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Care During Chemotherapy and Beyond

Proteinuria



What Is Proteinuria?

Proteinuria is a type of Nephrotoxicity.

Proteinuria is an excess of protein in the blood. Protein is an important component in our blood, as it carries food, hormones, and many other things through our blood stream.

Once the blood is cleansed of excess wastes, the proteins will continue to flow through the body, carrying out their important functions. Protein is not filtered out of the body, as the large protein molecules are too big to through the tiny kidneys.

When there has been damage to the kidneys, depending on the cause, you may develop protein in your urine.

Causes Of Proteinuria

You may develop proteinuria as a result of:

  • Chemotherapy drugs such as: Streptozocin
  • Biologic therapies such as: Interleukin-2
  • Certain diseases or conditions -
    • Multiple myeloma will cause you to have a special kind of protein in your urine, called the "M-protein", "myeloma protein", or Bence-Jones protein. These are all terms for the same kind of protein. If Protienuria is among your symptoms of kidney problems, your doctor or healthcare provider will monitor your urine proteins periodically - either monthly, or yearly, depending on the severity and activity of your disease.
    • Systemic lupus erythematosis (SLE) - you may develop a "glomerulonephritis", or lupus nephritis, from your disease. 
    • Diabetes - with diabetes, the protein that you will have in your urine is called albumin. If you have sustained long-term damage to your kidneys from poor blood sugar control, your kidneys may fail.
    • Long-standing high blood pressure (Hypertension) - long-standing hypertension may cause your kidney failure.
    • Infection - Inflammation in the kidneys (Nephritis) may cause protein in your urine

What Are Some Symptoms of Proteinuria To Look For?

  • Unless there has been damage to your kidneys, many people with Proteinuria will have no symptoms of kidney problems at all.
  • If you have Proteinuria due to diabetes, your diabetes may be out of control, which is causing damage to your kidneys. In this case, your Proteinuria symptoms will be that of Hyperglycemia (increased blood sugar), such as frequent urination, excessive thirst, or hunger.
  • If you have Proteinuria due to a form of multiple myeloma, you may only have symptoms of Proteinuria that are related to your disease, if it is active. This varies depending on how much or how little of the abnormal protein is present in your urine, and how active or aggressive your disease is.
Symptoms Of Proteinuria Indicating Active Disease May Include:

  • Bone pain, if you have bone lesions due to your myeloma
  • Fatigue if you have anemia or are undergoing your chemotherapy,
  • Confusion, dizziness or excessive sleepiness if you have high blood calcium levels (Hypercalcemia) due to your active disease.
  • Neuropathy - if you have protein deposits in your fingers and toes due to your disease
  • You may not be urinating very often. Your urine may be dark or red blood-tinged. You may have pain or an urgency to use the bathroom.
  • You may have fever or chills, if you have an infection
  • You may be overly tired, or very weak (fatigued). It may be hard for you to do any kind of your normal activities. Your muscles may become extremely weak.
  • You may notice that your feet or ankles are swelling. You may feel "puffy".
  • You may have nausea or vomiting. Some people experience a loss of appetite.
  • You may become confused, or have a seizure.

Things You Can Do When Signs of Proteinuria Are Present:

Prevention Of Dehydration:

  • Drink two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • Management of side effects that may lead to dehydration such as nausea, vomiting, or diarrhea. See specific symptoms of kidney problems for management tips.

Testing Of Kidney Function:

  • Your doctor or healthcare provider may order certain blood tests, including a blood urea nitrogen (BUN) and Creatinine test, to monitor your symptoms of kidney problems. He or she may also ask you to save your urine for a 24-hour period, in order to monitor how much creatinine is in your urine during a 24-hour period.
  • Your doctor or healthcare provider may order some tests to evaluate your kidneys and bladder. He or she may order:
    • An ultrasound of your kidneys
    • An x-ray of your kidneys, ureter and bladder (KUB)
  • He or she may place a tube in your bladder (called a catheter), if you are not urinating, to see if there is a obstruction with urine behind the blockage, or if you are not making any urine at all
  • Follow all of your healthcare provider's instructions.

