TITLE: PROTEINURIA
AUTHOR: P.M. HALL, MD -- Department of Nephrology
REVIEWED: DECEMBER 17, 2003
Table 1:
Detection Methods for Proteinuria
Method
Dipstick
Dipstick Sulfosalicylic Acid
Method of detection
Colorimetric
Acid precipitation
Proteins detected
Mostly albumin
All proteins
Lower limit of protein detection
30 mg/dL
1-10 mg/dL
Indicator
Color change
Turbidity
Interpretation
Negative
0 = no turbidity ( 0 mg/dL)
  
Trace = < 30 mg/dL
Trace = slight turbidity
(1-10 mg/dL)
  
1+ = 30 mg/dL
1+ = turbidity through which print can be read (15-30 mg/dL)
  
2+ = 100 mg/dL
2+ = white cloud without precipitate through which heavy black lines on white background can be seen
  
3+ = 300 mg/dL
3+ = white cloud with fine precipitate through which heavy black lines cannot be seen (150-300 mg/dL)
  
4+ = 2000 mg/dL
4+ = flocculent precipitate
(> 500 mg/dL)

 

Table 2:
Definition of Abnormalities in Albumin Excretion
Category
Time Collection
Spot Collection
  
24-h Collection
(mg/24 h)
(µg/min)
(µg/g creatinine)
Normal
< 30
< 20
< 30
Microalbuminuria
30-299
20-199
30-299
Clinical proteinuria
> 300
> 200
> 300

 

 

 


Table 3:
Differential Diagnosis of Kidney Disease by
Varying Levels of Proteinuria
Proteinuria Less than 1-2 Grams Daily
  • Nephrosclerosis*
  • Tubulointerstitial disease*
  • Polycystic kidney disease
  • Orthostatic proteinuria
  • More benign forms of glomerular disease (eg, IgA nephritis)*
Proteinuria Greater than 3.5 Grams Daily (Nephrotic-Range)
Primary glomerular disease
  • Minimal change disease
  • Membranous glomerulonephritis*
  • Focal and segmental glomerulosclerosis*
  • Membranoproliferative glomerulonephritis

Secondary nephrotic syndrome: glomerular disease associated
with specific causes

  • Systemic disease
    • Diabetic nephropathy*
    • Systemic Lupus Erythematosus
    • Amyloidosis
    • Vasculitic-immunologic diseases (Wegener's, Goodpasture's, Polyarteritis)
  • Infectious disease
    • Post-streptococcal glomerulonephritis
    • Hepatitis B and C*
    • Bacterial endocarditis
    • HIV*
  • Malignancies
    • Lymphoproliferative disorders, Hodgkin's (minimal change)
    • Solid tumors (membranous)
  • Medications:
    • Nonsteroidal anti-inflammatory drugs*
    • Gold, mercury, heavy metals
    • Penicillamine
    • Lithium
    • "Street" heroin
  • Hereditary and metabolic disorders
    • Alport's syndrome
    • Fabry's disease
    • Sickle cell anemia
    • Nail-patella syndrome
  • Others
    • Accelerated hypertensive nephrosclerosis
    • Massive obesity
    • Transplant rejection nephropathy
* Most common disorders in adults

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