Urine Protein and Urine Protein to Creatinine Ratio

Also known as: 24-Hour Urine Protein; Urine Total Protein; Urine Protein to Creatinine Ratio; UPCR Formal name: Urine Protein Related tests: Urinalysis; Albumin; Microalbumin; Protein Electrophoresis; Total ProteinAt a
GlanceTest SampleThe TestCommon QuestionsAsk UsRelated Pages

At a Glance
Why Get Tested?
To detect excessive protein escaping into the urine, to help evaluate and monitor kidney function, and to detect kidney damage

When to Get Tested?
As part of a routine physical, as a follow-up to a previous positive urine protein test, or when you have a disorder or disease that affects the kidney

Sample Required?
A random or 24-hour urine sample; occasionally, a split 24-hour sample, with the night collection separated from the day collection

The Test Sample
What is being tested?
Protein is not normally found in the urine, and urine protein tests detect and/or measure protein being excreted in the urine. There are several different kinds of urine protein tests. A semi-quantitative protein “dipstick” may be performed as part of aurinalysis, generally on a random urine sample. The quantity of protein in a 24-hour urine sample will be measured and reported as the amount of protein excreted per 24 hours. Also, the amount of protein in a random urine sample may be measured along with urine creatinine and reported as the ratio of urine protein to creatinine (UPCR). Creatinine, a byproduct of muscle metabolism, is normally excreted into the urine at a constant rate. When both a urine creatinine and a random urine protein test are performed, the resulting protein/creatinine ratio approaches the accuracy of the 24-hour urine protein test. Since saving all of the urine for a 24-hour period can be cumbersome for adults and difficult for infants and children, a random urine protein to creatinine ratio is sometimes substituted for a 24-hour urine protein sample. Albumin, a protein produced by the liver, makes up about 60% of the protein in the blood. The rest is a mixture of globulins, including immunoglobulins. Proteins are not normally found in the urine. The kidneys, two organs found in the back at the bottom of the rib cage, filter the blood, removing wastes and excreting them out of the body in the form of urine. When the kidneys are functioning normally, they retain or reabsorb filtered proteins and return them to the blood. However, if the kidneys are damaged, they become less effective at filtering, and detectible amounts of protein begin to find their way into the urine. Often, it is the smaller albumin molecules that

shortness of breath. then a repeat urinalysis and dipstick protein may be performed at a later time to see if there is still protein in the urine or if it has dropped back to undetectable levels. or if protein loss is severe. . How is it used? When is it ordered? What does the test result mean? Is there anything else I should know? How is it used? Urine protein testing is used to detect protein in the urine. Another article. such as may be seen with multiple myeloma. Tips to Help Children through Their Medical Tests. Since the dipstick primarily measures albumin. the patient is often asymptomatic. you might consider reading one or more of the following articles: Coping with Test Pain. as opposed to total urine protein (see microalbumin). Tips on Blood Testing. and to help detect and diagnose early kidney damage and disease. and Anxiety. A semi-quanititative test such as a dipstick urine protein is used to screen the general population for the presence of protein in the urine as part of a routine urinalysis. When a doctor is investigating the reason. the amount of protein in the urine increases. If the damage continues. nausea. provides a glimpse at the collection and processing of a blood sample and throat culture. he also may order a serum and urine protein electrophoresis test to determine which proteins are being excreted and in what quantities. can also lead to proteinuria. Discomfort. The urine protein test tells the doctor that protein is present in the urine. For a 24-hour urine collection. but it does not indicate which types are present or the cause of the proteinuria. Proteinuria is frequently seen in chronic diseases. and globulins may also begin to be lost. If there is a large amount of protein in the first sample and/or the protein persists in the second sample. in some situations the doctor may test specifically for albumin in the urine. or even difficult to manage. then a 24-hour urine protein may be used as a follow-up test. If slight to moderate amounts of protein are detected. How is the sample collected for testing? A random urine sample is collected in a clean container. With early kidney damage. to help evaluate and monitor kidney function.are detected first. such as diabetes and hypertension. As damage progresses. the 24-hour urine protein test also may be ordered if a doctor suspects that proteins other than albumin are being released. Therefore. Excess protein production. It is important that the sample be refrigerated during this time period. embarrassed. the patient may have symptoms such as edema. and Tips to Help the Elderly through Their Medical Tests. all of the urine is collected for a 24-hour period. 2. The presence of albumin in the urine (albuminuria) has been shown to be a sensitive indicator of kidney disease in patients with diabetes and with hypertension. with increasing amounts of protein in the urine reflecting increasing kidney damage. 4. 3. Is any test preparation needed to ensure the quality of the sample? No test preparation is needed. and fatigue. The Test 1. Follow That Sample. There should be no preservative in the container. NOTE: If undergoing medical tests makes you or someone you care for anxious.

