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WantItGone
03-25-2007, 06:32 PM
Hi guys and gals,

I'm a new member but I was diagnosed 2 years ago. Until recently I've only had raynauds, sun sensitivity, aches, swelling, inflammation, and mouth ulcers. My rheumatologist recently discovered protein in my urine after a urinalysis. I've only read a couple threads on here so far (quite alarming but informative). I'm wondering how common it is to have trace protein in urine. I don't feel comfortable with the 1st or 2nd rheumatologists that I've been seeing over the past 2 years and have an appointment with a 3rd Thursday. They just don't seem to be all that helpful and pretty much seem to have a "just wait and see" attitude as opposed to the attitutude that my husband and I have which is preventive. Is it normal to eventually have kidney involvement eventually. For those members who now have kidney involvement, did your urinalysis progressively reveal trace proteins of urine then increase? This is stressful. I'm trying not to worry but it's so hard with this disease. It should be called "what'snext?" Lol. Thanks in advance for any help!! Also, I've scheduled an appointment with a nephrologist. Is that a bit much? I just wanted to see what he/she has to say about all my lab work over the past 2 years.

Saysusie
03-26-2007, 08:38 AM
Hi WantItGone:
It is estimated that about one-third of people with lupus will develop nephritis during the course of their disease. The Lupus nephritis will require medical evaluation and treatment. The two medical terms for the kidney disease that occurs in systemic lupus erythematosus are: lupus nephritis or lupus glomerulonephritis.
When protein leaks from the kidneys, it is eliminated from the body in the urine. Foamy, frothy urine and getting up to urinate during the night can sometimes suggest excessive protein loss. The loss of protein in the urine from lupus nephritis can lead to fluid retention with weight gain and swelling (edema). This is often the first symptom noticed of lupus nephritis. The edema generally appears as puffiness in the feet, ankles and legs. This swelling will be absent in the morning, but will gradually worsen as you walk about during the day.
Protein leakage in the urine can be mild and detected only on testing, or severe gradually leading to a lowering of the protein level in the blood (a low albumin level). When this happens there is a tendency to ankle swelling, to fluid retention and to general fluid bloating. When the kidney is inflamed, the blood pressure frequently rises and blood pressure measurement is one of the important parts of the physical examination of lupus patients. When the kidney is more severely damaged, its normal filtering process is grossly impaired and toxic elements such as urea and creatinine, normally present in the blood in small amounts, build up leading to weight loss, nausea and overall ill feelings.
Many factors must be taken into consideration before treatment can be decided upon. Kidney disease is treated with steroids and/or cytotoxic drugs. High doses of steroids are usually given until an improvement is seen, the steroid dose can then be slowly reduced. Also, diuretic drugs are used to eliminate waste fluid, and drugs are used to control high blood pressure. Your doctors may also suggest a change in your diet.
For active or severe kidney disease, the most widely used immunosuppressive drug is cyclophosphamide. This is generally given intermittently by injection. This comes in the form of a drip given into the vein, usually given weekly for three weeks then monthly for 3-12 months. Doses vary from clinic to clinic, but the more modern fashion has been to use lower doses than those previously used and this has the benefit of far less side-effects.
A milder and very widely used immunosuppressive is azathioprine. This is given as tablet-form and the dosage depends upon your body weight. All immunosuppressives can affect the blood count and regular blood counts will have to be taken.
Other immunosuppressive drugs such as cyclosporin-A are increasingly used, but the two mainstays of treatment remain cyclophosphamide and azathioprine.
Not all kidney problems in people with lupus are due to lupus nephritis.
Infections of the urinary tract, with burning on urination, are quite common in people with lupus and can require antibiotic treatment.
Also, signs or symptoms of kidney disease that can be confused with lupus nephritis may be caused by some medications used in lupus treatment. These problems usually go away when the medications are discontinued. Two medications that can cause fluid retention or loss of kidney function are: -Salicylate compounds (e.g., aspirin) and/or non-steroidal anti-inflammatory drugs (NSAIDs)
I hope that this has been helpful. Let us know if you need any more information!
Peace and Blessings
Saysusie

WantItGone
03-26-2007, 02:31 PM
Wow! Thanks so much. I'd read a lot of that information on many sites but you kind of summed it up if I need to repeat it (or send) to family members.

I don't know if you answered it or not (maybe I missed it) but I guess my main conern is the increase of protein. Is it common to gradually have trace protein in urine and then for it to eventually increase and increase? Also, will a nephrologist be able to give me more answers with regard to the trace protein than my rheumatologist? The 2 that I've seen thus far just don't seem to be all that informed. I know none of this is 100% but dang, the 2 that I've seen seem to be so uninformed.

MARYCAIN
03-26-2007, 03:47 PM
A trace of protein in the urine is actually quite common in normal healthy people. There are a lot of things that can cause it - eating meat or a high protein meal or shake before a test, exercising, dehydration, fever, viral or bacterial infection, even medications like prednisone or aspirin. So a small amount of protein may be nothing to be concerned about. "Proteinuria" is protein excretion of more than 150 mg. per day. Since most of the urinalysis done in a doctor's office is a "dipstick" type test, it doesn't give an accurate picture of how much protein may be involved. So most doctors recommend a 24 hour urine test, where the urine is collected for 24 hours and then the amount of protein being excreted is tested. This gives a more accurate picture of how much protein is being lost. So if you haven't had this test done yet, you might want to discuss it with your doctors. Normally when large amounts of protein are being lost, the urine may appear foamy or frothy. So if you have noticed that, your doctors definitely need to follow up on it.

WantItGone
03-26-2007, 05:33 PM
Thanks Mary. That really helps. I'm scheduled for another urinalysis in a couple weeks. I have noticed that my urine is frothy even before he told me there were traces of protein. Can alcohol increase protein in the urine? I like a rum and coke every now and then and have been having one or two a couple nights a week. Could that have increased the protein? I tried investigating on my own the various reasons for the possible increase and didn't see anything about alcohol and protein. Only alcohol and high blood pressure. Thanks for all your help! I'm really glad I found this site.

MARYCAIN
03-26-2007, 06:18 PM
Well, alcohol and coke can both cause dehydration, so the combination might not be so good for your kidneys, especially if you don't drink other fluids to compensate. Since you are scheduled to have another urinalysis soon, you might try not having the rum/coke combo, and limiting the amount of protein in your diet until after the test to see if it makes any difference. I'll look in some of my reference books tomorrow to see if I can find any other info about the action of alcohol on the kidneys - I don't have them with me at home.

WantItGone
03-26-2007, 07:21 PM
I didn't have any rum and cokes for a while before the urinalysis. That was about 2 weeks ago. Since that time I've had a couple. My rheumatologist said the rum & cokes didn't have anything to do with the protein in my urine but that's the only thing (un-natural) that I could think of in my diet. I have a really anti-flare diet (e.g. no dairy, nightshade vegetables, sugar). So, the only thing that's not exactly recommended is rum. Thanks so much though. It's so weird how it feels really good just talking to someone who knows how I feel. I seriously love this site.