March 31 Revised Paraphrased

LPU St. Cabrini College of Allied Medicine, Inc.
BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY
CHAPTER 1
INTRODUCTION
Standing is a natural human posture and poses no particular health hazard.
However, working in a standing position on a long period of time can cause
swelling of the legs, varicose veins and general muscular fatigue and other types of
uneasiness which may lead to proteinuria, specifically called as Orthostatic
(Postural) Proteinuria.
Orthostatic proteinuria is a condition where an individual excretes abnormally high
amount of protein in the urine. It is commonly found in individuals whose jobs
require a prolonged standing, such as sales people. It is undeniable that they were
the ones who normally acquire the said condition because they have less chance to
move around and sit in their workplace. The fewer body positions to choose from,
the lesser the chances to rest working muscles.
Orthostatic proteinuria is known as non-pathologic and is not associated
with other urine abnormalities.It is use the term "condition" rather than "disease"
because orthostatic proteinuria carries with it a benign prognosis with no danger of
worsening renal function.
According to Edgar V Lerma, MD., 2016, orthostatic proteinuria refers to
the development of increased risk of having protein in urine that develops only
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when the person is in upright position. It typically resolves over time yet it may
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possibly progress into a serious complication. Total urinary protein excretion may
increase but levels above 1g per 24 hours are more likely to be associated with
underlying renal disease.
At this point in time, majority of the fish vendors often tend to ignore this
condition. Aside from prolonged standing, orthostatic proteinuria occurs because of
other factors like emotional stress and dehydration. When we keep our body in an
upright position, it requires us a considerable muscular effort that is obviously
unhealthy and due to this fact, that it has no accurate figures on the prevalence but
only a rough estimate from direct evidence, we have decided to conduct a study of
determining the number of cases of fish vendors who are constantly experiencing
postural proteinemia to be able to know if their physical activity specifically
prolonged standing as a fish vendors may lead to serious renal complication.
REVIEW OF RELATED LITERATURE
In previous years, proteinuria has been given much consideration,
especially on its pathologic importance with regards to renal illnesses including its
movement, and for proteinuria as a marker of optional harms of other causative
maladies, for example, arteriosclerosis or diabetes. Moreover, protein misfortune
itself may show that there is harm to the glomeruli and tubules of the kidneys
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which may eventually cause inconvenience of renal capacity. In any case,

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proteinuria is not generally a harbinger of renal harm and loss of renal capacity.
The case demonstrates that secluded proteinuria without renal illness or renal harm
may happen and may have a guiltless inception. (de Joode, A.A.E., 2011)
More so, according to de Joode, A.A.E., 2011, Orthostatic proteinuria is
said to be the most well-known reason for protein misfortune in 60 % of kids and
75% of teenagers however its event diminishes amid maturing and is said to be
uncommon in grown-ups more than 30 years old. While this type of proteinuria has
been known for a drawn out stretch of time and has been portrayed in numerous
course readings, the pathophysiology may in any case not be finished or maybe
misjudged. There are a few classifications that might be in charge of the
improvement of proteinuria, incorporating changes in the glomerular permeability
or insufficient tubular dysfunction, yet lasting renal damage is not really the reason
for proteinuria to happen.
For advance testing of positive result of protein in urine, sulfosalicylic acid
(SSA) test is performed by mixing one part of urine supernatant (eg, 2.5 mL) with
three parts of 3% sulfosalicylic acid, and grading the resultant turbidity according
to the following method (the numbers in parentheses represent the approximate
protein concentration) [3]: 0 = no turbidity (0 mg/dL) trace = slight turbidity (1 to
10 mg/dL) 1+ = turbidity through which print can be read (15 to 30 mg/dL) 2+ =

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white cloud without precipitate through which heavy black lines on a white
background can be seen (40 to 100 mg/dL) 3+ = white cloud with fine precipitate
through which heavy black lines cannot be seen (150 to 350 mg/dL) 4+ =
flocculent precipitate (>500 mg/dL). (Theodore W Post, MD, Burton D Rose, MD,
2000)
The standard test for protein in urine is using reagent strip which measures
a protein called albumin. There is a condition called orthostatic proteinuria, which
typically involves people less than 30 years of age. People who have this condition
only leak protein into the urine that is produced when they are upright but when
they lie down, the protein stops appearing in the urine. It could be that the
foaminess is the result of urine that has been sitting in your bladder, but was
actually produced by your kidneys during the day. The second problem - getting up
at night - may be due to a physiological inability to "close down" your kidneys at
night. There are some people who lack the natural biochemical rhythm which tells
the kidneys to produce more urine during the day than at night. I doubt that either
the foamy urine or the nocturia represent kidney or bladder disease. (Dr. Fred
Kavalier, November 2005)
A previous study has shown that there are imaging studies that are able to
show an entrapment of the left renal vein in between the aorta and proximal
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superior mesenteric artery in cases of isolated orthostatic or postural proteinuria.

