24-Hour Urine Protein

Also Known As:  24-Hour Urine Protein, Urine Total Protein, Urine Protein to Creatinine Ratio, UPCR

Test Panel: Urine Protein, Spot Urine Protein, Urine Creatinine, Urine Albumin, Urine Protein to Creatinine Ratio, Microalbuminuria,

Why To Get Tested:

1. The presence of protein in urine is an indicator of renal diseases.
2. This may be done to evaluate the edema.

Required Sample:

• Collect a random sample of urine to rule out the presence of protein.
• 24 hours urine is collected in a sterile container.
  • Discard the first sample then collect all other samples for 24 hours.
  • Add the last sample in the container.
• Add a few ml of HCL into the container.
• Also, refrigerate the sample during collection.
• Centrifuge and adjust to pH 7.0.
  • Analyze a fresh sample.

Precautions for Sample

• Avoid dehydration due to the lake of fluid intake.
• Avoid the contamination of urine from the vaginal secretions.
• Not adequate collection during urinary tract infections (UTI).
• Use of contrast media in radiology within the last three days.
• Avoid strenuous exercise.
• Avoid emotional stress.

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Normal Ranges:

• 1 to 14 mg/dL
• At rest = 50 to 80 mg/day
• After intense excercise = <250 mg/day

Lab Diagnosis

• Usually, 24 hours urine sample is needed.
• Urine protein assays are sensitive to all types of proteins like albumin, globulins, and Bence-Jones protein.
• Most of the assay can detect a minimum of 3 mg/dL of protein in the urine.
• Urine dipstick is most commonly used. This is most sensitive to albumin.
  1. The dipstick can detect albumin when it is about 18 mg/dL

Increased proteinuria is seen in:

• Glomerular diseases : 
  • Acute and chronic glomerulonephritis.
  • Nephrotic syndrome.
  • Polycystic kidney
  • Amyloidosis.
  • Autoimmune diseases like SLE.
  • Diabetes mellitus.
  • Malignant hypertension.
• Decreased tubular reabsorption :
  • Acute and chronic pyelonephritis.
  • Renal tubular diseases.
  • Wilson’s disease.
  • Fanconi’s syndrome.
  • Interstitial nephritis.
  • Cystinosis.
• Other causes are :
  • Congestive heart failure.
  • Multiple Myeloma.
  • Malignant Lymphoma.
  • Waldenstrom’s macroglobulinemia.
  • Trauma and stress.
  • Acute infections like septicemia.
  • Toxemia of pregnancy.
  • Hyperthyroidism.
  • Poisoning from phosphorus, gold, mercury, lead, and phenol.
  • Drugs like opiates and etc.
  • Hypertension.
  • Postural proteinuria.

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