycystosis. The average degree is determined in the range from 1 to 3 g per day. Such values ​​indicate the pathology of the renal tubules, glomerulonephritis. Urinalysis in severe cases shows a level above 3.5 g. The protein concentration in the urine test in the morning is normal if it is less than 0.033 g / l.

Symptoms of high protein content:

• increased body temperature;
• progressive anemia, weakness, fatigue;
• dizziness, drowsiness;
• lack of appetite.

With elevated rates, additional examinations are prescribed to determine the characteristics of violations and causes. Carefully examine the blood and urine. This measure eliminates the physiological factor.

Pathological albuminuria is renal and extrarenal. The second is caused by the admixture of protein in cystitis, prostatitis, vulvovaginitis and is not associated with kidney disease. Urinalysis shows protein in the urine of 0.1 g per day. The renal form is provoked by acute and chronic diseases. Main pathologies: kidney tuberculosis, chronic heart failure, nephritis, nephrosis, congenital pathologies.

The norm of protein in urine for women is no more than 0.1 g / l, the presence of its traces up to 0.14 g / l is not a pathology.

Normal values ​​for pregnant women with daily urine collection are no more than 0.3 g / l. With an indicator higher than 0.3 g / l, malfunctions in the work of the genitourinary system and kidneys are determined.

The higher the score, the more significant the problem. To determine the correct diagnosis, it is necessary to repeat the tests after 1-2 weeks. Pathologies that are characterized by increased rates are pyelonephritis, urolithiasis, infections, chemotherapy, tumors, leukemia, kidney or brain injuries.

To accurately determine the amount, a daily analysis is carried out. It is done both on an outpatient basis and in hospitals. Fix the start time of the collection, for example at 6 am. Urine collection occurs during the day. Be sure to follow the rules of personal hygiene, avoid physical overload, exclude certain foods from the diet, stop taking medications. After that, the total volume of urine is calculated, 50 ml are taken for laboratory testing.

Forms and methods of treatment

The mild form of proteinuria has no pronounced symptoms in the early stages of the disease. Sometimes the normal state of the urine, or just a too frothy structure, can cause anxiety. Doctors recommend regularly 1 time per year to take tests for the timely detection of deviations from the norm.

The first symptom - the appearance of puffiness - indicates that there is not enough protein in the blood. Depending on the etiology, prerenal, renal and postrenal proteinuria are determined. At the initial stage of urine formation, an increased amount of albumin is observed. Then there is a reverse absorption into the renal tubules, so the protein in the urine is normal. The presence of deviations may not be determined by conventional methods.

Kidney disease leads to dysfunction of the tubules, so protein substances are not fully reabsorbed into the blood plasma. Kidney diseases associated with increased secretion of albumin and other protein compounds are:

• glomerulonephritis;
• polycystic;
• pyelonephritis;
• tuberculosis.

Glomerulonephritis is characterized by an increased content of proteins and erythrocytes in the urine. Pyelonephritis is characterized by the presence of protein substances, leukocytes, bacteria and epithelial cells. Kidneys subsequently suffer from pathologies in other organs. Why are their functions impaired? Basically, failure occurs with hypertension, nephropathy, vascular atherosclerosis, and diabetes.

With adrenal proteinuria in the body, the formation of normal or pathological proteins is increased. Which means an additional burden on the kidneys, which do not have time to process such a number of compounds. Increased secretion of hemoglobin, fever, heart attack are the causes of an increase in protein substances.

Proteinuria is not an independent disease, but a consequence of the pathology of other organs. Inflammatory processes of the kidneys and other urinary organs are treated with the appointment of antibiotics, uroseptics, anti-inflammatory drugs. Diabetes mellitus requires constant use of insulin-containing drugs. Hypertension requires constant monitoring and lifelong antihypertensive medication.

Treatment is prescribed depending on the underlying disease, and the presence of protein is only a consequence. Regularly monitor this indicator, especially if there are these pathologies. Do not self-medicate, seek help from specialists.

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Passing through the kidneys, the blood is filtered - as a result, only those substances that the body needs remain in it, and the rest is excreted in the urine.