Because of this, it is assumed that a partial obstruction to the flow in the left renal
vein in an upright position is a cause of the said type of proteinuria. A girl with
isolated postural proteinuria, the kidney ultrasonic imaging and the Doppler flow
scanning has shown a left renal wein entrapment. Seven years later,a new
evaluation was found to show a resolution of both postural proteinuria and left
renal vein entrapment. There was also a longitudinal observation that has provided
an/a important/ major additional support for entrapment of the left renal vein by the
aorta and superior mesenteric artery as a casue of an condition called isolated
postural protenuria. (Milani GP, Mazzoni MB, Burdick L., Bianchetti MG and
Fossali EF, 2010)
In addition to, Jyothsna Gattineni, 2012 said that transient proteinuria is
associated with fever, exercise, or stress and is not an indicative of underlying renal
disease. When the underlying predisposing condition resolves, the proteinuria
resolves. There is another condition of proteinuria occurring at irregular intervals
that causes concern for the parents and the pediatrician called orthostatic
proteinuria. Orthostatic proteinuria is common in older children and adolescents
with a prevalence of 25%. Orthostatic proteinuria is the most common cause of
proteinuria in 75% of adolescents. The etiology is assumed as changes in
glomerular hemodynamics due to postural changes, and rarely exceeds 1gm/day.

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The first step in patients who present with persistent proteinuria is to do a urine
protein creatinine ratio on a first morning urine specimen. Another option is to
collect a split 24hr urine collection based upon lying/supine position and upright
position and not on the time of day.
The occurence of proteinuria among children on a single random urinalysis
is typically between 5 to 15%. Majority of them is found to have a transient or
orthostatic proteinuria, secondary to fever, stress, dehydration or exercise, as
opposed to a more important finding of persistent non-orthostatic proteinuria.
There are precious studies that had estimated the prevalence of orthostatic
proteinuria in the generalized pediatric population which is around 6%. Recently, a
prospective cohort study of 91 patients in 6 to 18 years of age demonstrated a 20%
prevalence of orthostatic proteinuria. The total preotein excretion mean of those
individuals with orthostatic proteinuria in the said cohort was 170 mg/m2 / 24hours
and has a maximum mean of 341 mg/m2 /24hours [606mg/24hours]. An
approximate of 80% of patients with orthostatic proteinuria was males and those
who are over 10 years of age. Furthermore, the prevalence of orthostatic
proteinuria in the 91 patients mentioned earlier have an increased BMI or Body
mass index. (Sonderman, MD., 2014),
Individuals who are younger than 30 years of age that excrete less than 2
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grams of protein during the day and have a normal creatinine clearance are ought to
be tested for orthostatic or postural proteinuria. The said condition is benign and
occurs in about 3 to 5% of adolescents and young adults, which is characterized by
an increased protein excretion during on an upright position but a normal protein
excretion when an individual on a supine position. In the diagnosis of orthostatic
proteinuria, split urine samples are collected for comparison. First morning sample
must be discarded whereas a 16-hour daytime specimen is collected with patient
performing their daily routine activity. The collection is finished by voiding just
before bedtime. An 8-hour overnight specimen will then be collected. The
specimen obtained during the day usually has an increased protein concentration
while the specimen collected during nighttime has a normal concentration. Patients
who have a true glomerular disease have a decreased protein excretion while in a
supine position but will not return into a normal excretion of <50mg per 8 hours as
it will with orthostatic proteinuria.
Orthostatic proteinuria a benign condition that is associated with a normal renal
function after 20 to 50 years of follow-up. Blood pressure measurement and
urinalysis must be done annually for it is recommended to the patients involved in
the study. (Michael F. Carroll, M.D., & Jonathan L. Temte, M.D., PH.D., 2000)
Orthostatic proteinuria accounts for 60% of chilren and 75% of adolescents
and can also be detected in 2 to 5% of normal adolescents in a conducted study.

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The incidence showed a slow decrease during the seconde decade of life and is rare
in individuals over 30 years of age. The condition, Orthostatic Proteinuria is not
always the first symptom of a renal disease yet this condition was also documented
to resolve acute glomerulonephritis phases. Orthostatic Proteinuria is commonly
found in 20% of children in this studys cohort and is more common in boys who
are associated with the age >10 years and have a BMI of >85%. Children who are
experiencing orthostatic proteinuira have their first morning Upcr value in the
normal range, whereas their random daytime Upcr is increased. A diurnal
variability in urinary protein excretion is found to be exaggerated in individual with
Orthostatic Proteinuria. Upcr estimates a 25-hour TsTP. In the use of current
pediatric criteria, Orthostatic Proteinuria is very common, most especially in boys.
A normal first morning Upcr ratio is an indication of an elevated random urine
protein. (John Robert Brandt, Aaron Jacobs, Hengameh H. Raissy, Franceska
Marie Kelly, Amy Otten Staples, Ellen Kaufman, & Craig Stephen Wong, June
2010),
Multistiz dipsticks characteristics are suitable for the detection of albumin
present in the urine in Aboriginal and other groups of young individuals. More than
2/3 of children that can be detected in just a single test that will result to a transient
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rather than persistent albuminuria. The said dipsticks are particularly useful in
detecting persistent albuminuria in children. (Haysom, Leigh; Williams, Rita;
Hodson, Elisabeth; Lopez-Vargas, Pamela; Roy, L.; Lyle, David; Craig, Jonathan,
February 2009)
On the contrary, MO Oni, OO Oguntibeju, 2008, persistent characteristic of
the kidney performs active roles in the formation of urine and
is essential to correct health. Underneath an ordinary physiological situation, urine
is expected to be protein free. The manufacturing of protein loose urine
is completely executed by way of the nephrons. Nephrons are structured to carry
out an vital position of filtration and reabsorption. consequently, a
kidney dysfunction is related to faulty reabsorption mechanisms and indicates that
the nephrons are damaged. The presence of proteins in urine (proteinuria) is
a robust indicator of kidney sickness. The assessment of proteinuria is clinically
and diagnostically an essential index in
renal characteristic generally and especially that of nephrons. Proteinuria is
also giant in a few non-pathological cases consisting of pregnancy
and static proteinuria observed amongst military men. There are
various techniques used for the screening and detection of pathological and non-
pathological proteinuria; the ones methods have their unique benefit and demerits.
Researchers have made considerable contributions

