What Does The Test Result Mean
A negative test result means that there is no detectable amount of protein in the urine at the time of testing.
Protein detected in a random urine sample may be temporary due to an infection, medication, vigorous exercise, pregnancy, diet, cold exposure, or emotional or physical stress. Testing should be repeated after these conditions have resolved.
Protein in the urine can also be a warning sign of a serious condition and usually warrants further investigation. Typically, three positive urine samples over a period of time without other significant symptoms will often be followed up with additional tests, including a 24-hour urine.
Persistent and/or an increased amount of protein in the urine may indicate kidney damage or disease. With kidney disease, the amount of protein present is generally associated with the severity of the damage. Increasing amounts of protein over time indicate increasing damage and decreasing kidney function. The most common cause of protein in the urine is kidney damage resulting from:
- Diabetes proteinuria is one of the first signs of deteriorating kidney function in people with type 1 and 2 diabetes.
- High blood pressure proteinuria in someone with high blood pressure is also a first sign of declining kidney function.
Proteinuria may also be seen with many other diseases and conditions. A healthcare practitioner may order other tests and take into account those results to help determine the cause. Some examples of these causes include:
What Level Of Creatinine Indicates Kidney Failure
Blood Tests A creatinine level of greater than 1.2 for women and greater than 1.4 for men may be an early sign that the kidneys are not working properly. If the level of creatinine in the blood increases as the disease progresses, it can lead to failure of the kidneys.
Kidney Disease Kidney disease is the most common cause of death in people with diabetes. It can be caused by a number of different conditions, including kidney stones, kidney infections, and kidney tumors. Kidneys can also be damaged by diabetes-related conditions such as diabetes mellitus, nephrotic syndrome, or diabetic ketoacidosis.
Is There Anything Else I Should Know
The different methods of detecting protein in the urine vary in performance. For example, a positive dipstick protein may be elevated due to other sources of protein, such as blood, semen, or vaginal secretions in the urine. Since it measures primarily albumin, the dipstick may occasionally be normal when significant quantities of other proteins are present in the urine.
A 24-hour urine sample gives the protein elimination rate over 24 hours. It will be accurate only if all of the urine is collected. The protein to creatinine ratio is more of a snapshot of how much protein is in the urine at the time the sample is collected. If it is elevated, then protein is present if it is negative, the amounts or the type of protein released in urine may not be detectable at that time.
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When Is A Upcr Test Performed
Your provider orders this test to look for high levels of protein in your urine, a condition called proteinuria. It’s a symptom of kidney disease.
You may get a UPCR:
- At a routine physical examination to screen for proteinuria.
- During pregnancy, if you have signs of preeclampsia.
You may get a UPCR to diagnose or monitor kidney damage and kidney disease/chronic kidney disease if you have signs or symptoms of these conditions .
If I Have A Positive Urine Protein Test What Other Tests Might Be Done In Follow Up
A positive urine protein test tells your healthcare practitioner that protein is present in your urine, but it does not indicate which types are present or the cause of the proteinuria. When investigating the reason, your health care practitioner may order additional laboratory tests, such as:
- Comprehensive metabolic panel includes tests such as BUN, creatinine, albumin and total protein, which help evaluate kidney and liver function
- A full urinalysisif a condition such as urinary tract infection is also suspected
- Serum and urine protein electrophoresis testto determine which proteins are being released into the urine and in what quantities this is especially true if your health care practitioner suspects abnormal monoclonal protein production, such as with multiple myeloma or lymphoma.
If kidney disease or damage is suspected, your healthcare practitioner may also order imaging scans to evaluate the appearance of your kidneys.
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How Is Protein Tested Routinely
There are several different kinds of urine protein tests, including:
Dip stick method : It is done on a random sample. It is ideal for screening. estimation is done basing on the colour change observed on a urine dipstick. Also called as semi-quantitative method.
