| Normal | Microalbuminuria | Overt proteinuria | Overt proteinuria | Massive | |
| ACR (mg/mmol)
(Spot urine sample) |
<2.5 (male)
<3.5 (female) |
2.5 – 30 (male)
3.5 – 30 (female) |
30-70 | 70-300 | >300 |
| PCR (mg/mmol) | <25 | 25-50 | 50-100 | 100-350 | >350 |
| Albumin/day | < 30 mg/day | 30 – 300 mg/day | >300 mg/day | >300 mg/day | > 3.0 gm/day |
| Protein/day | <150 mg/day | 150 – 500 mg/day | 0.5- 1gm/day | > 1 g/Day | >3.5 gm/day |
| Dipstick test | Negative | Negative | +/++ | (++/+++) | (++++) |
Source: Davidson, ADA classification of microalbuminuria
Localization of proteinuria
Physiologic/benign
- Heavy exercise
- Seizure
- Fever
Pathological
- Urinary
- Renal:
-
-
- Glomerular proteinuria
- Tubular proteinuria → associated tubular dysfunction: glycosuria, electrolytes imbalance
- Parenchymal inflammation: pyelonephritis, stone, tumor
- Non renal (LUT inflammation)
-
-
-
- UTI, bladder stone, polyp, tumor
-
- Non-urinary
- CCF → history, physical examination
- Hemoglobinuria, myoglobinuria → urine remain red after centrifugation
- Dysproteinemia (eg. MM) → electrophoresis
Evaluation of proteinuria
History:
- Frothy urine
- H/O heavy exercise, seizure, fever, UTI
- F/O significant real disease?
- Hypertension?
- Real function
- F/H of real disease?
- Sign of systemic disease?
Investigation:
| Investigation | Finding |
|
|
|
→ consider renal biopsy |