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in improving the conventional techniques used inside the detection

and estimation of protein in urine.
The use of urine dipsticks for testing leukocytes is said to be a primary
means of screening otherwise healthy children for a serious renal condition is
considered to have a little value. Patients who have developed proteinuria, a
positive dipstick result for leukocytes is a simple way of determining more
prominent and non-infectious renal inflammation that may progress into a kidney
disease. This finding may serve as an early marker of severity of a renal
complication whether the primary process is glomerular or tubular. (Koss, Shira;
Perl, Ari; Wieder, Adinah; Frank, Rachel; Vento, Suzanne; Trachtman, Howard, et
al., April 2006),
According to Dr. Collin Tidy, February 2015, the condition called
Orthostatic Proteinuria is defined having a normal urinary protein excretion during
the night but has an increased secretion during the day and is also associated with
activity and an upright position. Total urinary protein excretion may be increased
but levels that are above 1 gram per 26 hours are more likely considered to be
associated with an underlying renal disease. There is no known exact cause of the
said condition. Orthostatic proteinuria is most common in children and young

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adults, most specially in males. There is a prevalence of 2 to 5% adolescents and is

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rare in those individuals who are older thant 30 years. The long term prognosis of
orthostatic proteinuria is excellent although most of the patients still continue to
have minor degreee of proteinuria for several decades, they do not acquire
hypertension or renal complication.
In contrary, Silvia German, RN said that transient proteinuria is the
impermanent excretion of protein which can be caused by strenuous exercise, a
high fever, exposure to cold, stress and other conditions. Pregnant women may also
excrete more protein in their urine. Transient proteinuria does not involve
primary kidney disease and requires no treatment. Orthostatic proteinuria suggests
an increased amount of protein is excreted when a person is in the upright position.
Its most often found in tall, thin adolescents and young adults less than 30 years of
age. The kidneys are usually healthy.
Proteinuria is a common laboratory finding in pediatric practice and can be
found incidentally in children at school screening tests and during evaluation for
other reasons. Usually only repeat urine testing is required to confirm transient
nature of this phenomena. However, a small subset of these children may have
persistent proteinuria but they are at highest risk for developing chronic kidney
disease. Aggressive diagnostic procedures are usually not necessary at the

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beginning unless there is nephrotic range proteinuria or other parameters

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suggesting severe renal disease. Orthostatic proteinuria is one of the most common
causes of proteinuria in children and has excellent diagnosis with spontaneous
resolution in most individuals. (Matja Kopa, MD, PhD, 2016)
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This study entail to confirm the presence of protein in urine before standing
at work and after prolonged standing which have a general objective that is to be
able to know the occurrence of orthostatic proteinuria among selected Fish
vendors at Tanauan Public Market. Specifically, it aimed to address the following
objectives:
General Objectives
1. To present the demographic profile of the respondents in terms of age and
gender.
2. To determine the hours of standing of each respondents.
3. To determine respondents urine properties in terms of protein content
when tested by Reagent strip and Sulfosalicylic Acid test.
4. To be able to know if there is a significant difference in their protein level
when grouped by:
4.1 Age
4.2 Gender
4.3 Hours of standing
5. To be able to determine if there is a significant relationship between the
protein content tested by Reagent Strip, Sulfosalicylic Acid test and their
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Hours of standing.
Conceptual Framework
This is the schematic framework of our study on how the procedure is done.
Dependent Variable
Independent Variable
Orthostatic Proteinuria
among Fish Vendors
Hours of standing (Positive reagent strip for
testing protein and SSA)
The Hours of standing is the independent variable which will be analyzed to
cause an effect to the following dependent variable: positivity in protein from the
urine sample of the respondents. The dependent variable which is the positivity of
protein using reagent strip and Sulfosalicylic Acid thus termed Orthostatic
Proteinuria is expected to exhibit change in the experiment due to the reaction of
the following independent variables.

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CHAPTER 2
MATERIALS AND METHODS
This chapter contains the research method used in the study, the research
design, sampling technique, the research instruments, the methods used and the
statistical treatment used in the analysis of data.
Research Design
The study that has been conducted has a descriptive and experimental
research design using positive and negative controls. Descriptive and experimental
method of research was the best method in the study for its purpose to investigate
possible cause-and-effect relationship of respondents level of protein in urine
before and after standing. Experimental scientific method was the most precise and
reliable way of obtaining data.
The researchers studied the rate of orthostatic proteinuria using urine
samples collected from selected fish vendors at Tanauan Public Market. The urine
samples after being subjected to physical examination were then observed for the
presence of protein to address the objectives of the study.
Research Locale
All experiments were carried out at the Lyceum of the Philippines

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University-Laguna laboratory. Urine samples were collected from selected fish

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vendors at Tanauan Public Market after securing those informed consents and
questionnaires.
Sources of Data
The study has two sources of data, namely; primary and secondary sources.
The primary sources of data are the experiments which include chemical test or the
use of reagent strips and Sulfosalicylic Acid Test, physical test or the direct
observation of urine.
The secondary sources of data include the information acquired from the
books and other researches done by investigators.
Respondents of the Study
The residents of the study were composed of thirty (30) respondents
comprised of 15 males and 15 females. The actual sample of the study was chosen
through a simple purposive sampling method by asking pre-qualifier questions;
whether they are not taking medications, do not have recent illness, do not have
menstruation (for females) at the time of collection, have not had strenuous
exercise thus they are included in the study. Our respondents were equally
distributed having same number of 15 males and 15 females.