A dipstick urine protein and/or a protein to creatinine ratio on a random urine sample may be used as a screen for kidney involvement when a patient is taking a medication that may potentially affect kidney function. A protein to creatinine ratio may be ordered on a random urine sample if a child shows evidence of significant and persistent protein in their urine with the dipstick urine test. Children. Since the dipstick primarily measures albumin. Other blood tests. ^ Back to top When is it ordered? A dipstick urine protein is measured frequently as a screening test. A 24-hour urine protein may be ordered as a follow-up test when the dipstick test shows that there is a large quantity of protein present in the urine or when protein is shown to be persistently present. especially when abnormal protein production is suspected. When a doctor is diagnosing the cause of proteinuria. It may also be ordered when a patient has known kidney disease or damage and the doctor wants to monitor kidney function over time. It may also be done when a previous dipstick has been positive for protein to see if the protein excretion persists. If kidney disease or damage is suspected. It may indicate kidney damage or . The doctor may monitor their urine at intervals to see if the amount of proteinuria changes over time. Either a 24-hour urine protein or a random protein to creatinine ratio may be used to monitor a patient with known kidney disease or damage. or whenever the doctor wants to evaluate kidney function. he also may order a urine protein electrophoresis test to determine exactly which proteins are being excreted and in what quantities. ^ Back to top What does the test result mean? Protein in the urine is a warning sign. such as with multiple myeloma. a pregnancy workup. A serum protein electrophoresis may also be ordered to look at the proteins in the blood. A protein to creatinine ratio may be ordered on a random urine sample when a child shows evidence of significant and persistent protein in their urine with the dipstick urine test. such as aBlood Urea Nitrogen (BUN) and creatinine. when a urinary tract infection is suspected. He may order a Comprehensive Metabolic Panel (CMP) to look at albumin and total protein levels in the blood and to help evaluate kidney and liver function. occasionally have some degree of transient proteinuria without apparent kidney dysfunction and may have a higher excretion of protein into their urine during the day than at night. he may also may imaging scans to evaluate the appearance of the organ. the doctor may order a 24-hour urine protein test even when there is little protein detected on the dipstick if he suspects that there may be proteins other than albumin being released. as part of a hospital admission. A dipstick urine protein and/or a protein to creatinine ratio may be used to screen patients on a regular basis when they are taking a medication that may affect their kidney function. whenever a urinalysis is performed.This is especially true if he suspects abnormal protein production. and sometimes adults. may be ordered to evaluate kidney function and an albumin and/or total protein test may be performed to look at the proteins in the blood. This may be done as part of a routine physical.

In some people. Since it measures primarily albumin. it may be present during the day and absent at night when the patient is lying down (orthostatic proteinuria). elevated urine protein levels can be associated withpreeclampsia. If it is elevated. or vaginal secretions in the urine. and increasing amounts of protein over time indicate increasing damage and decreasing kidney function. including:               Amyloidosis Bladder cancer Congestive heart failure Diabetes Drug therapies that are potentially toxic to the kidneys Glomerulonephritis Goodpasture’s syndrome Heavy metal poisoning Hypertension Kidney infection Multiple myeloma Polycystic kidney disease Systemic lupus erythematosus Urinary tract infection ^ Back to top Is there anything else I should know? The different methods of detecting protein in the urine vary in performance. A 24-hour urine sample gives the protein excretion rate over 24 hours. Can I test for protein in my urine at home? . vigorous exercise. Should I eat more protein to make up for lost protein? 1. or emotional or physical stress.diseaseor it may be a transient elevation due to an infection. it is possible that the patient was just not excreting measurable amounts of protein at that time Common Questions 1. medication. if it is negative. For example. Proteinuria is associated with many diseases and conditions. such as blood. It will be accurate only if all of the urine is collected. When kidney damage is present. The protein to creatinine ratio is more of a snapshot of how much protein is in the urine at the time the sample is collected. semen. Does kidney damage go away? 3. In pregnant women. Can I test for protein in my urine at home? 2. the amount of protein present is generally associated with the severity of damage. then protein is present. the dipstick may occasionally be normal when significant quantities of other proteins are present in the urine. a positive dipstick protein may be elevated due to other sources of protein.

