Urine Protein and Urine Protein to Creatinine Ratio

Also known as: 24-Hour Urine Protein; Urine Total Protein; Urine Protein to Creatinine Ratio; UPCR Formal name: Urine Protein Related tests: Urinalysis; Albumin; Microalbumin; Protein Electrophoresis; Total ProteinAt a
GlanceTest SampleThe TestCommon QuestionsAsk UsRelated Pages

At a Glance
Why Get Tested?
To detect excessive protein escaping into the urine, to help evaluate and monitor kidney function, and to detect kidney damage

When to Get Tested?

As part of a routine physical, as a follow-up to a previous positive urine protein test, or when you have a disorder or disease that affects the kidney

Sample Required?
A random or 24-hour urine sample; occasionally, a split 24-hour sample, with the night collection separated from the day collection

The Test Sample

What is being tested?
Protein is not normally found in the urine, and urine protein tests detect and/or measure protein being excreted in the urine. There are several different kinds of urine protein tests. A semi-quantitative protein dipstick may be performed as part of aurinalysis, generally on a random urine sample. The quantity of protein in a 24-hour urine sample will be measured and reported as the amount of protein excreted per 24 hours. Also, the amount of protein in a random urine sample may be measured along with urine creatinine and reported as the ratio of urine protein to creatinine (UPCR). Creatinine, a byproduct of muscle metabolism, is normally excreted into the urine at a constant rate. When both a urine creatinine and a random urine protein test are performed, the resulting protein/creatinine ratio approaches the accuracy of the 24-hour urine protein test. Since saving all of the urine for a 24-hour period can be cumbersome for adults and difficult for infants and children, a random urine protein to creatinine ratio is sometimes substituted for a 24-hour urine protein sample. Albumin, a protein produced by the liver, makes up about 60% of the protein in the blood. The rest is a mixture of globulins, including immunoglobulins. Proteins are not normally found in the urine. The kidneys, two organs found in the back at the bottom of the rib cage, filter the blood, removing wastes and excreting them out of the body in the form of urine. When the kidneys are functioning normally, they retain or reabsorb filtered proteins and return them to the blood. However, if the kidneys are damaged, they become less effective at filtering, and detectible amounts of protein begin to find their way into the urine. Often, it is the smaller albumin molecules that

are detected first. If the damage continues, the amount of protein in the urine increases, and globulins may also begin to be lost. Proteinuria is frequently seen in chronic diseases, such as diabetes and hypertension, with increasing amounts of protein in the urine reflecting increasing kidney damage. With early kidney damage, the patient is often asymptomatic. As damage progresses, or if protein loss is severe, the patient may have symptoms such as edema, shortness of breath, nausea, and fatigue. Excess protein production, such as may be seen with multiple myeloma, can also lead to proteinuria. The presence of albumin in the urine (albuminuria) has been shown to be a sensitive indicator of kidney disease in patients with diabetes and with hypertension. Therefore, in some situations the doctor may test specifically for albumin in the urine, as opposed to total urine protein (see microalbumin).

How is the sample collected for testing?

A random urine sample is collected in a clean container. For a 24-hour urine collection, all of the urine is collected for a 24-hour period. It is important that the sample be refrigerated during this time period. There should be no preservative in the container. NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests. Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test
1. 2. 3. 4. How is it used? When is it ordered? What does the test result mean? Is there anything else I should know?

How is it used?
Urine protein testing is used to detect protein in the urine, to help evaluate and monitor kidney function, and to help detect and diagnose early kidney damage and disease. A semi-quanititative test such as a dipstick urine protein is used to screen the general population for the presence of protein in the urine as part of a routine urinalysis. If slight to moderate amounts of protein are detected, then a repeat urinalysis and dipstick protein may be performed at a later time to see if there is still protein in the urine or if it has dropped back to undetectable levels. If there is a large amount of protein in the first sample and/or the protein persists in the second sample, then a 24-hour urine protein may be used as a follow-up test. Since the dipstick primarily measures albumin, the 24-hour urine protein test also may be ordered if a doctor suspects that proteins other than albumin are being released. The urine protein test tells the doctor that protein is present in the urine, but it does not indicate which types are present or the cause of the proteinuria. When a doctor is investigating the reason, he also may order a serum and urine protein electrophoresis test to determine which proteins are being excreted and in what quantities.