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Instrumentation and Validation

Reagent strips used were stored in the original capped vial at room
temperature (below 85 degrees F/ 30 degrees C) and replaced cap immediately
after removing test strip. The researchers checked the expiration date and made
sure that it is not yet expired. The expiration date is on September 2017. The
microscope used is functional and is being used for the experiments of medical
technology students in the laboratory. The centrifuge we used is also functional,
calibrated and in good condition. We tested the rotation per minute (rpm) of the
centrifuge using the tachometer. The resulting rpm was 1500.
Collection of Samples
The researchers provided two sterile specimen bottles to the selected
respondents of the study. The respondents were then instructed to collect 40 mL of
urine before standing at work and another 40 mL after prolonged standing with a
minimum of 8 hours and maximum of 10 hours. This procedure is the most reliable
and attainable way to compare the results of the samples before and after work.
Researchers instructed the respondents not to adulterate or place water on
their urine samples. Midstream Clean Catch technique is used to avoid bacteria
from contaminating the urine specimen. The researchers transported the

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respondents urine to the laboratory in less than an hour. The respondents were
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purposively chosen and were asked if they have a history of kidney failure, as well
as the span of their standing hours.
Statistical Treatment
This study used statistical tools to interpret and analyze research data.
Kruskall-Wallis is used to determine significant difference in the protein level
when grouped by age. To determine significant difference in the protein level when
grouped by gender, Mann-whitney U test is used.
Research Methods
In chemical testing, the urine is mixed first in a circular motion three times
before analyzing it. Then the reagent strip is dipped in the urine and observed for
the possible reaction of the strip that will changed the color of the protein
parameter. Positive (+) reagent strip testing for Protein is measured and graded as
trace, 1+, 2+, 3+ or 4+. After reagent strip test, sulfosalicylic acid test was
performed by adding 3 mL of 3%. Sulfosalicylic Acid in 2 mL urine then observed
for its cloudiness. The Sulfosalicyclic Acid (SSA) reagent is used as a confirmation
of the initial test where urine reagent strip is utilized, if there is a presence of
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protein in urine.
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Standards:
Reagent strip:
Negative= -
Trace= +/-
Small= +
Moderate = ++
Large= +++
Sulfosalicylic Acid: Positive= Cloudiness
Negative= -
Trace= +/-
Small= +
Moderate = ++
Large= +++
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Representation Diagram of the Procedure
URINE
BEFORE AND
AFTER STANDING
URINE
CHEMICAL TEST CHEMICAL TEST
3%
REAGENT STRIP SULFOSALICYLIC
ACID TEST
(+) cloudiness=
(+) presence of PROTEIN (-) NORMAL
Presence of protein
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CHAPTER 3
RESULTS AND DISCUSSION
Table 1.Frequencies and Percent Distribution of the Respondents According

to Age
Age Frequency Percent
20-29 12 40%
30-39 6 20%
40-49 4 13.3%
50-59 8 26.7%
Total 30 100
Table 1.In the table presented above, results show that less than half of the
respondents are in the range of ages 20-29 years old which accounts for 12
respondents (40%), the second is in the range of ages 50-59 which accounts for 8
of the total respondents (26.7%) and lastly, the range of ages of 30-39 accounts for
20% of the respondents. The age group that has the least percentage is in the range
of ages of 40-49 which accounts for 13.3% of the total population. The percentage
of the age group that ranges from 50 to 59 have also shown to be the 2nd group
having the most number of respondents in the study.

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Table 2. Frequencies and Percent Distribution of the Respondents According

to Hours of standing
Hours of Trial 1 Trial 2 Trial 3 Total
standing
6 14 0 0 14
7 7 6 0 13
8 9 16 7 32
9 0 7 18 25
10 0 1 5 6
Total 30 30 30 90
Table 2 shows that during the first trial of the experiment, majority of the
respondents stand for 6 hours with a frequency of 14 and 7 has its minimum
frequency. In the second trial, most of the respondents have a frequency of 16
which have stand for 8 hours, 6 respondents have stand for 7 hours and 1
respondent has stand for 10 hours. In the third trial, most of the respondents with a
frequency of 18 have stand for 9 hours, 7 respondents for 8 hours and 5
respondents for 10 hours.
This supports Springberg PD, Garrett LE Jr, Thompson AL Jr, et al. that
Orthostatic proteinuria is diagnosed by obtaining a split urine collection. This
requires collecting two urine samples: one while you have been sitting and after
standing for several hours (usually during the day) which is done also in this study.
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In line with this, hours of standing and duration of time before the second
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collection is prolonged and have increased from 1st trial up to the 3rd trial of the
study for more positive results.
Table 3. Frequency of protein in urine before and after prolonged standing

