Proteinuria and hematuria

What each finding shows

A small amount of protein may appear after fever, strenuous exercise or dehydration and disappears by itself. Persistent proteinuria shows that the glomerular filter lets proteins through and is an early sign of kidney damage. The urine dipstick is a screening test; it is confirmed with the albumin/creatinine or protein/creatinine ratio. See also chronic kidney disease.

Hematuria may be visible (red or tea-colored urine) or microscopic, found only on testing. The red cells may come from the glomeruli or from the urinary tract (hematuria). Red urine is not always blood: beetroot, some medicines and foods can change the color.

How glomerular origin is told from urological origin

Glomerular hematuria is more often accompanied by proteinuria, red cell casts and deformed red cells under the microscope, and there are usually no clots. Hematuria from the urinary tract (stones, infection, tumors) may have clots, pain or urinary symptoms. This distinction determines whether investigation continues with the nephrologist or the urologist. In older people and smokers, visible hematuria without a clear cause always requires exclusion of a urinary tract tumor.

Investigation

The doctor assesses blood pressure, edema, medicines (including anti-inflammatories), recent infections, family history and accompanying diseases such as diabetes or lupus. Tests include repeated urine, creatinine, eGFR, electrolytes, quantitative protein or albumin and, as appropriate, immunological markers. Kidney ultrasound shows size, structure and obstruction. When glomerulopathy is suspected, kidney biopsy may be recommended at a specialized center; it is not performed at our clinic.

How a urine sample is taken correctly and what can change the result

The result of a urine test depends greatly on how it is collected. For the routine test a midstream sample is used: wash your hands, clean the genital area, begin urinating into the toilet, collect the middle portion in the sterile container and close it. The first morning sample is concentrated and suited to proteinuria. In women during menstruation the result may contain blood that does not come from the urine, so the test is done after it ends or on instruction.

False or temporary proteinuria may appear after strenuous exercise, fever, dehydration, a urinary infection or stress; the values are repeated after a few days. Orthostatic proteinuria, frequent in adolescents and young adults, appears only when standing and is usually benign; it is distinguished by a sample collected right after sleep. The dipstick mainly detects albumin, so other proteins may be missed; when in doubt, a quantitative test is requested. A single value is not enough for diagnosis; the trend is assessed.

What to do after an abnormal result and how follow-up works

An abnormal result is not a reason to panic, but neither to ignore. Repeat the test as the doctor advises, within days or weeks; measure blood pressure at home twice a day for a week and note weight and any swelling of eyelids or ankles. Avoid anti-inflammatories without advice and vigorous exercise before the sample. Tell the doctor if you have had fever, sore throat or a skin infection in recent weeks, because some glomerulonephritides appear after infections.

When proteinuria persists, it is followed with regular checks of the protein/creatinine ratio, creatinine and blood pressure, every 6 months to a year or sooner when needed. Reducing salt and controlling blood pressure and glucose are the practical measures that protect the filters. Bring all earlier tests to the visit, because the chronology is more informative than the last value.

Treatment and follow-up

Treatment depends on the cause. Blood pressure control and some medicines against proteinuria protect the kidneys; immune glomerulopathies may require immunosuppressive therapy under specialist control. Small isolated proteinuria in young people may not need treatment but is followed. Declining function, rising proteinuria or new hematuria require reassessment.

Check-ups are done every 6 months to a year, or sooner when the doctor considers it reasonable. Care at Tirana Polyclinic: we offer nephrology consultation, abdominal ultrasound and interpretation of tests. Biopsy, cystoscopy and other imaging are recommended at other centers, and the results are interpreted by us.