See: Creatinine . unless your doctor is monitoring a known kidney condition. This article discusses the laboratory test to measure the amount of creatinine in the blood. though. Creatinine levels also vary according to a person's size and muscle mass. that will need to be addressed. see: Venipuncture How to Prepare for the Test The health care provider may tell you to stop taking certain drugs that may affect the test. Creatinine is removed from the body entirely by the kidneys. which is an important part of muscle. (For more. see the article on Home Testing. If it is due to a medication. Why the Test is Performed The test is done to see how well your kidneys work. This is usually not necessary. If you have severe protein shortages. creatinine levels will increase in the blood (because less creatinine is released through your urine). ^ Back to top 3. Cisplatin) Kidney damaging drugs such as cephalosporins (for example. there may be some throbbing. Creatinine . The goal is to detect kidney disease and damage early to minimize the damage and prolong kidney function. If kidney function is abnormal.) ^ Back to top 2. then in most cases the kidneys are likely to return to normal or near normal function when the medication is stopped. but ingesting additional protein also puts additional stress on your kidneys. it does not. Should I eat more protein to make up for lost protein? This is something to discuss with your doctor. Does kidney damage go away? In general. Afterward. Such drugs include:       Aminoglycosides (for example. For information on how this is done. gentamicin) Cimetidine Heavy metal chemotherapy drugs (for example. cephalexin) Nonsteroidal anti-inflammatory drugs (NSAIDs) Trimethoprim How the Test Will Feel When the needle is inserted to draw blood.Potentially yes.blood Creatinine is a breakdown product of creatine. some people feel moderate pain.urine How the Test is Performed A blood sample is needed. There are dipsticks available that allow patients to monitor the protein in their urine. Creatinine can also be measured with a urine test. while others feel only a prick or stinging sensation. If the proteinuria detected is due to a kidney infection or urinary tract infection. the kidneys frequently will return to normal function as the infection resolves. .

Females usually have a lower creatinine than males.7 to 1. Talk to your doctor about the meaning of your specific test results. The examples above are common measurements for results of these tests. Some labs use different measurements or test different samples.Normal Results A normal result is 0. because they usually have less muscle mass. Normal value ranges may vary slightly among different laboratories.1 mg/dL for women. congestive heart failure) Rhabdomyolysis Urinary tract obstruction Lower-than-normal levels may be due to:   Muscular dystrophy (late stage) Myasthenia gravis Additional conditions under which the test may be performed:                Alport syndrome Amyloidosis Atheroembolic kidney disease Chronic kidney disease Cushing syndrome Dementia due to metabolic causes Dermatomyositis Diabetes Digitalis toxicity Ectopic Cushing syndrome Generalized tonic-clonic seizure Goodpasture syndrome Hemolytic-uremic syndrome (HUS) Hepatorenal syndrome Interstitial nephritis .6 to 1. What Abnormal Results Mean Higher-than-normal levels may be due to:             Acute tubular necrosis Dehydration Diabetic nephropathy Eclampsia (a condition of pregnancy that includes seizures) Glomerulonephritis Kidney failure Muscular dystrophy Preeclampsia (pregnancy-induced hypertension) Pyelonephritis Reduced kidney blood flow (shock.3 mg/dL for men and 0.