using Reagent Strip
Trial 1 Trial 2 Trial 3 Total
BEFORE AFTER BEFORE AFTER BEFORE AFTER
POSITIVE 0 1 0 3 0 10 16
NEGATIVE 30 29 30 27 30 20
Total 30 30 30 30 30 30
Table 3 shows that in the first trial, only respondent Number 3 has a
positive result, having (1+) in reagent strip. In 2nd trial, 3 respondents had positive
results having (1+) result as well. In the last trial, 10 respondents had positive
result in terms of protein having (1+) in reagent strip based on standards. Therefore
it indicates that there are positive results after prolonged standing in all trials. There
is also a marked increase of respondents positivity for orthostatic proteinuria
during the 3rd trial of the study after prolonged standing compared to 1st and 2nd
trials because 3rd trial has the most number of hours standing. This explains that the
longer the hours of standing, the increased risk of developing presence of protein in
urine.
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This result supports the findings of Brad H Rovin, MD, 2000 that
orthostatic proteinuria occurs when one loses protein in the urine while in a
prolonged upright position same is through with respondents results with a
negative result before standing and positive result after standing.
Table 4. Sulfosalicylic Acit test result of urine before and after prolonged
standing
Trial 1 Trial 2 Trial 3 Total
BEFORE AFTER BEFORE AFTER BEFORE AFTER
POSITIVE 0 1 0 3 0 10 16
NEGATIVE 30 29 30 27 30 20
Total 30 30 30 30 30 30
Table 4 shows the Sulfosalicylic Acid Test results have confirmed the
results based on reagent strip test for protein shown in Table 4. In the first trial, no
one got positive result in protein before standing and only 1 respondent got positive
result having a grade of (1+) turbidity based on standards after prolonged standing.
In 2nd trial, 3 got positive results having a grade of (1+) turbidity after long hours of
standing. In the last trial, 10 respondents got positive result in terms of protein
having a grade of (1+) in terms of turbidity based on SSA standards. In all three
trials, no one got positive result in protein before standing thus proves orthostatic
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proteinuria which is positive only after prolonged standing not just in reagent strip
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but also in Sulfosalicylic Acid test.

This result also supports the findings of Jess Arnulfo Velsquez Penagos; John
Jairo Zuleta Tobn; Jos Duvn Lpez Jaramillo; Natalia Luca Gmez Marulanda;
Jder Gmez Gallego, 2011 that good sensitivity was demonstrated in a study
carried out in Africa with the sulfosalicylic acid test: it was able to detect 5 to 10
mg/dL of protein in urine that is can be use to confirm the results from the reagent
strip which is also utilized in this study after testing reagent strip that in result,
yield positive results.
Table 5. Significant difference of protein when grouped in terms of Age/

Gender/ Hours of standing
Protein After F Significance Interpretation
Age 1.755 0.083 Not significant
Gender 1.495 0.222 Not significant
Hours standing 6.682 0 Significant
*If p value is <0.00, then there is a significant different between before and after prolonged standing of respondents.
*If p value is >0.00, then there is no significant different between before and after prolonged standing of respondents.
In this table, study has been used Analysis of Variance (ANOVA) which is
a statistical method used to test differences between two or more means. Table 5
shows that there is no significant dofference when grouped by gender having (p

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value 0.222) and age having (p value 0.083) which supports the findings of Keita
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Uehara, Naoto Tominaga, and Yugo Shibagaki in 2014 that in adolescents, the
prevalence of orthostatic proteinuria is reported to be between 2 and 5% thus it is
an uncommon disorder in individuals over 30 years of age similar to the age of the
said respondents.
However, table 6 also demonstrates that there is a significant difference in
their protein level in terms of hours of standing considering p value of 0.00 as
significant after prolonged standing. When protein level is grouped by the hours
standing, absolute 0 values indicate a significant result of orthostatic proteinuria.
This result is supported by findings of Richard A. McPherson, MD, MSc and
Matthew R. Pincus, MD, PhD after 2 hours of at least minimum standing, urine
specimens are assessed for protein, and if the first is negative and the second is
positive which get more protein into urine while standing than while lying down
the patient may have postural proteinuria.
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Table 6. Pearson Correlation of Protein
Protein Sulfosalicylic Hours of

after after standing
Protein in Pearson Correlation 1 1.000** .311**
Reagent
strip
(after
standing)
Sig. (2-tailed) 0 0.003
Sulfosalicylic Pearson Correlation 1 .311**

acid test
(After
standing)
Sig. (2-tailed) 0.003
**Correlation is significant at the 0.01 level (2-tailed)
The Pearson correlation coefficient has been used to measure the strength
of the linear relationship between two variables such as the protein to hours of
standing. Table 6 shows that there is a significant relationship between the protein
in Reagent Strip and Sulfosalicylic Acid Test and the hours of standing. When
hours of standing are prolonged, there is an increase and positivity in the protein
level and the Sulfosalicylic acid Test.
This supports the findings of Michael F. Carroll, M.D., and Jonathan L.
Temte, M.D., PH.D, 2000 that dipstick analysis is used in most outpatient settings
to semi quantitatively measure the urine protein concentration and sulfosalicylic
acid (SSA) turbidity test which qualitatively screens proteinuria that results
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positive in orthostatic proteinuria which are the tests used in the study.
CHAPTER 4
CONCLUSIONS AND RECOMMENDATIONS
In this chapter, the researchers reflect on their results based on the trials
made. Conclusions are made based on the results they meet. Recommendations
written on this chapter will serve as an aid for the future researchers to improve the
study.
The conducted research study has shown the correct distribution of selected fish
vendors in terms of age which results less than half of the respondents are in the
bracket of middle aged fish vendors which account for twelve respondents or forty
percent of the total respondents. In terms of gender, study shows an equal
distribution of the respondents having fifty percent male and fifty percent female
respondents.
In terms of presence of protein content when tested by Reagent Strip and

