PROTEINURIA

Ask the Following Questions:

1. Are there significant numbers of white blood cells (WBCs) in the urine? This would suggest a UTI. If there are white cell casts or clumps, the infection may be a pyelonephritis. A urine culture and colony count should be ordered. Sterile urine with persistent proteinuria and pyuria may be seen in toxic nephritis.
2. Are there increased RBCs in the urine? This would suggest glomerulonephritis, collagen disease, polycystic kidney, tuberculosis, renal calculus, trauma, or neoplasm. The presence of red cell casts would make glomerulonephritis or collagen disease more likely.
3. Is glucose present in the urine? This would point to diabetic nephritis or nephrosis.
4. If none of the above associated findings are present, one should look for hypertension, toxemia of pregnancy, fever, cardiac disease, poisoning, orthostatic proteinuria, multiple myeloma, or amyloidosis.

DIAGNOSTIC WORKUP

When faced with a report of protein in the urine, the first thing to do is look at the urine under the microscope. If there are significant numbers of bacteria and WBCs, one has only to order a urine culture and colony count and begin therapy. Recurrent UTIs warrant an IVP and a referral to a urologist, especially in males. If no infection is found, a more thorough workup is warranted, including CBC, chemistry panel, serum protein electrophoresis, ANA, sedimentation rate, urine for Bence-Jones protein, Addis count, ASO titer, IVP, and CT scan of the abdomen. A urologist may need to be consulted for cystoscopy and retrograde pyelography. A nephrologist may need to be consulted for renal biopsy and further evaluation.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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