Protein in urine

harka

Hi Ron,

First off how old you? There are medications that are available to treat proteinuria, but you have to figure out the CAUSE for what you have. Depending on the amount of protein in the urine, you can somewhat predict where it's coming from. Usually whenyou are putting out>3.5g of protein/day, and your body is all swollen from loss of this protein, it's called nephrotic syndrome, and it's always from a "glomerular source". The glomeruli are the microscopic filtering units of the kidney.

Minimal change disease just refers to a person with nephrotic syndrome clinically who, when you do a kidney biopsy you see "minimal change" in terms of the architecture of the kidney. There ARE architechtural changes, they're just not as severe as other diseases which can present with nephrotic syndrome.

In children, if you present with nephrotic syndrome it's almost ALWAYS minimal change disease where a cause is never found so a biopsy doesn't need to be done. You can just go ahead and treat with prednisone. If the treatment doesn't work, THEN you consider a biopsy. For adults, nephrotic syndrome can be a host of other things, and a kidney biopsy is necessary. Additionally, EVEN if an adult is found to have minimal change disease, it is important to realize a cause can be found more often than in children and should be sought. Things that cause MCD include certain medications (like NSAIDs, lithium), certain types of malignancies etc. But don't worry, the nephrotic syndrome/minimal change disease is found once the cancer is VERY evident. It's not that the person is found to have kidney disease first and is later found to have a cancer hiding somewhere.

Now, to get rid of the proteinuria, you treat the underlying cause, which in this case is immunosuppression with corticosteroids as first line, and then other things follow. Medications such as the ACE inhibitors and the Angiotensin receptors blockers and the calcium channel blockers can help to decrease the amount of proteinuria, but are more of a symptomatic treatment rather than treating the cause.

Ron, are you on any other medications? How long has this been going on for? How did your doctor figure out you had protein in the urine? Were you very swollen? Do you have any other health problems?

idunno

Hi Cgranulomatis,
I am 58. My neprologist originally thought I may have had amyloidosis as my symptoms included peripheral neuropathy ,significant protein loss, very high cholesterol levels and apparent hypotension. That was the reason for the kidney biopsy. It now appears that it is not hypotension but possibly menniere's disease involving the inner ear.(another specialist and more tests) I have to have a colonoscopy(another one)as I am an eleven year survivor of stage 3 colon cancer(it was into six lymph glands when they found it) I had chemo every tuesday for a year and have had at least 9 scopes using fleet prep. But I have always drunk much more water than was suggested.Last scope two small 2 mm polyps were removed and even at that small size one was precancerous. Since chemo I have had pancreatitis ,lost my gallbladder ,passed at least two kidney stones and have been diagnosed with significant insulin resistence though not yet diabetic.
I am a bit concerned about prednisolone. During chemo they used dexmethasone as an intraveinous anti-nausea med and it affected me rather badly,,,I could never get to sleep,,,already the prednisolone seems to be having the same effect even though I take it with breakfast.. I had a baseline 24 hr urine test last week and I think he will re do it after a month. It seems that their is usually some improvement by that time. I am having the scope in 5 weeks time. I hope my gi didn't leave any of the nasty one last time. Ron.

harka

Hey Ron,

One other thing--so with all the symptoms you were having that they were attributing to amyloidosis, did you have them immediately after your chemotherapy. The FOLFOX chemotherapy for colon cancer contains oxaliplatin which can cause an irreversible neuropathy.

I guess a biopsy will be important in you especially considering that the nephrotic syndrome from amyloidosis is not treated with steroids. For a diagnosis of amyloidosis have they:

1. Done a kidney biopsy?
2. Done an abdominal fat biopsy?
3. Done a rectal biopsy?