Sulfosalicylic Acid, the urine samples before standing in were mostly negative.
After the respondents had stand for minimum hours of eight and maximum of ten
hours, samples without the presence of protein decreased while those with 1+ result
increased.
In terms of significant difference, study shows that there is no significant

difference in their protein level when grouped by age and gender. However, when
protein level is grouped by the hours standing, absolute 0 value indicates a
significant difference with protein level after prolonged standing.
Study has also proved that there is a significant relationship between the
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protein, SSA and the hours of standing. Therefore, researchers concluded that as
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hours of standing are prolonged, an increase number of respondents show positive

results in their protein level and sulfosalicylic acid test. This also attested that
Orthostatic proteinuria is characterized by elevated levels of urinary protein
excretion while in the upright position and normal when in the supine or recumbent
position, such as when not standing.
Recommendations
In analysis of the findings presented and the conclusions made, the

researchers recommend the following for future studies:
To still apply descriptive and experimental research and gather more

number of respondents to see if there will be a higher incidence of
orthostatic proteinuria cases.
To conduct an extensive study about orthostatic proteinuria and to consider
more of the possible factors that would really have an effect on
respondents orthostatic proteinuria cases.
Use other respondents such as sales personnel for further detection of

presence of protein in their urine caused by prolonged standing.
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References
American Association for Clinical Chemistry. 12 July 2009. Retrieved from
http://labtestsonline.org/understanding/analytes/urinalysis/sample.html
Abiodun Omoloja, M.D., Orthostatic Proteinuria. Retrieved from
http://www.childrensdayton.org/cms/resource_library/nephrology_files/81e
89724b8bfc15d/orhosthatic_prot.pdf
Brad H. Rovin, (2000) Patient education: Protein in the urine (proteinuria)
Retrieved from https://www.uptodate.com/contents/protein-in-the-urine-
proteinuria-beyond-the-basics
Brandt, John; Jacobs, Aaron; Raissy, Hengameh; Kelly, Franceska; Staples, Amy;
Kaufman, Ellen; Wong, Craig, June (2010). Orthostatic proteinuria and the
spectrum of diurnal variability of urinary protein excretion in healthy
children. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677044/
De Joode, A. A. E., & Sluiter, H. E. (2011). Orthostatic proteinuria: a harmless
variant of protein loss?, Netherlands Journal of Medicine, 69(2), 62-65.
Dr. Collin Tidy, February (2015). Orthostatic Proteinuria. Retrieved from
http://patient.info/doctor/orthostatic-proteinuria
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Dr. Fred Kavalier, November (2005). A Question Of Health. Retrieved from
http://www.independent.co.uk/life-style/health-and-families/health-news/a-
question-of-health-5349153.html
Haysom, Leigh; Williams, Rita; Hodson, Elisabeth; Lopez-Vargas, Pamela; Roy,
L.; Lyle, David; Craig, Jonathan, February (2009). Diagnostic accuracy of
urine dipsticks for detecting albuminuria in indigenous and non-indigenous
children in a community setting. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/18815816\
Jess Arnulfo Velsquez Penagos; John Jairo Zuleta Tobn; Jos Duvn Lpez
Jaramillo; Natalia Luca Gmez Marulanda; Jder Gmez Gallego (2011)
Use of sulfosalicylic acid in the detection of proteinuria and its application
to hypertensive problems in pregnancy. Retrieved from
http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0121-
07932011000300004
Jyothsna Gattineni (2012). Highlights for the Management of a Child with
Proteinuria and Hematuria International Journal of Pediatrics
Volume 2012 (2012), Article ID 768142. Retrieved from
https://www.hindawi.com/journals/ijpedi/2012/768142/
Keita Uehara, Naoto Tominaga, & Yugo Shibagaki (2014). Adult orthostatic
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proteinuria Retrieved from

