Proteinuria - Revision history

Danbot: Expanded with concise EM-focused content: when to evaluate in ED, transient vs pathologic causes, preeclampsia association, disposition

2026-03-21T00:41:45Z

Expanded with concise EM-focused content: when to evaluate in ED, transient vs pathologic causes, preeclampsia association, disposition

← Older revision		Revision as of 00:41, 21 March 2026
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	==Background==		==Background==
	*Normal protein excretion 150mg/24 hours ~~or 10mg/100mL~~		*Normal protein excretion <150mg/24 hours
	*>3.5g/24h ~~considered~~ nephrotic range		*>3.5g/24h is nephrotic range
	*Dipstick: more sensitive to albumin, less sensitive to Bence-Jones protein and globulins		*Dipstick: more sensitive to albumin, less sensitive to Bence-Jones protein and globulins
	**"Trace" protein ~~≈ 10mg~~/~~100mL~~ (~~i.e. upper limit of normal~~)		**"Trace" protein on dipstick is approximately normal
			*Key EM role: identify proteinuria associated with emergent conditions ([[preeclampsia]], [[nephrotic syndrome]], [[glomerulonephritis]])
			*Incidental proteinuria on UA often requires outpatient follow-up, not ED workup

			==Differential Diagnosis==
			===Transient/Functional (Benign)===
			*[[Fever]], acute illness, strenuous exercise, orthostatic proteinuria
			*[[Dehydration]], cold exposure
			*Usually resolves when precipitant corrected — no further workup needed in ED

	~~==Causes/Differential Diagnosis==~~
	~~===Functional===~~
	*Benign: [[fever]]/acute illness, cold exposure, orthostatic proteinuria, strenuous exercise, [[hypertension]]
	*[[CHF]], [[shock]]
	*[[Preeclampsia]]/[[eclampsia]]/[[HELLP]], [[acute fatty liver of pregnancy
	===Renal===		===Renal===
	*~~Tubular dysfunction~~		*'''[[Glomerulonephritis]]''': hematuria + proteinuria + RBC casts
	*Glomerular disease (e.g. [[~~glomerulonephritis~~]], [[~~diabetes~~]], ~~[[HIV]]~~, ~~[[SLE]]~~, ~~[[amyloidosis]]~~, [[IgA nephropathy]] or membranous nephropathy)		*'''[[Nephrotic syndrome]]''': massive proteinuria, hypoalbuminemia, edema, hyperlipidemia
	*[[Nephrotic syndrome]]		*'''Diabetic nephropathy''': most common cause of chronic proteinuria
	*[[Pyelonephritis]]		*Tubular dysfunction, [[IgA nephropathy]], membranous nephropathy
	*[[~~Malignant~~ hypertension]]		*[[Pyelonephritis]], [[malignant hypertension]]
	*[[Alport syndrome]]
	===~~Drugs~~===		===Pregnancy-Related===
	*[[~~Aminoglycosides~~]]~~, [[penicillin]s, [[amphotericin]], [[penicillamine]], [[deferasirox]]~~		*'''[[Preeclampsia]]''' / [[eclampsia]] / [[HELLP]]: proteinuria + hypertension after 20 weeks
	*[[NSAIDs]], gold		*[[Acute fatty liver of pregnancy]]
	*[[Chloral hydrate toxicity]]
	*[[Lead toxicity]]
	~~===Protein overload===~~
	''~~Note: bence-jones globulins NOT detected on dipstick~~''
	*[[Multiple myeloma]], [[~~lymphoma~~]], [[~~leukemia~~]]
	*[[~~Rhabdomyolysis~~]]
	===Other===		===Other===
	*[[~~Gout~~]]		*[[CHF]], [[shock]] (functional/prerenal)
	*[[~~Hypokalemia~~]], [[~~Cushing's syndrome~~]]		*Drug-induced: [[NSAIDs]], [[aminoglycosides]], [[amphotericin]], [[penicillamine]]
	*[[~~Electrocution~~]]		*Multiple myeloma (Bence-Jones protein — may be missed by dipstick)
	*[[~~Polycystic kidney disease~~]]
	*~~[[Hepatorenal~~ syndrome]]		==Evaluation==
	*[[~~Leptospirosis~~]]		===When to Evaluate in ED===
	*[[~~Polyarteritis nodosa~~]]		*Pregnant patient with proteinuria → check BP, labs for preeclampsia
	*~~[[Serum sickness]]~~		*Proteinuria + hematuria + RBC casts → glomerulonephritis workup
	*~~[[Scleroderma]]~~		*Proteinuria + severe edema → nephrotic syndrome workup
	==~~=False Positives=~~==		*Isolated trace/1+ proteinuria without above features → outpatient follow-up
	*~~Menses or other~~ [[~~vaginal bleeding~~]]
	*~~Highly concentrated urine~~		===Workup===
	*~~Alkaline urine~~		*[[BMP]]: creatinine, albumin
	*~~[[Acetazolamide]]~~, ~~[[cephalosporins]]~~, ~~[[bicarbonate]]~~		*[[CBC]]
			*Urine protein-to-creatinine ratio (spot urine — correlates with 24h protein)
			*Urine microscopy: RBC casts (GN), oval fat bodies (nephrotic syndrome)
			*If preeclampsia: LFTs, uric acid, LDH, platelet count