Protein molecules are large, and the filtering system of the renal corpuscles does not let them through. However, due to inflammation or due to other pathological reasons, the integrity of the tissues in the nephrons is broken, and the protein freely passes through their filters.

Proteinuria is the appearance of protein in the urine, and I will discuss the causes and treatment of this condition in this publication.

In the urine of women and men, two types of proteins are found - immunoglobulin and albumin, and most often the latter, so you can meet such a thing as albuminuria. This is nothing but widespread proteinuria.

The presence of protein in the urine is:

• Transient, associated with fever, chronic diseases outside the urinary system (tonsillitis, laryngitis) and functional causes - dietary habits (a lot of protein in the diet), physical overwork, bathing in cold water.
• Permanent, which is due to pathological changes in the kidneys.

Proteinuria is also divided into types depending on the amount of protein (units - g / l / day):

• trace - up to 0.033;
• mild - 0.1-0.3;
• moderate - up to 1;
• pronounced - up to 3 or more.

There are many reasons for protein in the urine, and kidney pathologies occupy the first place:

• pyelonephritis;
• lipoid nephrosis;
• amyloidosis;
• glomerulonephritis;
• polycystic kidney disease;
• nephropathy in diabetes mellitus;
• kidney carcinoma;
• obstructive uropathy.

Among blood diseases, myeloma, leukemia, plasmacytoma, myelodysplastic syndrome can become causes of increased protein in the urine. These pathologies do not damage the tissues of the kidneys, but increase the load on them - the level of proteins in the blood increases, and the nephrons do not have time to completely filter them out. Protein inclusions in urine also appear with urethritis and prostatitis.

Severe increase in protein in the urine may cause the following violations:

• inflammation of the urinary organs;
• tumors in the lungs or gastrointestinal tract;
• kidney injury;
• diseases of the central nervous system;
• intestinal obstruction;
• tuberculosis;
• hyperthyroidism;
• subacute endocarditis caused by infections;
• arterial hypertension;
• chronic hypertension;
• intoxication of the body in case of poisoning and infectious diseases;
• extensive burns;
• sickle cell anemia;
• diabetes;
• congestion in heart failure;
• lupus nephritis.

Physiological increase in protein in the urine temporary and is not a symptom of any disease, occurs in such cases:

• high physical activity;
• prolonged fasting;
• dehydration.

The amount of protein excreted in the urine also increases in stressful situations, with the introduction of norepinephrine and taking certain other drugs.

In inflammatory diseases, there may be increased protein and white blood cells in urine. A common cause is pyelonephritis, diabetes mellitus, blood diseases, infections of the genitourinary system, appendicitis.

Leukocytes, together with protein, are present in the analysis of urine and due to the intake of aminoglycosides, antibiotics, thiazide diuretics, ACE inhibitors.

There should be no red blood cells in the urine. Protein, erythrocytes and leukocytes in the urine appear with injuries, inflammation of the kidneys, tumors in the urinary tract, tuberculosis, hemorrhagic cystitis, kidney and bladder stones.

This is a serious signal - if you do not find out the exact cause and do not start treatment on time, the disease can develop into kidney failure.

The rate of protein in the urine in women and men

The urine of a healthy person contains protein no more than 0.003 g/l- in a single portion of urine, this amount is not even detected.

For the volume of daily urine, the norm is up to 0.1 g. For protein in the urine, the norm for women and men is the same.

In a child up to 1 month. normal values ​​​​are up to 0.24 g / m², and in children older than a month it decreases to 0.06 g / m² of body surface.

Foods that increase protein in urine

Excess protein food increases the load on the kidneys. The body does not have the ability to accumulate excess proteins - the reserves of substances and energy are always deposited in the form of fat, or burned during physical activity.

If you are on a high protein diet, or high in these foods, the excess protein will inevitably increase. The body needs to either convert it (to fat with a sedentary lifestyle, into muscle mass and energy when moving). But the rate of metabolic processes is limited, so there will come a time when the protein will begin to be excreted in the urine.