24 hr urine method: Urine is collected for 24 hrs and protein is estimated in that sample. It is the most accurate method, however, it is the most cumbersome method.
Urine protein creatinine ratio: It is done on a random sample. Protein and creatinine are estimated and the ratio is calculated. Estimation of creatinine increases the accuracy of the test close to 24 hr urine protein.
Urine protein creatinine ratio is the best alternative to 24 urine protein considering its ease of collecting the sample.
What Causes Protein In The Urine
Healthy kidneys remove extra fluid and waste from your blood and transform it into urine. Healthy kidneys do not remove proteins and other important nutrients, which pass through and return to your blood. But when your kidneys are damaged, they may let this protein leak into your urine. This causes high levels of protein in your urine.
Anyone can have protein in their urine. You may be more likely to have protein in your urine if you have one or more of the risk factors for kidney disease. There are health problems that can cause long-lasting protein in the urine, and some that can cause short-term protein in the urine.
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How To Calculate Protein Creatinine Ratio
There are only two variables needed to estimate the rate of urinary protein excretion. You don’t need to know the urine volume or output for the calculation of UPCR, just the
- Urine protein and
- Urine creatinine .
The following formula the protein creatinine ratio calculation:
Urinary protein excretion = Urine protein / Urine creatinine
The normal range for urine protein should not exceed 15 mg/dL, while the reference range for spot urine creatinine is not established yet. Its value depends on many factors, such us diet, body weight, lean body mass, exercise, etc.
How To Interpret The Test Result
A negative test result means that there is no detectable amount of protein in the urine at the time of testing.
When the test is positive several factors needs to be considered.
- Rule out for the normal conditions which can cause transient elevation of protein levels. They include pregnancy, emotional stress
- Exclusion of the normal conditions can be done by repeat testing over a period of time especially after the conditions are resolved.
- The presence of 3 positive test results over a period of time is considered as significant and needs to be evaluated further with additional tests which include 24-hour urine.
Persistent and/or an increased amount of protein in the urine may indicate kidney damage or disease. With kidney disease, the amount of protein present is generally associated with the severity of the damage. Increasing amounts of protein over time indicate increasing damage and decreasing kidney function.
Disorders with increased urine protein.
- Urinary tract infection
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How Will I Know If I Have Protein In My Urine
The only way to know if you have protein in your urine is to have a urine test. The test will measure the levels of protein in your urine.
The name of the urine test that measures the level of albumin in your urine is called the urine albumin-to-creatinine ratio . A UACR compares the level of albumin to the level of creatinine . A normal UACR is less than 30mg/g. If your UACR is 30 mg/g or higher, it can be a sign of kidney disease, and you should ask your doctor if you should have other tests of kidney disease.
What Are The Benefits Of A Urine Protein Creatinine Ratio Test
A UPCR test is noninvasive, quick and painless. Using a small amount of urine, this test helps your provider check for disease and disorders that affect how your kidneys are working. It also helps your provider monitor treatments for conditions that cause kidney damage.
Some other types of urine tests, such as the creatinine clearance test, only measure creatinine levels . This test requires you to collect all of your urine over a timed period so a lab can measure the volume of urine produced over a specific length of time. Other tests, such as a urine protein test, only measure protein in your urine over a longer period of time, usually 24 hours.
Because a UPCR test measures both creatinine and protein levels, you only need to give one urine sample. A UPCR test is a convenient, reliable alternative to tests needing multiple samples.
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Using A Creatinine Ratio In Urinalysis To Improve The Reliability Of Protein And Albumin Results
Urinary protein and albumin as markers of kidney disease
Urine testing has been used to help identify disease in humans for centuries. It has proven to be an ideal test medium for many analytes because the test is noninvasive, and in most cases, the results are available within minutes. While there are a number of markers that are currently being looked at to detect early kidney changes, the only test that is widely available, at a reasonable cost, is the urine protein test. Persistent increased proteinuria is usually a marker of generalized kidney disease, while albuminuria has been found to be an even better marker of chronic kidney disease.5 The currently used reagent strips measure several common urinary proteins, although they are most sensitive to albumin.
