A large amount of protein in the urine, also known as “proteinuria”, is a finding that can appear when you take a urinalysis. Strictly speaking, proteinuria doesn’t actually do anything—peeing out extra proteins on its own will not harm you. The problem is that your kidneys don’t normally allow much protein to get filtered into the urine. Raised levels, therefore, can be indicators that something is going wrong. Since we as a species enjoy our kidneys and the ability to pee, this can be cause for concern. Understanding the significance of proteinuria, therefore, requires knowing a bit about what can trigger it in the first place.
Symptoms of Protein in Urine
Proteinuria does not have many symptoms, and in the early stages you might experience none at all. As the amount of protein being excreted rises, however, your urine can begin to appear excessively foamy in the toilet. The reduced level of proteins in the body can also affect how water is retained and may result in edema (swelling) of the hands, feet, abdomen, and/or face. Any other symptoms that may develop alongside proteinuria will depend on the underlying cause.
Incidentally, there is a variant to proteinuria known as “orthostatic proteinuria”, which is when the protein in the urine only goes when you are standing. This distinction can sometimes matter when it comes to narrowing down a final diagnosis.
What Causes Protein in Urine?
Before we go on to the actual reasons why proteinuria can be a concern, it’s worth pointing out that protein in the urine can have causes that are unrelated to major health problems. Relatively benign reasons for proteinuria include:
Prolonged exposure to hot or cold temperatures
Heightened emotional stress
Heightened periods of physical stress (exercise, etc.)
Therefore, proteinuria in and of itself is not an indicator of much. It takes looking at the protein levels alongside other symptoms and signs for your doctor to make their diagnoses. Three of the more common causes of proteinuria are outlined below.
This is a type of urinary tract infection that arises when bacteria travel from the bladder or urethra into the kidneys. In addition to proteinuria, a kidney infection can cause fever, back/flank/groin/abdominal pain, frequent urination, a persistent urge to urinate even if nothing or very little comes out, foul-smelling and/or cloudy urine, hematuria (blood in urine), and a burning sensation when you pee. Kidney infections should be brought to a doctor’s attention and treated properly and promptly, since letting them linger can give the infection time to advance and cause long-term damage.
Preeclampsia is a condition that can develop during pregnancy and is potentially life threatening to both the mother and fetus. The cause isn’t really known, but preeclampsia is considered a type of blood pressure disorder. Not surprisingly, high blood pressure is one of the first symptoms of preeclampsia that appear. It can come on slowly but more often it will rise quickly within a short period of time. Alongside proteinuria, preeclampsia has symptoms such as changes in vision, nausea/vomiting, reduced urine output, abdominal pain (usually under right-side ribs), severe headaches, seizures, and shortness of breath. Although regular prenatal visits are useful for tracking the progress of blood pressure changes and can catch preeclampsia, pregnant women should be mindful of the other symptoms and seek emergency medical care if they begin to develop other indicators.
Chronic kidney disease (CKD) is when kidney function becomes damaged and weakens over time. The most common causes of CKD are diabetes, hypertension, or inflammatory diseases. Protein in urine is a symptom of kidney disease, specifically the protein albumin. CKD progresses slowly and most symptoms don’t become fully apparent until it has reached a more advanced stage of deterioration. Proteinuria, therefore, is an important indicator that can be seen before other symptoms, particularly in diabetics. As CKD develops, it can also cause nausea/vomiting, fatigue/weakness, lower mental acuity, muscle twitches or cramps, persistent itching, edema, changes in urinary patterns (volume, frequency, etc.), and chest pain.
Protein in the urine can be caused by any condition which could affect the kidneys. The full list can include things like rheumatoid arthritis, malaria, heart disease or failure, various types of cancer, and sickle cell anemia.
Treatment for Protein in the Urine
Proteinuria is a symptom, not a condition. Therefore any cure requires resolving whatever is stressing the kidneys in the first place. Since there are a wide number of potential causes, each with different treatment options, this section will focus on the more common tools that get employed.
- Blood Pressure Medication
If the cause of your proteinuria is related to blood pressure (hypertension, diabetes, heart condition, etc.), then medication may be used to keep levels under control. Two specific blood pressure medicines, ACE inhibitors and ARBs, are known to be better at both protecting the kidneys and controlling blood pressure, so these are more likely to be used if kidney damage is suspected.
As mentioned earlier, inflammatory conditions like lupus or rheumatoid arthritis can damage the kidneys. Anti-inflammatory drugs would be prescribed in these cases to help limit the damage to your body.
The only way to cure preeclampsia is delivery of the baby. Unfortunately, since preeclampsia can start as early as 20 weeks, this may not be an immediately viable option. Until the delivery happens, a combination of rest, steroids (helps liver function), blood pressure medication, anticonvulsants (due to seizure risk), and careful monitoring will be used.
- Glucose Control
Protein in the urine is an early sign of kidney damage in diabetics. Once found, you and your doctor may go over methods of better controlling your blood sugar. Whether this results in a change of medication or lifestyle/dietary adjustments will depend on individual cases.
The key thing to remember about proteinuria is that it is usually only a concern if it is persistent, very high, or is accompanied by other symptoms. Short-lived or low-to-moderate increases without any other problems can resolve on their own without need for any intervention.
When to See Your Doctor
Proteinuria is only detectable with a urinalysis, so unless you are doing some very weird back alley stuff, you will already be seeing your doctor when the protein levels are discovered.