If you eat a lot of protein foods, it is important to consume at least 2.5 liters of clean water every day and move actively. Otherwise, the kidneys will not be able to properly filter urine, which can lead to metabolic disorders and the development of urolithiasis.

The filtering ability of the kidneys is also reduced by other products:

• Alcoholic drinks irritate the parenchyma of organs, thicken the blood, increasing the load on the urinary system;
• Salty and sweet foods retain water in the body, slowing down its free movement - congestion and swelling develop, which
• Increases blood toxicity - this negatively affects the functioning of the kidney filters.

Symptoms of a pathological increase in protein in the urine

Mild proteinuria and trace amounts of protein in the urine do not manifest themselves. In this case, there may be symptoms of diseases that led to a slight increase in this indicator, for example, an increase in temperature during inflammation.

With a significant presence of protein in the urine, edema appears. This is because, due to the loss of proteins, the colloid osmotic pressure of the blood plasma decreases, and it partially exits the vessels into the tissues.

If the protein in the urine is elevated for a long time, the following symptoms develop:

1. Pain in the bones;
2. dizziness, drowsiness;
3. Fast fatiguability;
4. Fever with inflammation (chills and fever);
5. Lack of appetite;
6. Nausea and vomiting;
7. Turbidity or whitish urine due to the presence of albumin in it, or redness if the kidneys pass red blood cells along with the protein.

Often there are signs of dismetabolic nephropathy - high blood pressure, swelling under the eyes, on the legs and fingers, headaches, constipation, sweating.

Is high protein in the urine during pregnancy normal?

The volume of circulating blood in the body of a woman during this period is increased, so the kidneys begin to work in an enhanced mode. The norm of protein in the urine during pregnancy is the value up to 30 mg/l.

With analysis indicators from 30 to 300 mg, they speak of microalbuminuria. It can be caused by an abundance of protein foods in the diet, frequent stress, hypothermia, cystitis.

An increase in protein to 300 mg or more is observed in pyelonephritis and glomeluronephritis.

The most serious condition in which protein in the urine increases during pregnancy is preeclampsia. This complication is accompanied by an increase in blood pressure, edema, and in extreme cases, seizures, cerebral edema, coma, bleeding and death. Therefore, it is important for pregnant women to pay attention to any symptoms and regularly take a urine test.

It happens that even against the background of proper nutrition and the absence of symptoms, the presence of protein in the urine of women is detected. What does it mean? Trace amounts of protein can be detected if hygiene is not observed during urine collection.

• At the same time, vaginal secretions enter the urine, which contain up to 3% of free proteins and mucin (a glycoprotein consisting of carbohydrate and protein).

If there are no visible reasons, and the protein in the urine is more than normal, undergo a thorough examination - perhaps some kind of disease occurs in a latent form.

Treatment tactics, drugs

To prescribe the correct treatment, the doctor needs to find out the cause of proteinuria. If the release of protein is associated with the physiological state of the body, then therapy is not carried out.

• In this case, it is recommended to review the diet, reduce stress, be less nervous (perhaps the doctor will recommend light sedatives).

Inflammatory diseases

The causes of increased protein in the urine in women and men, associated with inflammatory processes in the genitourinary system, are treated with antibiotics, general tonic.

Antimicrobial drugs are selected taking into account the sensitivity of the pathogen, the form of the disease and the individual characteristics of the patient.

In the treatment of pyelonephritis are shown:

• antibiotics (ciprofloxacin, cefepime);
• NSAIDs to reduce inflammation and pain (Diclofenac);
• bed rest during exacerbation;
• supportive herbal medicine (diuretic herbs, rose hips, chamomile, Monurel);
• plentiful drink;
• diuretics (Furosemide);
• Fluconazole or Amphotericin are indicated for fungal etiology of the disease.

With sepsis (symptoms of suppuration - severe pain, fever, decrease in pressure), kidney removal is indicated - nephrectomy.

With glomerulonephritis, it is prescribed with restriction of proteins and salt, antimicrobial drugs. Cytostatics, glucocorticoids, hospitalization and bed rest are indicated in case of exacerbation.

