Proteinuria

What is proteinuria?

Proteinuria (pro-tee-nyur-ee-uh) is a high level of protein in your urine (pee). This condition can be a sign of kidney damage.

Proteins have many important functions, including:

• Building muscles and bones.
• Regulating the amount of fluid in your blood.
• Fighting off infection.
• Repairing damaged tissues.

Proteins should remain in your blood. If proteins enter your pee, they ultimately leave your body, which can harm your overall health.

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 (CKD), 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 (hypertension) pressure can damage your kidneys. They’re the two most common causes of kidney disease.

Who does proteinuria affect?

Anyone can get proteinuria. However, you may be more likely to get proteinuria if you:

• Are 65 years old or older.
• Have a family member who has or had kidney disease.
• Have diabetes or another condition that affects your kidneys.
• Are Black, Hispanic, Native American or Pacific Islander.

How common is proteinuria?

Proteinuria is relatively common. About 6.7% of the United States population has proteinuria.

What happens if you have proteinuria?

Protein gets into your pee if your kidneys aren’t working correctly.

Glomeruli (glo-mare-yoo-lye) are groups of tiny blood vessels in your kidneys. They perform the first stage of filtering waste products and excess water from your blood. The waste products and excess water leave your body through your pee. Glomeruli don’t allow passage of larger proteins or blood cells into your pee. If smaller proteins sneak through your glomeruli, then long, thin tubes in your kidneys (tubules) recover the proteins and keep them in your body.

Proteins may flow into your pee if there’s:

• Damage to your glomeruli or tubules.
• A problem with the reabsorption process of the proteins.

What are the signs and symptoms of proteinuria?

You may not have any symptoms in the early stages of proteinuria. In advanced stages of proteinuria, symptoms may include:

• Swelling (edema) in your face, belly, feet or ankles.
• More frequent urination.
• Shortness of breath.
• Tiredness.
• Nausea and vomiting.
• Lack of appetite.
• Muscle cramping at night.
• Puffiness around your eyes, especially in the morning.
• Foamy or bubbly urine.

These symptoms are also symptoms of chronic kidney disease. If you have these symptoms — especially foamy pee and swelling — you should contact your healthcare provider immediately.

What causes proteinuria?

In many cases, relatively benign (noncancerous) or temporary medical conditions cause proteinuria. These conditions may include:

• Dehydration.
• Inflammation.
• Low blood pressure (hypotension).
• Kidney stones.

Intense exercise, stress, taking aspirin every day (aspirin therapy) and exposure to cold temperatures can also trigger proteinuria.

More serious medical conditions can also damage your kidneys and cause proteinuria. These conditions may include:

• Certain immune disorders, including lupus and Goodpasture’s syndrome.
• Acute kidney inflammation (glomerulonephritis).
• Plasma cell cancer (multiple myeloma).
• The destruction of red blood cells, which causes hemoglobin to release into your bloodstream (intravascular hemolysis).
• Cardiovascular disease.
• The simultaneous development of proteinuria and hypertension in a pregnant person (preeclampsia).
• Poisoning.
• Trauma.
• Kidney cancer.
• Congestive heart failure.

What level of proteinuria is concerning?

A normal amount of protein in your pee is less than 150 milligrams per day. If you have more than 150 milligrams of protein in your pee per day, you have proteinuria. The upper limit of normal can vary a bit between laboratories.

If you have 3 to 3.5 grams of protein in your pee per day, you have nephrotic-range proteinuria. Nephrotic syndrome is a relatively rare condition that causes your kidneys to release an excessive amount of protein in your pee.

Is proteinuria contagious?

No, proteinuria isn’t contagious. However, you may be more likely to have proteinuria if other members of your biological family have it.

How is proteinuria diagnosed?

Your healthcare provider will use a dipstick test to help diagnose proteinuria. During a dipstick test, you’ll pee into a special container at your healthcare provider’s office or a hospital. Then, your healthcare provider will place a thin plastic stick coated with special chemicals (dipstick) into the container. If too much of a protein is in your pee, the dipstick changes color.

Your healthcare provider will conduct a urinalysis (urine test) on the rest of your pee. A urinalysis examines your pee’s visual, chemical and microscopic aspects under a microscope. Your healthcare provider looks for substances that don’t belong in your pee. These substances may include red blood cells, white blood cells, bacteria and salt or protein crystals that can develop into kidney stones.

What happens when kidney disease or another condition is suspected?