Over the years, the significance of even low levels of albumin, microalbuminuria , has been clearly identified in individuals with diabetes mellitus.1 Long-term studies in both Type 1 and Type 2 diabetes have shown that finding microalbuminuria is a clear and independent marker for diabetic nephropathy.6,7 The American Diabetes Association and other diabetes organizations all recommend yearly testing of all individuals with diabetes for microalbuminuria. 8 If a positive finding is obtained, aggressive management of both the patients blood glucose and blood pressure is indicated to reduce the potential for kidney and widespread vascular damage.
Measuring proteinuria and albuminuria to creatinine ratios
| Figure 4: NKF |
Why Is My Protein / Creatinine Ratio So High
Answered by: Dr Vijay Kher | Chairman,Department of Nephrology and Kidney transplant Medicine,Fortis Kidney and Urology Institute,Fortis Escorts Hospital, New Delhi
Q: I am 37 years old and had blood test done recently where my protein / creatinine ratio was found to be extremely high . The reference range was upto 0.2. I was fasting at that time. All other counts were normal. Would being a vegetarian affect this value? Are there any other factors or conditions that could affect this?
A:Urine protein / creatinine ratio reflects the amount of protein in the urine and avoids the need to do a 24 hours urine collection. I guess you do not have any symptoms and this is the only abnormality in the clinical examination. If it is so, I would recommend a repeat urine protein / creatinine ratio or 24 hours urine protein estimation. Urine protein / creatinine ratio of more than 2.5 is equivalent to 3.5 gms of protein in 24 hours urine and points to a diagnosis of nephrotic syndrome, for which a kidney biopsy would be required.
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Urine Protein : Creatinine Ratio
Proteinuria is protein in the urine.
Proteinuria is defined as:
- albumin:creatinine ratio > 30mg/mmol or albumin concentration > 200mg/l or
- urine protein:creatinine ratios > 45 mg/mmol
The loss of up to 150 mg of protein per day is normal this may be expressed as normal is less than 4 mg per hour per square metre of body surface area.
Proteinuria may be increased by a factor of 2-3 times by strenuous exercise or fever.
- other causes of transient include urinary tract infection, vaginal mucus, orthostatic proteinuria and pregnancy
Causes of persistent proteinuria include:
- primary renal disease: this may be glomerular or tubular
- secondary renal disease: diabetes mellitus, hypertension, connective tissue diseases, vasculitis, amyloidosis, myeloma, congestive cardiac failure
Pharmacotherapy for CKD in adults, children, and young people with related persistent proteinuria
- for adults with CKD and diabetes offer an ARB or an ACE inhibitor if ACR is 3 mg/mmol or more
- for children and young people with CKD and diabetes , offer an ARB or an ACE inhibitor if ACR is 3 mg/mmol or more
- for adults with CKD but without diabetes:
- refer for nephrology assessment and offer an ARB or an ACE inhibitor , if ACR is 70 mg/mmol or more
- if ACR is above 30 but below 70 mg/mmol consider discussing with a nephrologist if eGFR declines or ACR increases
SGLT2 inhibitors and CKD
Notes:
What Is Creatinine And Why Is It Used In This Test
Creatinine is a substance that appears in the blood as the result of muscle activity. Creatinine is excreted by the kidney at a constant rate, which means it can be used as a gauge to assess the rate of excretion of other substances. For example, the urine protein:creatinine ratio measures whether the excretion of protein is greater than expected when compared to the excretion of creatinine.
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What Is Urine Protein Creatinine Ratio
Proteinuria is a common finding in the routine examination of the urine. Protein creatinine ratio in the urine quantifies the loss of the protein and helps in further evaluation of the kidney function. It is a simple , rapid and inexpensive way to monitor kidney disorders . It is an ideal alternative for the more cumbersome 24 hr urine protein estimation.
What Is Protein Creatinine Ratio
The sample is collected at a certain point in time, and the ratio is a snapshot of how much is in the urine. If it is elevated, then protein is present if it is negative, the amounts or the type of protein released in urine may not be indicative of the amount of ingested protein. If you are concerned about the protein content of your urine, you may want to talk to your doctor.
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Urinary Protein Excretion Estimation
INSTRUCTIONS
Avoid using overnight or first morning void as urine sample.
- Patients in whom renal disease is suspected .
- Patients with known renal disease .
- Patients with low-grade proteinuria and otherwise intact renal function .
- The Urinary Protein Excretion Estimation calculates the protein/creatinine ratio from a random urine sample to estimate 24-hour protein excretion.
- Based on the physiologic principle that urinary creatinine excretion is constant if glomerular filtration rate is constant and therefore protein/creatinine ratio from a single urine sample should reflect protein excretion, cancelling out the time factor.
- Confirmed for correlation with 24-hour protein excretion in multiple studies .
- Correlation is lowest for urine samples voided overnight and upon arising.
- Can be used only in presence of stable renal function .
- If albumin is the predominant component, persistent proteinuria suggests renal disease, even in the absence of decreased glomerular filtration rate, hypertension, or other abnormal findings on urinalysis.
Vitamin D Deficiency In The Onset And Progression Of Renal Lesions
Urinary protein is a well-recognized determinant of renal disease progression and higher risk for cardiovascular complications . This section presents potential defects in autocrine/paracrine mechanisms that may explain why the degree of vitamin D deficiency strongly correlates with the severity of albuminuria in a large population of individuals with normal kidney function .
Amer Wahed MD, Amitava Dasgupta PhD, DABCC, in, 2015
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What Is A Urine Protein Creatinine Ratio Test
A urine protein creatinine ratio test is a urine test. It measures the levels of protein and creatinine in your urine . Creatinine is a waste product produced by your muscle cells as they use creatine .
When your kidneys work like they should, they filter waste products, including creatinine, out of your blood. They exit your body with your pee.
A UPCR test gives your healthcare provider important information about how your kidneys are working. The results of this test help your provider diagnose conditions that can cause kidney damage. UPCR is also used to monitor how well treatments are working. Depending on the results, your provider may recommend further tests or treatments.
Protein In Urine Treatment
Proteinuria a sign of another illness. So treatment depends on figuring out what caused it. You might not need treatment if proteinuria is mild or lasts only a short time. But itâs crucial to treat kidney disease before it leads to kidney failure.
Your doctor might prescribe medication, especially if you have diabetes and/or high blood pressure. Most people will take one of two types of blood pressure medicine:
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Synopses From The Scientific Literature
2004 ACVIM Forum Consensus Statement
A great deal of attention has been given to the role of proteinuria in the diagnosis of renal disease.
The leading veterinary experts in Nephrology developed the ACVIM Forum Consensus Statement on July 28, 2004: Assessment and Management of Proteinuria in Dogs and Cats. This 18 page document highlights the most recent research on urine protein and reviews the definition and classification of proteinuria, how it is best to detected and assessed, what the implications are of increased persistent renal proteinuria, when and how to test for proteinuria and how the veterinarian should respond clinically to a finding of proteinuria.
Relation of Survival Time and Urinary Protein Excretion in Cats with Renal Failure and/or Hypertension
The degree of proteinuria is predictive of the survival times in cats with CRF.
In addition to monitoring proteinuria and evaluating the response to therapy, the UPC ratio can be used to determine the approximate survival time of the cat. The higher the level of proteinuria, the shorter the survival time for a given feline patient.
Proteinuria and Renal Disease A roundtable discussion
This Roundtable is a discussion by the worlds leading experts on renal disease and practitioners discussing kidney disease and proteinuria.