14-08-2020

PROTEINURIA

Dr.Gayathri

PROTEINS
• High molecular weight proteins are retained
within circulation by the glomerular filter

• Low molecular weight proteins are freely

filtered and reabsorbed and catabolised
within the tubular cells

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PROTEINURIA
• Common finding in patients with kidney
disease
• Its presence suggest a poorer prognosis
• Reduction of protein excretion is therapeutic
target
• Normal - < 100mg/day
- < 150mg/day in pregnancy

Normal urinary protein excretion -< 150 mg/day

Of that
40%-Tamm Horsfall protein-secreted by thick
ascending limb of the loop of Henle
40%- Low molecular weight immunoglobulins
(IgA), Urokinase, Peptide hormones
20%- Albumin

Normal albumin excretion- < 30 mg/day

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• Increased protein excretion

- Upright position
- Exercise
- Fever
- Symptomatic UTI
- Heart failure
- Kidney disease

Types of proteinuria

TYPES PROTEINS
Glomerular Albumin
Overflow Bence Jones proteins
Myoglobin

Tubular α1 Microglobulin
β2 Microglobulin
Retinol Binding Protein

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CLASSIFICATION OF RENAL PROTEINURIA

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Diagnostic Evaluation of Proteinuria

Albuminuria
• Normal – 3.9 to 24.4 mg / day
• Uses :
1. Cardiovascular mortality
2. Kidney disease progression in diabetes
3. Glomerular pathology associated with
other systematic diseases.
• Methodology : Immunoturbidimetric or
nephelometric

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Albuminuria

Micro Macro

30-300 >300 mg/

mg/day day

Microalbuminuria
• ↑ in urinary excre on of albumin above the
reference interval but at an excretion that is
not generally detectable by less sensitive
clinical test

• Indicator of deteriorating renal function in

diabetics

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Protein to Creatinine ratio (PCR)

Protein
PCR =
Creatinine

• Normal - < 50 mg / g (< 5 mg / mmol )

• Approximates protein excretion in 24 hrs

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• PCR < 0.2 corresponds to proteinuria of

< 200mg/ 24 hrs

ACR
• Normoalbuminuria
Males - ≤ 2.5 mg/ mmol (23 mg/g)
Females - ≤ 3.5 mg/ mmol (32 mg/g)
• Microalbuminuria
3.5 to 29 mg / mmol
• Macroalbuminuria
≥ 30 mg / mmol

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• Increase ACR
- Menstrual contamination ,vaginal
discharge
- Uncontrolled HT,DM
- Heart failure
- Intercurrent illness
- Strenous exercise

Importance of PCR/ACR
• Creatinine excretion is fairly constant
throughout the day

• Reduced intra individual variation in a random

sample

• More practical and convenient

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Confirmation of Microalbuminuria

• ↑ ACR or ↑ albumin loss in a med collec on

in atleast two of three samples collected in
the absence of infection or an acute metabolic
crisis

• Screening in diabetes
Type 1 – 5 years after diagnosis

Type 2 - at the time of diagnosis and

Then continue on annual basis

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ACR
• Spot Urine Albumin Creatinine Ratio >30mg/g

diabetic

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