A. Also reviewed by David Zieve. Philadelphia. the date. collect all urine in a special container for the next 24 hours. Cecil Medicine. Schafer AI. Update Date: 8/20/2011 Updated by: David C. On day 2. urinate into the toilet when you get up in the morning. Approach to the patient with renal disease. Keep it in the refrigerator or a cool place during the collection period. MD. Afterwards. 2011:chap 116. Cap the container. Dugdale.M. MHA. eds. and return it as instructed.A. How the Test is Performed A 24-hour urine sample is needed. 24th ed.D. Other risks associated with having blood drawn are slight but may include:     Excessive bleeding Fainting or feeling light-headed Hematoma (blood accumulating under the skin) Infection (a slight risk any time the skin is broken) Alternative Names Serum creatinine References Landry DW. the time of completion. Department of Medicine. Professor of Medicine.      On day 1. .. III. Division of General Medicine. Taking blood from some people may be more difficult than from others. Label the container with your name. Inc Urine 24-hour volume The urine 24-hour volume test measures the amount of urine produced in a day. Bazari H. In: Goldman L. Veins and arteries vary in size from one patient to another and from one side of the body to the other. Pa: Saunders Elsevier. Medical Director. urinate into the container when you get up in the morning. University of Washington School of Medicine. MD.         Lupus nephritis Malignant hypertension (arteriolar nephrosclerosis) Medullary cystic kidney disease Membranoproliferative GN I and GN II Type 2 diabetes Polymyositis (adult) Prerenal azotemia Thrombotic thrombocytopenic purpura Wilms' tumor Risks There is very little risk involved with having your blood taken.

if necessary. causing the urine to be absorbed by the diaper. If the collection is being taken from an infant. Why the Test is Performed Urine volume is normally measured as a part of the creatinine clearance test. For males. to stop taking any drugs that may interfere with the test results. See also:    Sodium .renal Diabetes insipidus . some extra collection bags may be needed. Talk to your doctor about the meaning of your specific test results. thoroughly wash the area around the urethra. place the entire penis in the bag and attach the adhesive to the skin. Deliver it to the laboratory or your health care provider as soon as possible upon completion.urine Urea nitrogen . This procedure may take a couple of attempts -. such as is seen in diabetes insipidus. not enough fluid intake. and there is no discomfort. Open a urine collection bag (a plastic bag with an adhesive paper on one end). For females.urine Potassium . Drain the urine from the bag into the container provided by your health care provider. Normal Results The normal range is 800 to 2000 milliliters per day (with a normal fluid intake of about 2 liters per day). What Abnormal Results Mean Disorders that cause reduced urine volume include dehydration. Check the infant frequently and change the bag after the infant has urinated into it. How the Test Will Feel The test involves only normal urination.lively infants can move the bag. or some types of chronic kidney disease.urine This test may also be done if you have polyuria (abnormally large volumes of urine). How to Prepare for the Test The health care provider will instruct you. Some labs use different measurements or test different samples. Diaper as usual over the secured bag. Normal value ranges may vary slightly among different laboratories. and place it on the infant. place the bag over the labia. or any test that measures the amount of a substance eliminated in a day.For an infant. The examples above are common measurements for results of these tests.central Diabetes . Some of the conditions that cause increased urine volume include:    Diabetes insipidus .

(Creatinine is a breakdown product of creatine. see: venipuncture. University of Washington School of Medicine. In: Goldman L. 2011:chap 116. Philadelphia. How to Prepare for the Test If the collection is being taken from an infant. Also reviewed by David Zieve.) The test helps provide information on kidney function. Bazari H. For information on how to collect the urine sample.73 m2). some people feel moderate pain. Update Date: 8/20/2011 Updated by: David C. Pa: Saunders Elsevier.blood test Creatinine . Schafer AI./1.5 ml/min. When the needle is inserted to draw blood. a couple of extra collection bags may be necessary.   For information on giving a blood sample.A. Medical Director. The samples are sent to a laboratory. The clearance rate is then calculated. A. 24-hour urine collection References Landry DW.urine test How the Test is Performed This test requires both a blood and urine sample. eds. See also:   Creatinine .   High fluid intake Some forms of kidney disease Use of diuretic medications Alternative Names Urine volume. Professor of Medicine. MHA.M. Cecil Medicine. MD. and then have blood taken. The calculation is adjusted for your specific body size. Inc Creatinine clearance The creatinine clearance test compares the level of creatinine in urine with the creatinine level in the blood. . Approach to the patient with renal disease. and looks at how much urine you collected in 24 hours. Afterward. see: 24-hour urine collection. The laboratory specialist measures the level of creatinine in both the urine and blood samples. Division of General Medicine. Department of Medicine. which is an important part of muscle. How the Test Will Feel The urine test involves only normal urination and there is no discomfort..D. 24th ed. MD. while others feel only a prick or stinging sensation. The creatinine clearance appears to decrease with age (each decade corresponds to a decrease of about 6. there may be some throbbing. Dugdale. III. You will collect your urine for 24 hours.

