Adult with positive urine dipstick for protein

RBD: red blood cell; UACR: urine albumin-creatinine ratio; UPCR: urine protein-to-creatinine ratio; WBC: white blood cell.

* The urine dipstick primarily detects albumin but is relatively insensitive to non-albumin proteins, most notably immunoglobulin light chains.

¶ The history should focus on identifying potential causes and risk factors for proteinuria. We ask about associated symptoms, comorbid health conditions, medications, and family history of kidney disease. Refer to UpToDate content on the initial evaluation of adults with proteinuria for further details.

Δ For most patients without diabetes, we prefer the urine protein-to-creatinine ratio as this ratio provides an estimate of total urine protein excretion (albumin and non-albumin proteins). For patients with diabetes, the spot urine albumin-to-creatinine ratio is the preferred test to quantify albuminuria.

◊ Symptoms and signs of glomerular disease include foamy urine, visible (gross) hematuria, and new or worsening edema. Symptoms or signs of systemic disease, such as fever, rash, joint pain, or weight loss, might suggest a systemic condition associated with glomerular disease (eg, systemic lupus erythematosus).

§ Transient proteinuria is diagnosed if a repeat qualitative test (eg, urinalysis) is no longer positive for proteinuria. Transient proteinuria can occur with fever, exercise, and urinary tract infection.

¥ Highly concentrated urine (specific gravity >1.015) can cause a false positive urine dipstick result for protein.

‡ Orthostatic proteinuria is characterized by increased protein excretion in the upright position but normal protein excretion when the patient is supine. It is uncommon in adults over the age of 30 years. Refer to UpToDate content for details on the evaluation of orthostatic proteinuria.