Total urinary proteins

The test measures the total amount of protein excreted by the kidneys in urine. Healthy kidneys allow only very small amounts through, so an increased amount, proteinuria, may indicate kidney disease. It is measured in urine collected over 24 hours.

Who is this test for

• people whose urine dipstick has repeatedly shown proteins;
• people with known kidney disease, to monitor its course and treatment effect;
• people with swelling around the eyes, legs or abdomen and people with low blood albumin;
• people with diabetes and high blood pressure when the doctor wants to know total protein loss;
• people with systemic diseases that may affect the kidneys, as assessed by the doctor.

What proteinuria is and what the test shows

The kidneys filter blood through small clusters of blood vessels, the glomeruli, which retain larger proteins in blood. Smaller proteins passing through are returned to blood in kidney tubules. Adult urine therefore generally contains less than 150 mg protein daily. Higher amounts are called proteinuria.

A urinalysis dipstick shows proteins only approximately and mainly detects albumin. Total proteins precisely measure all urinary proteins and are used to confirm and monitor proteinuria. For early kidney damage in diabetes and high blood pressure, testing measures urine microalbumin, with which the doctor can calculate the albumin-to-creatinine ratio.

The test must not be confused with total serum proteins, which show proteins in blood.

Preparation and sample

Testing requires urine collected over 24 hours. The doctor sometimes also assesses proteins in a single sample alongside creatinine from the same urine; the doctor then calculates and interprets the protein-to-creatinine ratio.

Avoid strenuous exercise the day before and during collection, and drink as usual. It is better to postpone testing during menstruation, fever or urinary tract infection, because these temporarily increase urinary proteins. State which medicines you take.

How results are interpreted

The result is expressed in mg or g protein daily. As a guide, less than 150 mg (0,15 g) daily is considered normal; use the reference interval printed on the report. When the doctor calculates a protein-to-creatinine ratio from a single sample, a ratio below 15 mg/mmol is approximately considered normal.

One elevated result is not a diagnosis. Urinary proteins may temporarily increase after strenuous activity, with fever, stress or urinary tract infection; some young people have proteins only while standing and walking, while morning urine is normal. This orthostatic proteinuria is harmless.

Persistent proteinuria suggests kidney disease. Most often this is chronic kidney disease with diabetes and high blood pressure; inflammatory diseases of the glomeruli (glomerulonephritis) may also cause it. Very high protein loss, above 3,5 g daily, with swelling and low blood albumin, indicates nephrotic syndrome and requires a nephrologist’s assessment. Certain diseases, such as multiple myeloma, increase excretion of proteins poorly detected by dipsticks and require specific tests for confirmation.

The doctor interprets results alongside creatinine and eGFR, urinalysis, blood pressure and blood albumin, and requests kidney ultrasound and nephrology assessment if needed.

During pregnancy, urinary proteins with high blood pressure may indicate pre-eclampsia. Severe headache, visual disturbances, pain below the ribs or sudden swelling then require urgent assessment.

How to arrange testing

Testing is available without a referral or appointment, and every branch accepts urine samples (listed on the page Contactpage). Prices for all tests and panels are listed in the service price list.

Frequently asked questions

What do proteins in urine mean?

Small amounts of protein may temporarily appear after strenuous activity or with fever without particular significance. If proteins are found in several samples, this may indicate kidney disease, so the doctor requests precise measurement and additional tests.

Is foamy urine a sign of urinary proteins?

It may be, but usually is not. Foam also forms with a strong stream or concentrated urine. If foamy urine repeatedly occurs, particularly with swelling, see your doctor and have urinalysis.

What is the difference between total urinary proteins and microalbumin?

Total proteins measure all urinary proteins and are used when proteinuria is already present. Microalbumin measures albumin only and detects very small amounts, so it is used for early kidney damage detection, particularly in diabetes and high blood pressure.