International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 4(2), January, 2012

Pages: 120-124

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Author: Sharan Badiger

Category: Healthcare

Abstract:Patients suffering from various kidney diseases have very few clinical symptoms and signs pointing towards renal involvement. Renal functions can be assessed by microscopic and biochemical examination of urine, biochemical determinations on plasma samples and by procedures involving administration of test substances. In this article a review on proteinuria is done which is useful in day to day clinical practice.

Keywords: Albumin, Globulin, Glomerular diseases, Proteinuria, Renal function

Full Text:

A normal barrier to protein filtration begins in the glomerulus. The normal glomerular endothelial cells form a barrier and hold back cells and other particles. They are penetrated by large pores of 100nm called fenestrae that can be easily traversed by proteins. The glomerular basement traps most large proteins (>100Kda), while the foot process of epithelial cells (podocytes) cover the urinary side of the glomerular basement membrane and produce a series of narrow channels (slit diaphragm) to allow passage of small solutes and water. These slit diaphragm bridges the slits between the foot processes of the glomerular basement membrane [1]. The visceral epithelial cells are covered with negatively charged heparan sulfate proteoglycans [2]. This negative charge and size selectivity of glomerular basement membrane impedes the passage of anion molecules such as albumin, globulin and large molecular weight protein across the glomerular wall. The smaller proteins that are filtered across the glomerular basement membrane are largely reabsorbed at the proximal tubule and only small amount are excreted.

1. Postural Orthostatic proteinuria
2. Functional
3. Transient
4. Intermittent
1. Glomerular
2. Tubular
3. Overflow
4. Secretory
This is a transient proteinuria that occurs with normal renal function, bland urinary sediment, and normal blood pressure and without any significant oedema. 24 hour urine albumin is usually less than one gram. They do not indicate any significant renal disease and disappears on repeated testing. 1) Postural /Orthostatic Proteinuria.

This is seen in 3 to 5% of adolescents, especially in young males. It is characterized by increased protein excretion in the upright position and normal protein excretion during recumbency [3] . It is diagnosed by split urine protein excretion examination. In orthostatic proteinuria, the day time specimen typically has an increased concentration of protein, with night time specimen having a normal concentration usually less than 50 mg over eight hours [4]. In true glomerular disease there is reduced protein excretion in the supine position but it will not return to normal as with orthostatic proteinuria. Springberg found that long term prognosis of orthostatic proteinuria is benign in virtually all cases over many decades [5]. Data on renal biopsies on orthostatic proteinuria are confusing. Some showed minor glomerular changes [6] .Posture affects urinary protein excretion, probably via an increase in glomerular capillary hydrostatic pressure and for change in permeability of the glomerular capillary walls [7] . An alternate explanation is entrapment of renal veins [8, 9] . 2) Functional Proteinuria It is a benign proteinuria due to changes in glomerular ultra filtration pressure and/or membrane permeability. It is seen in fever, exercise, cardiac failure, emotional stress and acute illness. Functional Proteinuria is usually less than 0.5 gm/day but may be as heavy as 5.0 gm/day (following marathon running). It disappears with the resolution of causative disorder [10] . Kallmeyer et al found that recent exercise can induce several gram of protein per litre of urine, sometimes together with haematuria and even casts so called jogger‘s nephritis [11]. Post exercise proteinuria is about 15 to 20 times the resting range of proteinuria and requires about 4 hours to regain resting value in the recovery period [12]. Poortmans et al found that proteinuria was influenced mostly by the intensity of exercise rather than its duration [13] . 3) Idiopathic Proteinuria This is seen in young healthy adults. This dipstick positive proteinuria disappears spontaneously by next clinical visit. 4) Intermittent Proteinuria This benign proteinuria is found in half of their different urine samples in absence of other renal or systemic abnormalities. B) PATHOLOGICAL PROTEINURIA This is persistent proteinuria that is detected on multiple ambulatory clinical visits.

This is seen in both recumbent and upright position and usually signals a structural renal disease. 1) Glomerular Proteinuria It is the most common cause of proteinuria in clinical practice. It is characterized by a disproportionate amount of albumin in urine [14] . Due to preservation of selectivity and large concentration of albumin in blood glomerular proteinuria is 85 to 90 % albumin, accompanied by pre-albumin, transferrin and relatively low molecular weight proteins since it contains mostly albumin. They are readily detected by stick or turbidometric methods. Glomerular proteinuria ranges from few hundred mg per 24 hours to 100 gms per 24 hours. McConnell et al on evaluation of proteinuria found that urinary excretion of more than 2 gm per 24 hours is usually a result of glomerular disease [15]. In glomerular proteinuria there is increased glomerular capillary permeability to high molecular weight anionic plasma proteins. How the glomerular barrier is damaged so that it leaks more than normal remains unclear [16]. This may be due to: -Loss of fixed anionic charge (Congenital nephrotic syndrome, minimal change nephropathy) - Detachment of epithelial podocytes from basement membrane [17] . - Immune aggregation.