If you have been diagnosed with Proteinuria such as damage or failure:

  • Make sure to inform all of your healthcare providers of your condition. Make sure that with each medication that you are given to take, your doctor or healthcare provider is aware of your kidney disease. Avoid any drugs that may cause your symptoms of kidney problems to worsen.
Diet For Proteinuria

If you have been diagnosed with Proteinuria your doctor may recommend some or all of the dietary recommendations below:

  • Renal Diet - If you are diagnosed with Proteinuria, you may be advised to follow a "renal diet".  This includes foods that are low in sodium, potassium, magnesium and protein. Reading the labels on food is helpful to know what kinds of calories, fat and protein you are taking in. Discuss this with your healthcare provider.
  • Limit Carbohydrates - Carbohydrates, either simple (such as fruit and sugar) or complex, (such as pasta and cereals), have the greatest impact on blood sugar levels, which is important if you have kidney problems due to your diabetes. In addition, excess carbohydrates that we take into our bodies are also converted into fat. In general, your diet should include around 50% carbohydrates. Avoid sugar, and instead, use artificial sweeteners, such as nutrasweet, aspartame, or saccharin, to help you lose weight, or maintain your current weight.
  • Protein - Foods that are high in protein include all kinds of meats. Your diet should consist of 15-20% protein if you have symptoms of Proteinuria. Long-term damage to your kidneys may be corrected by restricting protein, if you are diabetic, or experiencing kidney problems.
  • Increase fresh vegetables and fiber intake - Up to 55 grams of fiber per day is recommended. Fiber and fresh vegetables help to maintain regular bowel habits, and may prevent certain cancers. However, you should avoid foods that are high in potassium and magnesium, if you are have been diagnosed with Proteinuria. Foods that are high in potassium include most fresh fruits and vegetables. Some specific examples include:
    • Oranges and orange juice
    • Leafy green vegetables, such as spinach and greens (collard and kale)
    • Potatoes
  • There are many types of "good and bad" fats. The easiest thing to remember is to limit your intake of saturated fats and oils.
  • Avoid excess magnesium in your diet, often found in laxatives (such as milk of magnesia), or antacids unless specified by your healthcare provider.

Drugs That May Be Prescribed By Your Doctor To Treat Symptoms Of Proteinuria:

Depending on your overall health status, your doctor may recommend that certain drugs be used to treat or prevent Proteinuria. Some of the common drugs may include:

Antibiotics - If your doctor or healthcare provider suspects that you have an infection that has caused your Proteinuria, he or she may order antibiotics, either in a pill form or intravenous (IV). If you are prescribed antibiotics, take the full prescription. Do not stop taking pills when your symptoms of kidney problems clear up. Common antibiotics for a urinary tract infection include Bactrim® or Ciprofloxacin (Cipro®). 

Insulin - Insulin is a hormone that is naturally found in our bodies, that regulates blood glucose levels. Insulin may be given in the vein (IV), while you are in the hospital, or more commonly, under the skin (subcutaneous). You will be given insulin if you have renal failure or azotemia caused by your diabetes, and your blood sugar levels are too high.

  • If your blood sugar levels are not under good control, you may be ordered to take insulin alone, or in addition to an oral anti-diabetic agent. Insulin injections may be temporary, when your symptoms of kidney problems are first diagnosed, or they may need to be continued for a longer period of time. Your healthcare provider will determine this.

Oral anti-diabetic agents - There are many different kinds of medications that work by allowing your body to process insulin more effectively. You will receive one of these medications if you are diabetic, and you have Proteinuria due to your diabetes. These include Glipizide, Actos® or Amaryl®. Your healthcare provider will suggest one which is right for you.

  • Side effects of these medications may vary, but most include low blood sugar levels, weight loss, and improvement in your blood cholesterol levels. Some may cause slight nausea or loss of appetite, or diarrhea and bowel disturbances. It is important to follow your healthcare provider's recommendations for taking these pills.

Your healthcare provider will discuss with you which treatments are helpful to you based on your symptoms of Proteinuria. Do not stop any medications abruptly without first discussing them with your healthcare provider.

When To Call Your Doctor or Health Care Provider About Signs of Proteinuria:

  • If you begin urinating less frequently, or if your urine is dark, cloudy, or painful.
  • Any unusual bleeding or bruising; black or tarry stools, or blood in your stools or urine
  • Diarrhea (4-6 episodes in a 24-hour period), especially if it is becoming worse
  • Nausea (interferes with ability to eat and unrelieved with prescribed medications).
  • Vomiting (vomiting more than 4-5 times in a 24-hour period).
  • Dizziness or lightheadedness, "feeling faint", especially if severe.
  • Any new rashes on your skin, itchy skin.
  • Any unusual swelling in your feet and legs, or weight gain of greater than 3 to 5 pounds in 1 week.
  • Fever of 100.5° F (38° C), chills, sore throat (possible signs of infection if you are receiving chemotherapy).
  • Changes in your mental state, including confusion; or a recent episode of seizure(s).
  • Feeling your heart beat rapidly, or experience palpitations.
  • Extreme muscle weakness or twitching (may signify electrolyte imbalances that should be corrected).
  • If your symptoms of kidney problems worsen or do not improve in 3 days of therapy.

Read More About:
Kidney Problems | Nephrotoxicity | Azotemia | Proteinuria | Urinary Tract Infection (UTI)

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website about symptoms of kidney problems and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice.