Advice From Patients And Professionals
Elle Lee, LCSW began her career as a licensed therapist after experiencing kidney failure from IgA Nephropathy in 2009. While on peritoneal dialysis, she experienced worries, stress, and emotional struggles that are common among people with kidney failure, which motivated her to become a therapist to help people cope better.
Elle joins AKF to share tips on how people living with kidney disease can better safeguard their mental health.
What Are The Symptoms Of Nephrotic Syndrome
You may not know that you have nephrotic syndrome until you have routine blood and urine testsat a doctor’s appointment. The results of your tests can show that you have too much protein in your urine, not enough protein in your blood, or too much fat or cholesterol in your blood.Signs of nephrotic syndrome that you may notice are:
- Swelling in your legs, feet, ankles and sometimes face and hands
- Not feeling hungry
Why Protein Can Be Present In Urine
A positive result of protein in urine may be a sign of renal disease, although it may be also due to a transient condition, such as strenuous exercise or dehydration.
Normal urine has very little protein present. The proteins founds consist primarily of low-molecular weight serum proteins that have been filtered by the kidney and proteins produced in the genitourinary tract.
The most common type of protein present in the urine is albumin due to its low molecular weight. However, its presence is usually low because the majority of albumin that reach the kidneys is not filtered and much of the filtered albumin is usually reabsorbed by the renal tubules.
Other proteins that may be present in the urine are:
- Proteins from prostatic, seminal, and vaginal secretions
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Detecting And Quantifying Proteinuria
The results are graded as negative , trace , 1+ , 2+ , 3+ or 4+ . This method preferentially detects albumin and is less sensitive to globulins or parts of globulins .12
The sulfosalicylic acid turbidity test qualitatively screens for proteinuria. The advantage of this easily performed test is its greater sensitivity for proteins such as Bence Jones. The SSA method requires a few milliliters of freshly voided, centrifuged urine. An equal amount of 3 percent SSA is added to that specimen. Turbidity will result from protein concentrations as low as 4 mg per dL . False-positive results can occur when a patient is taking penicillin or sulfonamides and within three days after the administration of radiographic dyes. A false-negative result occurs with highly buffered alkaline urine or a dilute specimen.
What Happens During A Protein In Urine Test
You will need to give a urine sample for the test. A health care professional may give you a cleansing wipe, a small container, and instructions for how to use the “clean catch” method to collect your urine sample. It’s important to follow these instructions so that germs from your skin don’t get into the sample:
If you have hemorrhoids that bleed or are having your menstrual period, tell your provider before your test.
In certain cases, your provider may ask you to collect all of your urine during a 24-hour period. A “24-hour urine sample test” may provide more complete results, because the amount of protein and other substances in urine can vary throughout the day.
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What Happens When Kidney Disease Or Another Condition Is Suspected
If your healthcare provider suspects you have kidney disease, youll repeat a urine test three times over three months. If your urine samples test positive for the presence of proteins each time, you likely have a chronic disease. The earlier the diagnosis, the greater the chance your healthcare providers can slow kidney disease and stop it from progressing.
Additional tests may include:
If I Have Albuminuria Does It Mean I Have Kidney Disease
It may be an early sign of kidney disease, but your doctor will check you again to make sure albuminuria is not caused by something else, like not drinking enough water. If your doctor suspects that you have kidney disease, the test for albumin will be repeated. Three positive results over three months or more is a sign of kidney disease.
You will also be given a simple blood test to estimate GFR. GFR stands for glomerular filtration rate. Your GFR number helps determine how well your kidneys are working.
You may also be given:
-
Imaging tests. . This produces a picture of your kidneys and urinary tract. It can show whether your kidneys have kidney stones or other problems.
-
A kidney biopsy. This can help find out what caused your kidney disease and how much damage to the kidneys has happened.
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Which Circumstances May Interfere With The Results
The protein urine test may cause false-positive readings in case of:
- Highly pigmented urine
- Contamination of the sample with detergents
- Contamination of the sample with antiseptics
- High specific gravity
The protein urine test may cause false-negative readings in case of a high presence of proteins different of albumin, as previously mentioned, or in case of microalbuminuria.
Medically reviewed by our Medical staff on 30-11-2021
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What If My Kidneys Fail
If your kidneys stop working because of nephrotic syndrome, you will need dialysis or a kidney transplant to live. If you are interested in getting a transplant, you must have a full health evaluation by a transplant team at a transplant center. The evaluation will help the transplant team decide if you are ready for the kidney transplant. If the transplant team decides you are ready, the next step will be for your transplant team to help you find a kidney match.
What Does A Positive Result Mean
When protein in urine is above 30 mg/dL the test is considered positive.
Some dipsticks or labs report the trace readings in terms of negative, 1+, 2+, 3+, and 4+ or the semiquantitative values of 30, 100, 300, or 2000 mg/dL corresponding to each color change. The interpretation of trace readings can be difficult sometimes. To sum it up:
- + corresponds to more than 30 mg/dl
- ++ corresponds to more than 100 mg/dl
- +++ corresponds to more than 300 mg/dl
- ++++ corresponds to more than 2000 mg/dl
A positive result for protein in a routine analysis does not always indicate kidney damage. The positive require additional testing to determine whether the protein represents a normal or a pathologic condition. Benign proteinuria is usually transient and can be produced by conditions such as:
- Strenuous exercise
- Orthostatic or postural proteinuria
When the positive in the protein urine test is due to a pathologic condition, the main causes are:
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Talk To Your Social Worker
Social workers can provide strategies to help you manage the challenges you are facing in your life. If your dialysis clinic has a social worker, they are the person you can turn to when you are struggling with mental health. Social workers are trained to connect you with the proper resources in your area. They are there to help you. Social workers also help communicate your mental health needs with your doctor.
