Proteinuria: Understanding Protein in Urine - Causes & Significance
Normal urine protein: <150 mg/day (albumin <30 mg/day). Proteinuria indicates glomerular/tubular dysfunction or overflow.
Mechanisms of Absence (Normal)
- Glomerular barrier: Size/charge selectivity retains albumin.
- Tubular reabsorption: Proximal tubule reclaims filtered low-MW proteins.
- Normal hemodynamics: Controlled BP, no hyperfiltration.
Clinical Significance
- Transient: fever, exercise, orthostatic (benign).
- Persistent: diabetic nephropathy, hypertensive nephrosclerosis, glomerulonephritis, myeloma (Bence Jones), preeclampsia.
Evaluation
- Urine ACR (albumin-creatinine ratio) — preferred screen.
- 24-hr urine protein if ACR elevated.
- Workup per etiology.
Early detection (microalbuminuria) enables renoprotection (ACEi/ARB, SGLT2i, glucose/BP control).
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