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What are the reasons for the presence of albumin in urine?

Tuesday, 29 June 2010
Answered by: Dr. Naveen Atray
Asst. Professor of Medicine and Nephrologist,
Overton Brooks VA Medical Centre,
USA
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Q. In one of my routine urine tests done, it was found that the albumin level was (+) which was repeated after 3 weeks and was found to be the same. My blood test was done, the results of which are: Urea - 40.0 mg/dL; Creatinine - 1.30 mg/dL; Sodium - 1.40 mEq/L; Potassium - 4.14 mEq/L. Further, I was asked by the doctor to get a 24 hr Urine test done wherein Protein was 112.5 mg/L. The nephrologist asked me to keep a watch on my protein intake. I have observed that albumin is consistently upto (+) (done by Uristix), but I have seen that it becomes nil with the second urine sample and remains so throughout the day. I have a habit of drinking 1.5 L to 2.0 L of water everyday. This observation of albumin present in the morning urine sample and remaining NIL in the subsequent samples has been cross-checked a number of times. I am disturbed that why the albumin is coming in the morning sample. Kindly advise. I am a hypothyroid patient and taking Eltroxin 100 mcg once a day. Also, I have hypertension for the past 3 years for which I am taking Atenol-25 mg everyday. I get my blood pressure checked off and on and it is under control with the above medication. I am a non-smoker, non-drinker and a vegetarian. I am greatly perturbed by the above anomaly in my urine. What can be the reasons for this presence of albumin in the urine?

A.  It is mentioned that 24 hr urine collection returned urine protein [images] of 112 mg/L. Is it 112 mg/day or really 112 mg/L. If latter, what was the volume of urine submitted? The fact that morning dipstick detects the albumin and it disappears later during the day is not surprising since the morning sample is concentrated, and during the course of the day as you drink more liquids, the diluted urine escapes detection by the dipstick. The normal urinary excretion of albumin is less than 30 mg/day. An increase in urinary albumin excretion is indicative of increased permeability of the filters of kidney called glomerulus. Transient proteinuria may be associated with physical exertion and fever. Clearly, you have persistent proteinuria. The commonest causes of such proteinuria include diabetes, hypertension, any chronic inflammatory disease (eg, systemic lupus erythematosus [SLE]) or rheumatoid arthritis, infections (such as hepatitis B and C, malaria etc) and nephritis. Additionally, use of certain over the counter drugs such as pain killers, herbal remedies can result in such condition as well. Assuming that there are no other abnormalities in your urine test (i.e., red cell, white cells etc), diabetes or family history of kidney disease, I recommend that screening for hepatitis be performed, cholesterol checked, discontinue any painkillers or herbs and your blood pressure be strictly controlled to <130/80 with a medicine called ACE Inhibitor (rather than atenolol), lose weight to achieve BMI of 25 or less (your current BMI is 29), do renal sonogram and periodically monitor the albuminuria. If the albuminuria is noted to get worse, consult your nephrologist to assess if a kidney biopsy is needed.

A.  It is mentioned that 24 hr urine collection returned urine protein [images] of 112 mg/L. Is it 112 mg/day or really 112 mg/L. If latter, what was the volume of urine submitted? The fact that morning dipstick detects the albumin and it disappears later during the day is not surprising since the morning sample is concentrated, and during the course of the day as you drink more liquids, the diluted urine escapes detection by the dipstick. The normal urinary excretion of albumin is less than 30 mg/day. An increase in urinary albumin excretion is indicative of increased permeability of the filters of kidney called glomerulus. Transient proteinuria may be associated with physical exertion and fever. Clearly, you have persistent proteinuria. The commonest causes of such proteinuria include diabetes, hypertension, any chronic inflammatory disease (eg, systemic lupus erythematosus [SLE]) or rheumatoid arthritis, infections (such as hepatitis B and C, malaria etc) and nephritis. Additionally, use of certain over the counter drugs such as pain killers, herbal remedies can result in such condition as well. Assuming that there are no other abnormalities in your urine test (i.e., red cell, white cells etc), diabetes or family history of kidney disease, I recommend that screening for hepatitis be performed, cholesterol checked, discontinue any painkillers or herbs and your blood pressure be strictly controlled to <130/80 with a medicine called ACE Inhibitor (rather than atenolol), lose weight to achieve BMI of 25 or less (your current BMI is 29), do renal sonogram and periodically monitor the albuminuria. If the albuminuria is noted to get worse, consult your nephrologist to assess if a kidney biopsy is needed.

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Posted by : naresh, on Saturday, September 18, 2010
i like that.
 
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