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377758/
Koss, Shira; Perl, Ari; Wieder, Adinah; Frank, Rachel; Vento, Suzanne;
Trachtman, Howard, et al., April (2006). Proteinuria and renal disease:
prognostic value of urine dipstick testing for leukocytes. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/16508775
Matja Kopa, MD, PhD, (2016) Evaluation of Transient Proteinuria in Children.
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https://www.ghrnet.org/index.php/jnr/article/view/1711/2169
Milani GP, Mazzoni MB, Burdick L, Bianchetti MG, Fossali EF.
Am J Kidney Dis. 2010 Jun;55(6):e29-31. doi: 10.1053/j.ajkd.2010.03.004.
Epub 2010 Apr 28. Postural proteinuria associated with left renal vein
entrapment: a follow-up evaluation. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/20430499
McPherson, R. A., Pincus, M. R., & Henry, J. B. (2007). Henry's clinical
diagnosis and management by laboratory methods. Philadelphia: Saunders
Elsevier by 22nd ed., p.451-453
Michael F. Carroll, M.D., and Jonathan L. Temte, M.D., PH.D (2000). Proteinuria
in Adults: A Diagnostic Approach. Retrieved from
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MO Oni, OO Oguntibeju (2008). Clinical and diagnostic importance of
proteinuria: A review. Retrieved from
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Mohammed Al-Gayyar (2007/2008). Urine Analysis Diploma of biochemical
Analysis 2007/2008. http://www.slideshare.net/ehab10f/4-urine-analysis
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Education Team, https://www.davita.com/kidney-
disease/overview/assessing-your-risk/proteinuria/e/7463
Sonderman, David, "Orthostatic proteinuria" (2014). All. Paper 8. Retrieved from
http://digitalcommons.wustl.edu/kidneycentric_all/
Susan King Strasinger and Marjorie Di Lorenzo. Urinalysis and Other Body Fluids
by, 5th ed., p. 58
Theodore W Post, MD Burton D Rose, MD,. (2000). Urinalysis in the diagnosis of
renal disease. Retrieved March 22, 2016 from,
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Trinidad M. Tapia and Annabel Isaac-Quizon, (1990). The use of single urine
specimen for quantitation of proteinuria in children. Retrieved from
Walter LJM Devill et al; (2004) The urine dipstick test useful to rule out infections.
A meta-analysis of the accuracy.

33
Yugo Shibagaki, Keita Uehara, Naoto Tominaga (2014). Adult orthostatic

Page
proteinuria.
https://www.researchgate.net/publication/274727757_Adult_orthostatic_pr
oteinuria
34
Page
APPENDIX A
DEFINITION OF TERMS
Proteinuria is the presence of abnormal quantities of protein in the urine,

35
which may indicate damage to the kidneys.

Page
Orthostatic is relating to or caused by an upright posture

Protein is
any of numerous organic molecules constituting a large portion of the
mass of every life form
Urine is a liquid by-product of the body secreted by the kidneys
Posture is the position in which we hold our body upright against gravity
while standing, sitting or lying down
Non-pathological is does not involve or associated with a disease
Renal is relating to the kidneys
Supine (position) is lying face upward
Urine test strip (urine dipstick test) is a basic diagnostic tool used to
determine pathological changes in an individual's urine
36
Page
APPENDIX B
Letter of Permit to the Program Chair

and Laboratory Custodian for the Usage of
Intrumentation Room of Lyceum ST. Cabrini
College of Allied Medicine
37
Page
To Whom It May Concern:

Warm Greetings!
We are the third year medical technologist students of Lyceum of the
Philippines University-St. Cabrini who are presently conducting a study
entitled Incidence of Orthostatic Proteinuria among Fish vendors in
Tanauan Public Market, would like to ask to access the instrumentation
room during in order to perform the procedures in order for execution of our
study. Also, we would like to use the following instruments/machines and
facilities:
1. Centrifuge
2. Microscope
3. Refrigerator
4. Test tubes
In line with this we are requesting for the availability of the following
reagents to be used in our experiments:
1. Reagent strip
2. Sulfosalicylic Acid
Respectfully yours,
Manaig, Shaira Alheena Mikaili O.
Nuevo, Marianne Carmel
Zumarraga, Lauri Leigh Q.
38
Page
APPENDIX C
INFORMED CONSENT
39
Page
INFORMED CONSENT
TITLE OF THE STUDY: Incidence of Orthostatic Proteinuria among selected fish

vendors in Tanauan City Wet Market.
RESEARCHERS: Manaig, Shaira Alheena Mikaili; Nuevo, Marianne Carmel;

Zumarraga, Lauri Leigh
PURPOSE: You are being asked to take part in a research study. Before you
decide to participate in the study, it is important that you understand why the
research is being done and what it will involve. Please read the following
information carefully. Please ask the researcher if there is anything that is not
clear or if you need more information.
The purpose of the study is to determine if there is a high amount of protein levels
present in the urine which may result to a condition called Orthostatic Proteinuria
due to prolonged standing that the respondents are experiencing.
PROCEDURE: For this study, about 40mL of urine samples will be collected. The
researchers will provide a sterile specimen container to selected respondents. The
said respondents will be asked to place their urine to the given container. Also,
they will be asked not to adulterate/contaminate their urine sample with water, for
this will affect the specimens integrity and could give a false positive or false
negative result.
CONFIDENTIALITY: Data or results collected during this study will be

confidential, except as may be required by law and any publication resulting from
the research will not personally identify the selected respondents.
By signing below, you consent to participate in the procedure described above.
______________________ _____________________
Signature over Printed Name Date
40
Page
APPENDIX D
INTERVIEW QUESTIONS
Dear Respondents,
We are conducting a research study about Incidence of Orthostatic

41
Proteinuria among Fish vendors at Tanauan Public Market as a requirement for

Research. In line with this, we genuinely ask you to answer this survey to gather
Page
the data we need. Your truthful response would surely be a big help to draw proper
conclusion and recommendation on the study. Thank you and Good day!
The
Researc
hers,
Manaiag, Shaira Alheena Mikaili

Nuevo, Mariane Carmel
Zumaraga, Lauri Leigh
Name:
Age:
Gender: _____M
______F
No. of Hours standing:
Had recent illness: ____UTI ______Diabetes ____kidney Disorder
Medications:
Had strenuous exercise: _______ YES ______ NO
Menstruation (for girls): _______YES _______NO

