Proteinuria Evaluation and Management

Definition and Significance

Significant proteinuria is defined as total protein excretion greater than 1,000 mg per 24 hours (1 g per day), or greater than 500 mg per 24 hours (0.5 g per day) if protein excretion is persistent or increasing, according to the American Academy of Family Physicians 1

Patients with newly diagnosed asymptomatic microscopic hematuria accompanied by proteinuria should be evaluated, as recommended by the American Academy of Family Physicians 1, 3
Patients with HIV infection should be evaluated at the time of diagnosis and annually for high-risk groups, according to the Infectious Diseases Society of America 2, 4
Patients with chronic kidney disease (CKD) should be evaluated for staging and monitoring, as recommended by the American College of Physicians 5

Urinalysis with microscopic examination should be performed to detect protein and assess for other abnormalities, such as red cell casts or dysmorphic red blood cells, as recommended by the American Academy of Family Physicians 1, 3
Quantification of proteinuria using spot urine protein-to-creatinine ratio (PCR) or albumin-to-creatinine ratio (ACR) is recommended, according to the American College of Physicians 5
Estimated glomerular filtration rate (eGFR) calculation should be performed, as recommended by the Infectious Diseases Society of America 2, 5

Assess GFR and albuminuria at least annually in people with CKD, as recommended by the National Kidney Foundation 7
More frequent monitoring is recommended for individuals at higher risk of progression, according to the National Kidney Foundation 7

Significant proteinuria (>1 g/day or >0.5 g/day if persistent or increasing) is an indication for nephrology referral, as recommended by the American Academy of Family Physicians 1
Presence of red cell casts or dysmorphic red blood cells is an indication for nephrology referral, according to the American Academy of Family Physicians 1, 3