How Do Doctors Test For Nephrotic Syndrome
Healthy kidneys remove extra fluid and waste from your blood but let proteins and other important nutrients pass through and return to your blood stream. The only way to know how well your kidneys are working is to get tested. Tests doctors use for kidneys are:
To be sure you do not have a problem with your kidneys, you should have both a urine test and a blood test. Having a urine and a blood test is important because you could have normal blood test results but still have too much protein in your urine. Protein in your urine could mean you have kidney disease.
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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:
How Is Nephrotic Syndrome Treated
There is no cure for nephrotic syndrome, but your doctor might tell you to take certain medicines to treat the symptoms and to keep the damage to your kidneys from getting worse. Talk with your doctor or a member of your dialysis care team about your medication options. They may prescribe:
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Urine Protein Spot Test For Urine Protein Microalbuminuria
- A random urine sample can be used.
Indications
Pathophysiology
Types of proteinuria
Kidney role in the urine protein excretion
How Is The Test Performed
This test is performed along with other urine tests. The patient must collect a sample of the urine in a specific container using a special kit. This sample will be sent to the lab for the analysis.
Protein in urine is usually tested either with a dipstick or with a tablet that change of color in the presence of a high amount of protein in the urine.
In laboratories, there are automated machines that perform the analysis, but it is also possible to buy strips that let you analyze a urine sample at home. They comprise up to 10 or more different reagents or chemical pads to perform different urine tests at the same time.
Most dipsticks detect only the presence of albumin. For most screening purposes, the dipstick method is adequate. However, this method does not detect the presence of abnormal proteins such as the globulins and the Bence Jones protein of myelomas. For this matter, it is necessary to use other testing methods to detect their presence, such as the sulfosalicylic acid precipitation test or the 24-hour urine collection.
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Is Protein In Urine Serious
Yes, protein in your urine is serious. Proteinuria may increase your risk of death from heart disease and cardiovascular disease.
Occasionally, proteinuria is an early sign of chronic kidney disease , although you can have CKD and have normal levels of protein in your urine. CKD is a gradual loss of your kidney functions, which may eventually require a kidney replacement therapy, dialysis or kidney transplant. Diabetes and high blood pressure pressure can damage your kidneys. Theyre the two most common causes of kidney disease.
Why You Should Get Help For Mental Health
When you are having trouble coping with difficult situations, you may not seek help. Why is this? If you are physically injured, you will see a doctor for help. But why is it difficult to seek help from a professional when you are having trouble with your mental health?Attitudes and beliefs about mental health differ across cultures. Some of these attitudes and beliefs can be negative and lead to stigma. Stigma is when a person is labeled by their illness and are no longer seen as an individual but as part of a stereotyped group. Negative attitudes and beliefs toward this group create prejudice. This may lead to negative actions and discrimination.Stigma around mental health can make you feel bad about yourself and prevent you from getting the help you need to feel better. Here are some common reasons you may not ask for help when you are struggling with your mental health:
- It is hard to admit you cannot handle this on your own
- You think you are being a bother
- You feel weak and that you should be able to “tough it out”
- You believe the problem will eventually just go away on its own
- You believe this is just the way it is and there is nothing that can be done about it
- You believe mental health professionals are for “crazy” people
- You do not realize you are having a problem
- You do not know where to go for help
- Getting help from a professional costs too much
- No transportation to get to appointments
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How Can I Prevent Diabetes From Causing Kidney Disease
Work with your doctor to create a plan to prevent or slow damage to your kidneys. Even if your kidneys are already damaged, you can slow the damage from getting worse. Your plan may include to:
- Work with your doctor to control your blood sugar. Tell your doctor if your blood sugar is often too high or too low.
- Work with your doctor to control your blood pressure. Having both diabetes and high blood pressure can make you more likely to get kidney disease.
- Work with your doctor to manage your cholesterol. Cholesterol is a waxy, fat-like substance in your blood. Having both diabetes and high cholesterol can make you more likely to get kidney disease. High cholesterol can also make your diabetic kidney disease get worse faster. Ask your doctor what your cholesterol level should be and how you can control it.
- Take all of your prescription medicines as your doctor tells you.
- Meet with a diabetes educator or dietitian to help you create and follow an eating plan.
- Quit smoking or using tobacco.
- Be active at least 30 minutes a day on most days of the week. Being active helps your body use insulin better.
- Stay at a healthy weight. Ask your doctor what a healthy weight is for you.
Persistent Asymptomatic Isolated Proteinuria
PAIP is said to be present when proteinuria is present persistently , including in recumbent specimens in an otherwise healthy child in whom clinical and laboratory work-up is normal. Renal biopsy studies in some children with PAIP have revealed glomerular abnormalities including focal sclerosis, immunoglobulin A nephropathy, membranous nephropathy, and diffuse mesangial proliferation. There is also a concern that unremitting proteinuria itself can cause focal sclerosis. Hence this entity is viewed with caution and deserves close follow-up. The proteinuria should be quantified if possible and monitored every 6 to 12 months. A progressive increase in proteinuria beyond 1 g/day warrants a renal biopsy. However, the yield of a renal biopsy is poor in the presence of mild-moderate proteinuria .
Robert M. Kliegman MD, inNelson Textbook of Pediatrics, 2020
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Questions To Ask Your Doctor
If you find out you have nephrotic syndrome, talk with your doctor about the cause of your symptoms and what treatment is best for you. Here are some questions you may want to ask: