Hi,
Here's the summarised answer to your concerns:
First and foremost, diabetes is a common cause of protein leaking in the urine, hence, it's important to rule this out as a cause.
Regarding the exact treatment of protein leaking in the urine, this will depend mainly on the cause and the severity of protein leakage. As there are many possibilities and more permutations, you should seek out a formal consultation with your doctor or nephrologist.
If you do indeed have persistent leaking of protein in the urine due to kidney dysfunction, you will certainly benefit from better control of the condition or addressing the risk factor(s) that is causing it (eg. medical issues like high blood pressure, diabetes, high BMI or high cholesterol).
This can be done through medications, as well as lifestyle modification and dietary advice. The use of a special type of blood pressure tablets referred to as anti-proteinurics to minimise the leaking of protein in the urine, thus, protecting the kidneys, is recommended in many patients.
The role of your kidneys
The main job of your kidneys is:
1. cleaning your blood and
2. controlling the right amount of water in your body.
How does your kidney clean your blood?
To clean your blood effectively, each kidney has around 1 million microfilters (the so-called glomeruli).
The size of the pores of these filters:
1. allows small toxins to be removed and
2. prevents larger substances like proteins from being lost in the urine, - to be healthy, we need to "keep" our proteins inside the blood, and not lose them in the urine.
What happens when your kidney is damaged?
When there is damage to the kidney microfilters, either because of
(i) inflammation like in the case of glomerulonephritis or
(ii) because of scarring like in the case of high blood pressure, diabetes or other diseases,
these microfilters get distorted and can even get destroyed.
When this happens, your kidneys:
(1) might not clean the blood properly, leading to an increase in the levels of blood creatinine
(2) might leak red blood cells in the urine, detected as blood in the urine, and
(3) might leak protein in the urine, which can cause bubbles in the urine. If large amounts of proteins are lost, this may cause medical issues such as fluid retention in the form of leg swelling and face swelling
What happens when protein is detected in your urine?
Thus, as protein leakage was detected in your screening by urinalysis, your doctor, first of all:
a) needs to ask you extra questions and examine you in more detailed (including measuring your blood pressure);
b) measure more accurately the amount of protein leaked in the urine;
c) do a more detailed analysis of the cells and debris present in the urine (looking for blood or signs of infection, for example);
d) check the status of your kidney function and order other pertinent blood tests, and
e) ideally refer you to a nephrologist, who will decide what further special tests you need to undergo to be sure your kidneys are working fine, and try to pin down the cause of protein leaking in your urine.
How do doctors determine the amount of protein in your urine?
Source: Verywell Health
Protein leaking in the urine can be identified and roughly measured by urine dipstick and urinalysis, (what you just did).
However, it can be quantified more accurately in the laboratory either by using:
1. a single fresh urine sample (which is very convenient, fairly accurate and widely used) or
2. after collecting urine for 24 hours in a bottle (which might be inconvenient, but preferred by some doctors and necessary in certain situations).
Thus, seeing a nephrologist might be necessary to propose an investigation plan and, importantly, to rule out glomerulonephritis - inflammation of the kidneys - as this can endanger the wellbeing of your kidneys.
Other causes of protein leakage in your urine
There are other causes of protein leaking; for instance:
1. people leaking some protein after doing intensive exercise or
2. having a fever or a viral infection.
These are regarded as benign because they are intermittent, transient and do not cause significant injury to the kidneys.
However, when the protein leaking in the urine is:
a) persistent,
b) severe,
c) accompanied by blood in the urine,
d) accompanied by your kidneys showing deteriorating function, or
e) accompanied by markers of other diseases that can affect the kidneys, such as like lupus (among others);
the nephrologist might suggest to perform a kidney biopsy, as well as for a pathologist to examine the biopsy samples under a microscope.
Why are kidney biopsies sometimes necessary?
You need to be properly assessed before a kidney biopsy will be recommended.
Kidney biopsies are important:
(i) first to diagnose a cause for the protein leaking,
(ii) second to check how much damage has occurred (i.e. scarring of the kidneys), and
(iii) third to provide more accurate treatment and prognosis advice.
To sum up:
There are many diseases that can cause protein leakage in the urine.
Some progress rapidly, while others progress more slowly. It's important to identify the cause behind kidney disease ASAP so that we can treat it and monitor the problem properly. This will prevent total kidney failure.
At this moment, do not alarm yourself too much. Discuss this again with your doctor and whether you need to be referred to a nephrologist; but you can consult one by yourself if worried, and he/she can reassure you and propose an initial investigative plan.
It might not be something urgent or severe (hopefully something mild and simple), but do not let the time pass by without investigating properly.
I hope this information was useful. Take good care.
Dr Francisco, wishing you the best possible health.
