Proteinuria (Albuminuria/Microalbuminuria)

This condition is treated in the Nephrology (Renal) clinic.

Pre-referral work-up

History

Who should be referred with Proteinuria?  

• Nephrotic Syndrome: Oedema, Hypoalbuminaemia or suggestive symptoms with over 3.5g/24hr protein
• Consider referral for patients withover 0.5g/24hr proteinuria - Not explained by correlating   diabetic history - especially if associated with progressive decline in kidney function

Quantifying Proteinuria:

• Urine ACR (random or first morning) is generally a sufficient screen for albuminuria/microalbuminuria in diabetic and non-diabetic populations and is a useful test in most Renal Clinic referrals (First morning specimens increase specificity - but not absolutely necessary)
• Urine dipstick is not calibrated to detect microalbuminuria (under 30ug albumin/24hr) but is useful in screening for proteinuria in those excreting over 0.3g/L (1+ on dipstick)
• 24 hour Quantification: Where urine ACR is significantly elevated (over 100g/mol) consideration can be given to 24 hour urine protein collections (Not generally required in most low level albuminuria but is more likely to be helpful in those with suspected Nephrotic Syndrome)
• Low level albuminuria/proteinuria can occur transiently during fever, cardiac failure, after strenuous exercise (usually no more than Trace on dipstick)
• Haematuria and Proteinuria present together is strongly suggestive of a glomerular source for Haematuria

All referrals should comply to the outpatient information for clinicians page, referral standards and include in particular:

• Duration of haematuria
• Associated symptoms including diabetes
• Physical examination including blood pressure
• Smoking history, occupational history especially exposure to chemicals
• Past urological/renal history

Tests

• FBC
• UEC
• LFT
• Comprehensive metabolic panel (includes calcium, magnesium, phosphate, urea, bicarbonate, chloride, blood glucose)
• Consider lipids
• Urine Albumin/Protein Quantification (Generally Urine ACR)
• Consider renal ultrasound if anatomical imaging needed

Interim/GP management

To refer a patient with this condition, please see the Nephrology (Renal) clinic page for the full referral process and templates.

Who does not usually need to be referred to a Nephrologist?

• Stable eGFR 30“89 mL/min/1.73m²
• Minor proteinuria (under 0.5 g/24hrs with no haematuria) - particularly in known diabetics
• Controlled blood pressure

For more information please see the HealthPathways Tasmania website.

* Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention.  They may or may not indicate an emergency.

Clinic appointments

? Red location flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Urgent (Category 1)

? (Glomerular Haematuria) Presence of Proteinuria and Haematuria with associated rapid unexplained decline in kidney function (over 25% decline in GFR over 6-12 weeks)

Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review.

We will endeavour to see these patients within four weeks, or sooner if clinically indicated.

Availability

North

Launceston General Hospital
Level 3 - Specialist Clinics

Phone: 1300 977 694
Fax: 03 6777 5227

North West

Phone: 03 6477 7746
Fax: 03 6777 5214

North West Regional Satellite Service

1 Strahan Street

South Burnie TAS 7230

South

Wellington Clinics
Phone: 03 6166 0000
Fax: 03 6234 3982