			==Management==
			*Treat underlying cause
			*Preeclampsia: [[magnesium sulfate]], antihypertensives, OB consultation
			*Nephrotic syndrome: diuretics for edema, nephrology referral
			*Most isolated proteinuria: outpatient nephrology follow-up

			==Disposition==
			*Admit: preeclampsia/eclampsia, acute GN with renal failure, severe nephrotic syndrome
			*Discharge: incidental proteinuria with normal renal function — arrange outpatient repeat UA and nephrology referral

	==See Also==		==See Also==
	*[[~~Urine analysis~~]]		*[[Glomerulonephritis]]
			*[[Nephrotic syndrome]]
			*[[Preeclampsia]]
			*[[Hematuria]]

			==References==
			<references/>

	[[Category:Renal]]		[[Category:Renal]]
	[[Category:Symptoms]]		[[Category:Symptoms]]

ClaireLewis at 18:14, 16 October 2019

2019-10-16T18:14:29Z

← Older revision		Revision as of 18:14, 16 October 2019
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	==Causes/Differential Diagnosis==		==Causes/Differential Diagnosis==
	===Functional===		===Functional===
	*Benign: fever/acute illness, cold exposure, orthostatic proteinuria, strenuous exercise, [[hypertension]]		*Benign: [[fever]]/acute illness, cold exposure, orthostatic proteinuria, strenuous exercise, [[hypertension]]
	*[[CHF]], [[shock]]		*[[CHF]], [[shock]]
	*[[Preeclampsia]]/eclampsia		*[[Preeclampsia]]/[[eclampsia]]/[[HELLP]], [[acute fatty liver of pregnancy
	===Renal===		===Renal===
	*Tubular dysfunction		*Tubular dysfunction
	*Glomerular disease (e.g. [[glomerulonephritis]], diabetes, HIV, SLE, ~~amyloid~~, IgA or membranous nephropathy)		*Glomerular disease (e.g. [[glomerulonephritis]], [[diabetes]], [[HIV]], [[SLE]], [[amyloidosis]], [[IgA nephropathy]] or membranous nephropathy)
	*[[Nephrotic syndrome]]		*[[Nephrotic syndrome]]
	*[[Pyelonephritis]]		*[[Pyelonephritis]]
	*[[Malignant hypertension]]		*[[Malignant hypertension]]
			*[[Alport syndrome]]
	===Drugs===		===Drugs===
	*[[Aminoglycosides]], [[penicillin]s, [[amphotericin]]		*[[Aminoglycosides]], [[penicillin]s, [[amphotericin]], [[penicillamine]], [[deferasirox]]
	*[[NSAIDs]], gold		*[[NSAIDs]], gold
			*[[Chloral hydrate toxicity]]
			*[[Lead toxicity]]
	===Protein overload===		===Protein overload===
	''Note: bence-jones globulins NOT detected on dipstick''		''Note: bence-jones globulins NOT detected on dipstick''
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	===Other===		===Other===
	*[[Gout]]		*[[Gout]]
	*[[Hypokalemia]], Cushing's syndrome		*[[Hypokalemia]], [[Cushing's syndrome]]
	*[[Electrocution]]		*[[Electrocution]]
	*Polycystic kidney disease		*[[Polycystic kidney disease]]
			*[[Hepatorenal syndrome]]
			*[[Leptospirosis]]
			*[[Polyarteritis nodosa]]
			*[[Serum sickness]]
			*[[Scleroderma]]
	===False Positives===		===False Positives===
	*Menses or other vaginal bleeding		*Menses or other [[vaginal bleeding]]
	*Highly concentrated urine		*Highly concentrated urine
	*Alkaline urine		*Alkaline urine
	*Acetazolamide, cephalosporins, ~~bicarb~~		*[[Acetazolamide]], [[cephalosporins]], [[bicarbonate]]