Nephropathy

The level of protein in the urine increases with nephropathy. The treatment regimen depends on the underlying cause (diabetes, metabolic disorders, intoxication, preeclampsia in pregnant women) and is determined individually.

In diabetic nephropathy, careful monitoring of blood glucose levels is necessary, and a low-salt, low-protein diet is indicated. Of the drugs, ACE inhibitors are prescribed, agents for normalizing the lipid spectrum (nicotinic acid, Simvastin, Probucol).

In severe cases, Erythropoietin is also used to normalize hemoglobin, a hemodialysis procedure, or a decision is made about a kidney transplant.

Preeclampsia of pregnant women

Preeclampsia during pregnancy can occur in four forms, or stages:

• dropsy - edematous syndrome develops;
• nephropathy - failure of the kidneys;
• preeclampsia - violation of cerebral circulation;
• eclampsia is an extreme stage, a pre-coma state, a threat to life.

Any of the forms requires immediate hospitalization and treatment in a hospital. The woman is shown complete rest and a diet with salt restriction.

Medical therapy includes:

• sedatives;
• removal of vascular spasms (more often they use drip administration of magnesium sulfate);
• replenishment of blood volume with the help of isotonic solutions, blood products;
• means for normalizing pressure;
• diuretics to prevent cerebral edema;
• administration of vitamins.

Why is high protein in urine dangerous?

Proteinuria requires timely clarification and elimination of its cause. Increased protein in the urine without treatment is dangerous for the development of such conditions:

1. Decreased sensitivity to infections and toxins;
2. Violation of blood clotting, which is fraught with prolonged bleeding;
3. If thyroxin-binding globulin leaves the body with urine, then the risk of developing hypothyroidism is high;
4. Damage to both kidneys, death in nephropathy;
5. With gestosis of pregnant women - pulmonary edema, acute renal failure, coma, hemorrhages in internal organs, the threat of fetal death, severe
6. Uterine bleeding.

An increase in protein in the urine does not allow self-treatment - by contacting a specialist in time, you can avoid the development of serious complications.

Urine is formed by filtering blood in the renal glomeruli and is practically devoid of protein - normally, the pores of the glomerular membrane are too small for protein molecules to pass through them.

• Proteinuria- the amount of protein in the urine more than 0.033 g/l.

1. Damage/inflammation of blood vessels in the kidney. Changes in the wall of glomerular capillaries increase their permeability to protein molecules.

2. Decreased reabsorption (reabsorption) of protein and water in the renal tubules.

3. Decreased blood flow in the kidney, stagnation of blood in the renal glomeruli.

1. Proteinemia is a decrease in the concentration of protein in the blood plasma.

Normal indicators of protein metabolism:

• total blood protein: 65 - 85 g/l
• blood albumins: 35 - 50 g/l

2. Hypertension - blood pressure rises due to increased production of the antidiuretic hormone ADH and aldosterone.

3. Hypercholesterolemia is an increase in blood lipids.

4. Retention of salts and water in tissues with the formation of edema.

Prolonged massive proteinuria ≥3.0-3.5 g/day leads to a decrease in the concentration of albumin proteins in the blood plasma - it is albumins that keep the liquid part of the blood from flowing through the capillaries. The loss of protein in the urine potentiates tissue edema.

The appearance of protein in the urine during pregnancy in excess of the permissible norm can be a clinical symptom of late toxicosis of pregnancy, more precisely one of the forms of gestosis - nephropathy of pregnant women with diffuse kidney damage.

Changes in the kidneys during gestosis are similar to membranous glomerulonephritis with severe degeneration of the epithelium of the renal tubules. During gestosis, not only the kidneys suffer, pathological changes in the liver, myocardium, and cerebral vessels are possible. As a rule, all these disorders disappear soon after childbirth.

Pregnancy itself cannot be the cause of irreversible changes in the kidneys and other vital organs. If proteinuria and its accompanying symptoms persist after childbirth, then it can be argued that certain chronic / undiagnosed diseases existed in the patient even before pregnancy.

Protein levels in urine

Protein traces in the urine during pregnancy have no clinical significance. Small proteinuria (traces / 1+) is most often transient, benign.