- Increase in glomerular capillary pressure. The filtered protein, that reach the tubules overwhelm the limited capacity of tubular reabsorption and cause these proteins to appear in urine. Glomerular disease is classified as primary when the pathology is confined to the kidney and secondary when it is a part of multi system disorder. Glomerular proteinuria is of two types: a) Selective Proteinuria b) Non-selective Proteinuria In selective proteinuria the clearance ratio of immunoglobulin to albumin or transferrin is less than 0.10(50%). GLOMERULAR PROTEINURIA -CAUSES Primary Glomerulonephropathy: - Minimal change disease - Focal segmental glomerulonephritis - Idiopathic membranous glomerulonephritis - Membranoproliferative glomerulonephritis - IgA nephropathy Secondary Glomerulonephropathy: - Diabetes Mellitus - Amyloidosis - Collagen vascular disease (Eg-Lupus nephritis) - Infections - HIV - Hepatitis B and C infection - Post streptococcal - Syphilis - Malaria - Infective Endocarditis - Drugs - NSAIDS - Penicillamine - Lithium - Heroin - Heavy metals - Gastrointestinal and lung cancers - Lymphoma 2) TUBULAR PROTEINURIA Proteinuria results from the damage of proximal tubule so that normally reabsorbed protein, principally of low molecular weight pass into the urine .This usually occurs as part of the Fanconi syndrome of proximal tubular dysfunction. Tubular proteinuria usually does not exceed 2 gm per day [18, 19] . Beta 2-microglobulin is one of the many micro globulin which make up tubular proteinuria. Normal level of Beta 2- microglobulin in urine is less than 0.4 mcg/L. It can be assessed by RIA or ELISA. The urinary albumin and Beta 2-microglobulins ratio of 10 to 1 suggests the presence of Beta 2-microglobulin. Further measurement of Beta 2 lysozyme may help in distinguishing type of urinary tract infection besides diagnosis of heavy metal poisoning [20, 21] .Urinary protein electrophoresis and/or immuno electrophoresis may aid in distinguishing tubular and glomerular proteinuria. TUBULAR PROTEINURIA – CAUSES -Hypertensive nephrosclerosis -Tubulo interstial diseases -Fanconi syndrome -Heavy metals -Uric acid nephropathy -Acute hypersensitivity -Interstitial nephritis -Sickle cell disease -Drugs (NSAID, antibiotics) 3) OVERFLOW PROTEINURIA It is due to filtration by normal glomerulus of an abnormally large amount of low molecular weight proteins, which exceeds the capacity of the normal tubules for reabsorption. It is characterized by the presence of abnormal peak or spike on urinary electrophoresis. Most often, this is a result of the immunoglobulin over production that occurs in multiple myeloma.

The resultant light change immunoglobulin fragments (Bench Jones proteins) produce a monoclonal spike in the urine electrophoresis [22, 23] . OVERFLOW PROTEINURIA – CAUSES -Multiple myeloma -Myoglobinuria - Rhabdomyolysis -Lymphoproliferative disorders 4) SECRETORY PROTEINURIA It occurs due to secretion of proteins into the urine after glomerular filtration. About 20 to 30 mg/24 hours of non plasma protein is contributed by renal tubules and lower urinary tract. Mostly they are formed by Tomm-Horsfall proteins . Some secretary IgA is added by lower urinary track including the urethral glands together with trace quantity of protein of prostatic or seminal vesicular organ [24, 25] . Tomm-Horsfall protein is secreted by the ascending thick limb and early distal convoluted tubule into the tubular fluid. It is an easily polymerized glycoprotein. They form the major constituent of renal tubular casts [26], along with albumin and traces of many plasma proteins, including immunoglobulins [27]. In myeloma, casts contain paraproteins polymerized with Tomm-Horsfall protein, and may show a micro fibrillar structure that will stain positive with Congo red, even though no amyloid is present in renal tissue. Thus, the normal 24 hours urine protein excretion does not exceed 150 mg/dl in adults and 140 mg/m2 in children and generally this corresponds to approximately 10 mg/dl. Microalbuminuria refers to elevated urinary albumin excretion with normal total urine proteins. This corresponds to albumin excretion rates in the range of 20 to 200 µg/min. It has been found a useful early marker of development of diabetic nephropathy. It is detected by RIA or ELISA technique.


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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to for more details.

Best Article Award

A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
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A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
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A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
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A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
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A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.


International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal


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