If your healthcare provider suspects you have kidney disease, you’ll 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 (long-lasting) 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:

• Creatinine clearance test. Creatinine is a chemical waste product. A creatinine clearance test examines the amount of creatinine in your pee and blood. If your kidneys are healthy, they move creatinine from your blood to your pee. If your kidneys aren’t working correctly, creatinine remains in your blood.
• Glomerular filtration rate (GFR) blood test. The GFR compares your size, age, biological sex (assigned sex) and race to levels of creatinine and the protein albumin in your blood. The GFR tells your healthcare provider how well your kidneys are working and how far your kidney disease has advanced. This information helps your healthcare provider develop the best treatment plan.
• Blood tests to measure all proteins in the serum. The serum is the part of your blood that contains proteins.
• Imaging tests. Imaging tests, including CT scans and ultrasounds, help your healthcare providers identify problems like kidney stones, tumors or obstructions in your urinary tract.
• Urine protein electrophoresis (UPEP). A UPEP helps your healthcare provider search for specific types of proteins. Your healthcare provider will send your urine sample to a lab. A lab technician will apply an electric current to your urine sample, which helps reveal the amounts of proteins in your pee.
• Immunofixation blood test (IFE). Your healthcare provider will use a small needle and tube to take a blood sample from a vein in your arm or hand. They’ll send your blood sample to a lab and check for specific proteins in your blood.
• Kidney biopsy. Your healthcare provider will remove a tiny piece of your kidney. They’ll send the kidney sample to a lab. A lab technician will examine your kidney sample under a microscope to determine what caused your kidney disease and the extent of the damage.

How do you treat proteinuria?

Proteinuria treatment depends on its cause. Each cause requires different treatments.

If kidney disease causes proteinuria, your treatment plan may include medication, diet changes and exercise. Your healthcare provider may prescribe blood pressure medication if you have high blood pressure. If you have low blood pressure, you should schedule annual urine tests and blood pressure checks.

If you have diabetes, you may need to manage your blood sugar. You should also receive GFR blood tests every year.

Pregnant people with a history of preeclampsia should schedule regular checkups with their healthcare provider. Though preeclampsia is a serious condition, it typically goes away days to weeks after your baby is born.

If you have proteinuria but don’t have diabetes, high blood pressure or any other medical condition, your healthcare provider may prescribe blood pressure medication to help prevent kidney damage. It’s a good idea to have your blood pressure checked and urine tested every six months to ensure you don’t have kidney disease.

If you have mild or temporary proteinuria, you may not need treatment.

Can drinking water reduce protein in urine?

No, drinking more water won’t treat proteinuria. Drinking more water will make you pee more, so there may be less protein every time you pee, but it won’t stop your kidneys from leaking protein.

How do I take care of myself?

The best way to take care of yourself is to take your medications as prescribed by your healthcare provider.

Other ways to help take care of yourself include:

• Eating less protein.
• Limiting your salt intake, which can lower your blood pressure.
• Eating more fiber, which can help reduce cholesterol and regulate blood sugar.
• Exercising or moving regularly. Aim for at least two hours of activity every week.
• Regularly checking your blood sugar.
• Quitting smoking and tobacco use.
• Avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) unless recommended by your healthcare provider. The most common NSAIDs include aspirin (Bayer®), ibuprofen (Advil®) and naproxen (Aleve®).

How can I prevent proteinuria?

You can’t prevent proteinuria. However, you can manage it. Many conditions that cause proteinuria are treatable with medications and lifestyle changes.

What can I expect if I have proteinuria?

With proper diagnosis and treatment, the outlook for people with proteinuria is good.

Without treatment, proteinuria may cause death. Studies suggest that people who don’t have proteinuria have a longer life expectancy than people with heavy or even mild proteinuria.

When should I see my healthcare provider?

Contact your healthcare provider if:

• You pee more frequently than you usually do, or it hurts to pee.
• Your pee is foamy or bubbly.
• You feel nauseous or vomit.
• You feel dizzy, weak or lightheaded.
• You have any swelling or puffiness around your face, abdomen or lower body.
• Your symptoms don’t improve after treatment.

What questions should I ask my healthcare provider?

• How do you know I have proteinuria?
• What condition caused me to develop proteinuria?
• What tests do you recommend?
• Do I have mild or temporary proteinuria?
• What medications or treatments do you recommend?
• Should I make any changes to my diet or lifestyle?
• If I don’t have proteinuria, what other condition might I have?

What is the difference between proteinuria and orthostatic proteinuria?

Orthostatic proteinuria (postural proteinuria) is a condition in which there is a high amount of protein in your urine when you pee standing up but a normal amount of protein in your urine when you pee while lying on your back (supine).

What is the difference between proteinuria and transient proteinuria?

Transient proteinuria is temporary. Causes typically include intense exercise, stress, fever and prolonged exposure to cold temperatures. Transient proteinuria usually goes away on its own.

A note from Cleveland Clinic

Proteinuria is high levels of protein in your pee. If you have proteinuria, you may have to pee more often, and your pee may be foamy or bubbly. You may have general feelings of illness, including nausea, vomiting, tiredness and swelling. If you have any of these symptoms for more than a few days, it’s a good idea to reach out to your healthcare provider. They can help you diagnose a condition that’s causing your proteinuria and prescribe treatments that help keep your kidneys healthy.