42
Page
APPENDIX E
MATERIALS AND PROCEDURES
43
Page
44
Page
45
Page
CURRICULUM VITAE
46
Page
FULL NAME:Shaira Alheena Mikaili O. Manaig
ADDRESS:#137 Brgy. Lawa Calamba City Laguna
EMAIL ADDRESS: so.manaig@yahoo.com
CONTACT NUMBER: 0917-392-2043
EDUCATIONAL ATTAINMENT:
TERTIARY LEVEL: Bachelor of Science in Medical Technology

Lyceum of the Philippines University -
Laguna (LPU) St. Cabrini
College Allied Medicine
June 2013 May 2017
SECONDARY LEVEL: Liceo de Calamba

June2009 March 2013
I hereby certify that the above informations are true and correct.
SHAIRA ALHEENA MIKAILI O. MANAIG

47
Page
FULL NAME:Marianne Carmel M. Nuevo
ADDRESS: San Miguel Sto. Tomas Batangas
EMAIL ADDRESS: mrnnnuevo@gmail.com

June 2016 May 2017
Bachelor of Science in Medical Technology

Daniel Mercado Medical Center Institute of
Health Sciences
June 2013 - 2015
SECONDARY LEVEL: St. Paul Learning School

June2011 March 2013
De La Salle Lipa
June 2009- March 2010
48
Page
MARIANNE CARMEL M. NUEVO
FULL NAME:Lauri Leigh Q. Zumarraga
ADDRESS:Ambulong Tanauan City Batangas
EMAIL ADDRESS: laurizumarraga@gmail.com

June 2013 May 2017
SECONDARY LEVEL: Tanauan School of Fisheries

June2009 March 2013
49
Page
LAURI LEIGH Q. ZUMARRAGA
50
Page

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LPU St. Cabrini College of Allied Medicine, Inc.

BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY

Standing is a natural human posture and poses no particular health hazard.

However, working in a standing position on a long period of time can cause

uneasiness which may lead to proteinuria, specifically called as Orthostatic

Orthostatic proteinuria is a condition where an individual excretes abnormally high

amount of protein in the urine. It is commonly found in individuals whose jobs

the lesser the chances to rest working muscles.

Orthostatic proteinuria is known as non-pathologic and is not associated

because orthostatic proteinuria carries with it a benign prognosis with no danger of

worsening renal function.

According to Edgar V Lerma, MD., 2016, orthostatic proteinuria refers to

BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY

underlying renal disease.

condition. Aside from prolonged standing, orthostatic proteinuria occurs because of

upright position, it requires us a considerable muscular effort that is obviously

postural proteinemia to be able to know if their physical activity specifically

prolonged standing as a fish vendors may lead to serious renal complication.

REVIEW OF RELATED LITERATURE

In previous years, proteinuria has been given much consideration,

movement, and for proteinuria as a marker of optional harms of other causative

maladies, for example, arteriosclerosis or diabetes. Moreover, protein misfortune

which may eventually cause inconvenience of renal capacity. In any case,

BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY

More so, according to de Joode, A.A.E., 2011, Orthostatic proteinuria is

misjudged. There are a few classifications that might be in charge of the

improvement of proteinuria, incorporating changes in the glomerular permeability

for proteinuria to happen.

For advance testing of positive result of protein in urine, sulfosalicylic acid

to the following method (the numbers in parentheses represent the approximate

protein concentration) [3]: 0 = no turbidity (0 mg/dL) trace = slight turbidity (1 to

10 mg/dL) 1+ = turbidity through which print can be read (15 to 30 mg/dL) 2+ =

BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY

a protein called albumin. There is a condition called orthostatic proteinuria, which

at night - may be due to a physiological inability to "close down" your kidneys at

Kavalier, November 2005)

superior mesenteric artery in cases of isolated orthostatic or postural proteinuria.

BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY

aorta and superior mesenteric artery as a casue of an condition called isolated

Fossali EF, 2010)

In addition to, Jyothsna Gattineni, 2012 said that transient proteinuria is

disease. When the underlying predisposing condition resolves, the proteinuria

resolves. There is another condition of proteinuria occurring at irregular intervals

proteinuria. Orthostatic proteinuria is common in older children and adolescents

with a prevalence of 25%. Orthostatic proteinuria is the most common cause of

proteinuria in 75% of adolescents. The etiology is assumed as changes in

glomerular hemodynamics due to postural changes, and rarely exceeds 1gm/day.

BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY

protein creatinine ratio on a first morning urine specimen. Another option is to

position and not on the time of day.

The occurence of proteinuria among children on a single random urinalysis

is typically between 5 to 15%. Majority of them is found to have a transient or

orthostatic proteinuria, secondary to fever, stress, dehydration or exercise, as

opposed to a more important finding of persistent non-orthostatic proteinuria.

proteinuria in the generalized pediatric population which is around 6%. Recently, a

prospective cohort study of 91 patients in 6 to 18 years of age demonstrated a 20%

prevalence of orthostatic proteinuria. The total preotein excretion mean of those

and has a maximum mean of 341 mg/m2 /24hours [606mg/24hours]. An

who are over 10 years of age. Furthermore, the prevalence of orthostatic

proteinuria in the 91 patients mentioned earlier have an increased BMI or Body

mass index. (Sonderman, MD., 2014),

BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY

occurs in about 3 to 5% of adolescents and young adults, which is characterized by

an increased protein excretion during on an upright position but a normal protein