Urine Protein

The test for protein in the urine measures the amount of albumin in your urine, compared to the amount of creatinine in your urine. This is called the urine albumin-to-creatinine ratio (UACR).

A urinalysis is a test of your urine. A urinalysis is used to detect and manage a wide range of disorders, such as urinary tract infections, kidney disease and diabetes.

A urinalysis involves checking the appearance, concentration and content of urine. Abnormal urinalysis results may point to a disease or illness.

Also Known as:  Urine Test, Urine Analysis , Urine CE, Urine C/E, UCE, Urinalysis

Test Panel: Physical properties, Chemical Tests, Dipstick Tests, Microscopic Examination

Type of urine samples:

• Random sample:
  This is a diluted urine sample and may give an inaccurate interpretation of patient health. But is best to do microscopy to evaluate WBC or RBC.
• First Morning sample:
  This is the best sample for microscopy and urine analysis. This is the concentrated urine because of urine remained throughout the night in the urinary bladder. This will contains an increased concentration of analytes and cellular elements. Urine must have remained in the bladder for 8 hours is considered as the first-morning sample.
• Urine for sugar (Postprandial 2 hours):
  Postprandial 2 hours sample collected after 2 hours of high carbohydrate diet. 
• Midstream clean catch urine:
  This sample is needed for the culture and sensitivity of urinary infection. The patient is advised to clean the urethra, then discard the first few mL of urine. Now midstream of the urine is collected in the sterile container.
• 24 Hours of a urine sample
  • In this case, discard the first urine and note the time.
  • Now collect urine in the container for 24 hours and put the last sample in the container.
  • Refrigerate the sample.
  • This 24 hours samples are needed for measuring urea, creatinine, sodium, potassium, glucose, and catecholamines.
• Suprapubic collection of the urine sample:
  This is done in the patients who cannot be catheterized and the sample is needed for culture. This sample is collected by the needle.
• Catheter collection of urine:
  This is done by patients who are bedridden and can not urinate.
• Pediatric urine sample:
  In infants, special collection bags are made adherent around the urethra. Then urine is transferred to a container.

Spot Urine Protein

Proteinuria is a condition characterized by the presence of greater than normal amounts of protein in the urine. It is usually associated with some kind of disease or abnormality but may occasionally be seen in healthy individuals.

The Presence of Protein in Urine is Called Proteinuria

Why get Tested:

1. The presence of protein in urine is an indicator of renal diseases.
2. This may be done to evaluate the edema.
3. to see if a kidney condition is responding to treatment
4. if you have symptoms of a urinary tract infection (UTI)
5. as part of a routine urinalysis

NORMAL Range

• Spot urine protein = 0 to 8 mg /dl
• While 24 hours protein is <150 mg/dl

Causes of proteinuria:

Your kidneys filter waste products from your blood while retaining what your body needs — including proteins. However, some diseases and conditions allow proteins to pass through the filters of your kidneys, causing protein in urine.

Pre-renal cuases:

1. Multiple myeloma.
2. Intravascular hemolysis.
3. Muscle injury.
4. Infection and inflammation.

Renal causes:

1. Glomerular diseases:
   1. Amyloidpsis.
   2. Immune-complex disease.
   3. Diabetic nephropathy.
   4. Hypertension.
   5. Pre-eclampsia.
   6. Strenuous exercise.
   7. Dehydration.
   8. Toxic agents.
   9. Orthostatic or postural.
2. Tubular diseases:
   1. Drug toxicity like toxic agents and heavy metals.
   2. Fanconi’s syndrome.
   3. Viral infection (severe).

Post-renal causes:

1. Lower urinary infection.
2. Menstrual contamination.
3. Vaginal secretion.
4. Injury or trauma.
5. Prostatic fluid.
6. Presence of spermatozoa.

24 hours Urine Protein

The 24-hour urine protein test checks how much protein is being spilled into the urine, which can help detect disease or other problems. The test is simple and noninvasive.

Why get Tested:

1. The presence of protein in urine is an indicator of renal diseases.
2. This may be done to evaluate the edema.
3. to see if a kidney condition is responding to treatment
4. if you have symptoms of a urinary tract infection (UTI)
5. as part of a routine urinalysis

Sample Required:

• 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 of Sample

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

Normal Range:

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

Increased proteinuria is seen in:

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

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