	==See Also==		==See Also==
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	[[Category:Renal]]		[[Category:Renal]]
			[[Category:Symptoms]]

ClaireLewis: Created page with "==Background== Normal protein excretion 150mg/24 hours or 10mg/100mL >3.5g/24h considered nephrotic range *Dipstick: more sensitive to albumin, less sensitive to Bence-Jones..."

2016-11-13T03:18:40Z

Created page with "==Background== *Normal protein excretion 150mg/24 hours or 10mg/100mL *>3.5g/24h considered nephrotic range *Dipstick: more sensitive to albumin, less sensitive to Bence-Jones..."

New page

==Background==
*Normal protein excretion 150mg/24 hours or 10mg/100mL
*>3.5g/24h considered nephrotic range
*Dipstick: more sensitive to albumin, less sensitive to Bence-Jones protein and globulins
**"Trace" protein ≈ 10mg/100mL (i.e. upper limit of normal)

==Causes/Differential Diagnosis==
===Functional===
*Benign: fever/acute illness, cold exposure, orthostatic proteinuria, strenuous exercise, [[hypertension]]
*[[CHF]], [[shock]]
*[[Preeclampsia]]/eclampsia
===Renal===
*Tubular dysfunction
*Glomerular disease (e.g. [[glomerulonephritis]], diabetes, HIV, SLE, amyloid, IgA or membranous nephropathy)
*[[Nephrotic syndrome]]
*[[Pyelonephritis]]
*[[Malignant hypertension]]
===Drugs===
*[[Aminoglycosides]], [[penicillin]s, [[amphotericin]]
*[[NSAIDs]], gold
===Protein overload===
''Note: bence-jones globulins NOT detected on dipstick''
*[[Multiple myeloma]], [[lymphoma]], [[leukemia]]
*[[Rhabdomyolysis]]
===Other===
*[[Gout]]
*[[Hypokalemia]], Cushing's syndrome
*[[Electrocution]]
*Polycystic kidney disease
===False Positives===
*Menses or other vaginal bleeding
*Highly concentrated urine
*Alkaline urine
*Acetazolamide, cephalosporins, bicarb

==See Also==
*[[Urine analysis]]

[[Category:Renal]]

Proteinuria - Revision history

Danbot: Expanded with concise EM-focused content: when to evaluate in ED, transient vs pathologic causes, preeclampsia association, disposition

ClaireLewis at 18:14, 16 October 2019

ClaireLewis: Created page with "==Background== *Normal protein excretion 150mg/24 hours or 10mg/100mL *>3.5g/24h considered nephrotic range *Dipstick: more sensitive to albumin, less sensitive to Bence-Jones..."

ClaireLewis: Created page with "==Background== Normal protein excretion 150mg/24 hours or 10mg/100mL >3.5g/24h considered nephrotic range *Dipstick: more sensitive to albumin, less sensitive to Bence-Jones..."