What should be the focus of history for the evaluation of proteinuria?

Updated: Mar 25, 2020
  • Author: Beje Thomas, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Because proteinuria occurs frequently in the absence of serious underlying renal disease, considering the more common and benign causes of proteinuria first is important. Questions to ask include the following:

  • Is this transient proteinuria - This may be associated with physical exertion and fever

  • Is this orthostatic proteinuria - It typically is observed in tall, thin adolescents or adults younger than 30 years; it may be associated with severe lordosis; renal function is normal, and albuminuria usually is less than 1 g/day

  • Is this due to a nonrenal disease (eg, severe cardiac failure, sleep apnea) - Renal function is normal and proteinuria usually is less than 1 g/day; microalbuminuria frequently is observed in association with hypertension and the early stages of diabetic nephropathy

  • Are symptoms present that suggest nephrotic syndrome or significant glomerular disease

  • Have changes occurred in the urine’s appearance (eg, red/smoky, frothy); did this occur in relation to an upper respiratory tract infection

  • Is edema (eg, ankle, periorbital, labial, scrotal) present

  • Has the patient ever been told that his or her blood pressure is elevated

  • Has the patient ever been told that his or her cholesterol llevel is elevated

  • Is a history of multisystem disease or of another cause of glomerular disease present

  • Is a past or family history of kidney disease (including pregnancy related) present

  • Does the patient have diabetes mellitus - If so, for how long; are eye diseases or other complications present

  • Is a family history of diabetes mellitus present; does it include kidney disease

  • Is any chronic inflammatory disease (eg, systemic lupus erythematosus [SLE]) or rheumatoid arthritis present

  • Does the patient have any joint discomfort, a skin rash, eye symptoms, or Raynaud syndrome

  • Is the patient taking any medication, including over-the-counter or herbal remedies

  • Are any past health problems, such as jaundice, tuberculosis, malaria, syphilis, or endocarditis, present?

  • Are any other systemic symptoms, such as fever, night sweats, weight loss, or bone pain, present

  • Does the patient have any risk factors for human immunodeficiency virus (HIV) infection or hepatitis

  • Are symptoms present that suggest complication(s) of nephrotic syndrome

  • Does the patient have any loin pain, abdominal pain, breathlessness, pleuritic chest pain, or rigors


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