1. In the morning (6.00 - 8.00 hours, immediately after sleep) wash thoroughly.

2. Collect ALL the morning portion of urine in a clean, dry, specially prepared container (pot).

3. Pour 100-200 ml of the collected urine into a clean, dry container.

4. Deliver the container with urine to the laboratory no later than 2 hours after its collection.

1. Prepare a clean, dry large container with a capacity of up to 3 liters (2-3 liter jar with a lid) to collect daily urine.

2. Prepare a clean small container with a capacity of about 200 ml - for delivery of a daily urine sample to the laboratory. Mark:
FULL NAME_____
Exact time to start urine collection: (for example, 9.00)
The amount of fluid drunk per day: (-)
Total urine volume per day: (—)

3. Prepare a clean pot and a "Journal of fluids drunk per day."

4. In the morning at 9.00 empty the bladder (the first portion of urine) into the toilet.

5. Collect all subsequent urine within 24 hours in a pot and pour into a large container. Write down in the "Journal of Accounts" the volume of each portion of the drunk liquid.

6. At 9:00 the next morning, collect the last portion of urine, pour into a large container.

7. Measure the total volume of daily urine, calculate the amount of fluid drunk per day. Enter the data in the marking of the small container (-).

8. Shake the urine in a large container, pour 100-200 ml into a small container and immediately deliver the sample to the laboratory.

1. The large container should be kept refrigerated at all times during urine collection.

2. If at least one from portions of urine within 24 hours was not collected in a large container - pour out all the collected urine. The next morning, repeat the urine collection procedure correctly.

Express testing of urine for protein using diagnostic strips.
Decryption.

GLU…….glucose
PRO…….protein/protein
BIL…….bilirubin
URO…….urobilinogen
PH……….urine reaction/pH
S.G. …..relative density
BLD…….blood/hematuria
KET…….ketones
NIT…….nitrites
LEU…….leukocyte esterase

Functional/benign proteinuria

Minor less than 0.3 g/day, isolated (there are no other symptoms of ill health), transient (i.e., not) the appearance of protein in the urine during pregnancy is not always a sign of pathology of pregnancy or kidney disease.

Curvature (lordosis) of the lumbar spine - lordotic proteinuria.

• Nephroptosis is a prolapse of the kidney.
• Orthostatic proteinuria.

The phenomenon when a sufficiently high protein content is detected when collecting urine in a standing position. If urine is collected in the supine position, there is no protein in the urine. Orthostatic proteinuria is characterized by the absence of protein in the morning (collected immediately after sleep) portion of urine. This type of proteinuria is more often observed in young pregnant women (up to 18 years of age), as well as in tall thin women.

• Tension proteinuria.

Occurs after a large and prolonged physical exertion, intense sports training. The protein in the urine completely disappears after a few hours or 1-2 days after the end of the load.

Dehydration due to violation of the drinking regimen and increased sweating.

Thickening of the blood, especially in hot weather, leads to the concentration of albumin proteins in the blood plasma and may be accompanied by their appearance in the urine.

Transient proteinuria, as a result of febrile (hyperthermic) conditions, hypothermia, stress.

• Alimentary proteinuria.

The result of a high-protein diet is also the abuse of spicy, salty foods, alcohol.

• Congestive proteinuria of pregnancy.

Due to the growth of the pregnant uterus, hemodynamics in the pelvic area is disturbed, blood flow in the kidneys slows down, and urine outflow worsens. Under such conditions, low molecular weight blood albumin proteins can be filtered through the pores of the glomerular basement membrane into the primary urine.

• Doesn't pose a threat.
• Not progressing.
• Does not require special treatment.

It is temporary - it appears, then disappears without treatment.

It is not accompanied by any other symptoms - a thorough laboratory and instrumental examination of a pregnant patient does not reveal any pathology in her.

Pathological proteinuria

Aggravation already existing diseases listed below, can cause the appearance of pathological proteinuria at any stage of pregnancy:

• Glomerulonephritis, nephritis of various etiologies.
• Pyelonephritis.
• Amyloidosis of the kidneys.
• Polycystic kidney tumor.
• Autoimmune diseases - SLE, vasculitis, etc.
• Heart defects, s / s diseases.