Why the Test is Performed The creatinine clearance test is used to estimate the glomerular filtration rate (GFR). Female: 88 to 128 ml/min. because a small amount of creatinine is released by the filtering tubes in the kidneys. The examples above are common measurements for results of these tests. Talk to your doctor about the meaning of your specific test results. the following will occur:      Excessive bleeding at blood draw site Fainting or feeling light-headed Hematoma (blood accumulating under the skin) Infection (a slight risk any time the skin is broken) Multiple punctures to locate veins Considerations Factors that may interfere with the accuracy of the test are as follows:    Incomplete urine collection Pregnancy Vigorous exercise . Some labs use different measurements or test different samples. Normal value ranges may vary slightly among different laboratories. In fact. Normal Results Clearance is often measured as milliliters/minute (ml/min). Rarely. What Abnormal Results Mean Abnormal results (lower-than-normal creatinine clearance) may indicate:           Acute tubular necrosis Bladder outlet obstruction Congestive heart failure Dehydration End-stage kidney disease Glomerulonephritis Kidney failure Renal ischemia (too little blood flow to the kidneys) Renal outflow obstruction (usually must affect both kidneys to reduce the creatinine clearance) Shock Risks The risks of the test are minimal and are related to the blood draw process. This is particularly true in patients with advanced kidney disease. creatinine clearance is not exactly the same as the GFR. Normal values are:   Male: 97 to 137 ml/min. However. creatinine clearance usually overestimates the GFR.

Also reviewed by David Zieve. This article discusses the test done to measure the amount of creatinine in your urine. and there is no discomfort. such as cephalosporins. trimethoprim.urine Creatinine is a breakdown product of creatine. III. Department of Medicine. MD. A blood test can also be used to determine your creatinine level. 24th ed. Dugdale. In: Goldman L. Update Date: 8/21/2011 Updated by: David C. Inc Creatinine . 2011:chap 116. Philadelphia. Pa: Saunders Elsevier. Why the Test is Performed This test can be used as a screening test to evaluate kidney function. Professor of Medicine. Cecil Medicine. and drugs that can damage the kidneys. How to Prepare for the Test Your health care provider may tell you to temporarily stop taking certain medicines that may interfere with test results.D. MHA.M. Bazari H. For information on how to collect a 24-hour urine sample. University of Washington School of Medicine. It is often used to provide information on other chemicals in the urine such as albumin or protein. It may also be used as part of thecreatinine clearance test. Such medicines include:      Cephalosporins (cefoxitin) Cimetidine Cisplatin Gentamicin Trimethoprim How the Test Will Feel The test involves only normal urination. Approach to the patient with renal disease.A. Medical Director. References Landry DW. Creatinine is removed from the body entirely by the kidneys. MD. See: Serum creatinine How the Test is Performed A random urine sample or a 24-hour collection may used. Schafer AI. eds. Division of General Medicine.. Normal Results . which is an important part of muscle.Drugs that can interfere with creatinine clearance measurements include: cimetidine. see: 24-hour urine collection. A.

Philadelphia.D. Also reviewed by David Zieve.Urine creatinine (24-hour sample) values can range from 500 to 2000 mg/day. In: Goldman L. Normal value ranges may vary slightly among different laboratories. but may be due to any of the following conditions:           Glomerulonephritis High meat diet Kidney infection (pyelonephritis) Kidney failure Muscular dystrophy (late stage) Myasthenia gravis Prerenal azotemia Reduced kidney blood flow (as in shock or congestive heart failure) Rhabdomyolysis Urinary tract obstruction Alternative Names Urine creatinine test References Landry DW. 24th ed. MD. Another way of expressing the normal range for these test results are:   14 to 26 mg per kg of body mass per day for men 11 to 20 mg per kg of body mass per day for women The examples above are common measurements for results of these tests. Division of General Medicine.. MD.A. III. 2011:chap 116. Results depend greatly on your age and amount of lean body mass. MHA. Update Date: 8/21/2011 Updated by: David C.M. Talk to your doctor about the meaning of your specific test results. Inc . eds. Some labs use different measurements or test different samples. Bazari H. Dugdale. Approach to the patient with renal disease. Medical Director. Professor of Medicine. Cecil Medicine. What Abnormal Results Mean Abnormal results of urine creatinine are nonspecific. Pa: Saunders Elsevier. University of Washington School of Medicine. A. Schafer AI. Department of Medicine.