With congestive proteinuria due to circulatory failure of various origins, there may be a lot of protein in the urine during pregnancy (from 2.0-3.0 g / l to 10 g / l).

• Urolithiasis disease.

False/postrenal/nonrenal proteinuria

With a transient minimal (≤0.3-0.5 g / l) or trace appearance of protein in the urine during pregnancy, false proteinuria, not associated with kidney pathology, must first be excluded. Her reasons:

• Non-compliance with personal hygiene during urine collection.

Infections of the genital organs and urinary tract - cystitis, urethritis, etc.

During the period of infectious and inflammatory processes of the genitals / lower urinary tract, a large number of leukocytes, erythrocytes, bacteria, as well as the epithelium of inflamed mucous membranes and purulent-protein secretion of the genital organs can be found in the urine, which gives a false positive result for protein in the urine.

To confirm / exclude false proteinuria, additional urine tests are carried out: samples of Nechiporenko, Kakovsky-Addis, etc.

Protein in the urine due to early toxicosis of pregnancy
/prerenal overflow proteinuria/

Early toxicosis - a complication of the first half of pregnancy - usually occurs in the first 12 weeks of gestation.

Prerenal (non-renal) proteinuria of this period rarely exceeds 1 g / day and is the result of dehydration against the background of frequent vomiting, salivation (up to 1.5 liters of saliva can be secreted per day) and metabolic disorders in the body of a pregnant woman. By the 13-14th week of pregnancy, the condition of the expectant mother improves, the protein content in the urine returns to normal.

Treatment of severe early toxicosis is carried out in a hospital, in some cases the question of artificial termination of pregnancy becomes.

Protein in the urine due to late toxicosis of pregnancy - preeclampsia

Breakdown of hormonal homeostasis and dysfunction of the central nervous system in the mother's body.

The immunological conflict between the organism of the mother and the fetus leads to the development of immune inflammation in the kidneys, in other tissues, to the formation of edema.

The accumulation in the edematous ischemic placenta and uterus of harmful metabolic products - hysterotonic substances - causes an increase in the permeability of cell membranes, vascular walls, aggravates edema and inflammation.

Functional overload of the kidneys in the second half of pregnancy exacerbates all of the above processes.

• Hypertonic disease.
• Congenital / acquired before pregnancy kidney disease.
• Diabetes.
• Anemia.
• Reception of nephrotoxic drugs in the anamnesis of the patient.
• Tendency to allergic reactions, polyvalent allergy.
• Autoimmune pathology.
• Foci of chronic microbial infection (tonsillitis, caries, etc.)
• Smoking.

The appearance of proteinuria >0.3 g/day after the 20th week of pregnancy can be considered as a clinical symptom of nephropathy in pregnant women.

Mild/benign forms of nephropathy occur without hypertension, are accompanied by moderate edema and an acceptable protein content in the urine (0.3 - 0.5 g / l). After childbirth, proteinuria disappears without a trace.

The frequency of late toxicosis of pregnancy ranges from 2.2 to 15%. Severe (combined with other pathologies) nephropathy of pregnant women can cause maternal and perinatal (shortly after birth) infant mortality.

Symptoms of preeclampsia

The indicator of the severity of the patient's condition with preeclampsia is not so much edema and the amount of protein in the urine, but arterial hypertension, especially high diastolic pressure.

Treatment

Specific treatment of preeclampsia with the appearance of protein in the urine in pregnant women obstetrician-gynecologist together with other specialists.

1. Sparing, in some cases, bed rest.
2. Diet No. 7c.
3. Drug treatment:
- sedative therapy;
- eufillin, magnesium sulfate IV, IM.
- diuretics;
- antihypertensive drugs;
- anti-edema (fight against cerebral edema) measures: IV - rheopolyglucin, lasix, mannitol, glucose solution 40%, plasma, albumin solution 20%, etc.
Resuscitation consultation.

Treatment is carried out in a hospital, under constant monitoring of indicators of acid-base balance, blood clotting and the functional state of the kidneys.