This is especially true if he suspects abnormal protein production, such as with multiple myeloma. He may order a Comprehensive Metabolic Panel (CMP) to look at albumin and total protein levels in the blood and to help evaluate kidney and liver function. If kidney disease or damage is suspected, he may also may imaging scans to evaluate the appearance of the organ. A protein to creatinine ratio may be ordered on a random urine sample if a child shows evidence of significant and persistent protein in their urine with the dipstick urine test. Children, and sometimes adults, occasionally have some degree of transient proteinuria without apparent kidney dysfunction and may have a higher excretion of protein into their urine during the day than at night. The doctor may monitor their urine at intervals to see if the amount of proteinuria changes over time. Either a 24-hour urine protein or a random protein to creatinine ratio may be used to monitor a patient with known kidney disease or damage. A dipstick urine protein and/or a protein to creatinine ratio may be used to screen patients on a regular basis when they are taking a medication that may affect their kidney function. ^ Back to top

When is it ordered?
A dipstick urine protein is measured frequently as a screening test, whenever a urinalysis is performed. This may be done as part of a routine physical, a pregnancy workup, when a urinary tract infection is suspected, as part of a hospital admission, or whenever the doctor wants to evaluate kidney function. It may also be done when a previous dipstick has been positive for protein to see if the protein excretion persists. A 24-hour urine protein may be ordered as a follow-up test when the dipstick test shows that there is a large quantity of protein present in the urine or when protein is shown to be persistently present. Since the dipstick primarily measures albumin, the doctor may order a 24-hour urine protein test even when there is little protein detected on the dipstick if he suspects that there may be proteins other than albumin being released. When a doctor is diagnosing the cause of proteinuria, he also may order a urine protein electrophoresis test to determine exactly which proteins are being excreted and in what quantities. A serum protein electrophoresis may also be ordered to look at the proteins in the blood, especially when abnormal protein production is suspected. Other blood tests, such as aBlood Urea Nitrogen (BUN) and creatinine, may be ordered to evaluate kidney function and an albumin and/or total protein test may be performed to look at the proteins in the blood. A protein to creatinine ratio may be ordered on a random urine sample when a child shows evidence of significant and persistent protein in their urine with the dipstick urine test. It may also be ordered when a patient has known kidney disease or damage and the doctor wants to monitor kidney function over time. A dipstick urine protein and/or a protein to creatinine ratio on a random urine sample may be used as a screen for kidney involvement when a patient is taking a medication that may potentially affect kidney function. ^ Back to top

What does the test result mean?

Protein in the urine is a warning sign. It may indicate kidney damage or

diseaseor it may be a transient elevation due to an infection, medication, vigorous exercise, or emotional or physical stress. In some people, it may be present during the day and absent at night when the patient is lying down (orthostatic proteinuria). In pregnant women, elevated urine protein levels can be associated withpreeclampsia. When kidney damage is present, the amount of protein present is generally associated with the severity of damage, and increasing amounts of protein over time indicate increasing damage and decreasing kidney function. Proteinuria is associated with many diseases and conditions, including:

Amyloidosis Bladder cancer Congestive heart failure Diabetes Drug therapies that are potentially toxic to the kidneys Glomerulonephritis Goodpastures syndrome Heavy metal poisoning Hypertension Kidney infection Multiple myeloma Polycystic kidney disease Systemic lupus erythematosus Urinary tract infection ^ Back to top

Is there anything else I should know?

The different methods of detecting protein in the urine vary in performance. For example, a positive dipstick protein may be elevated due to other sources of protein, such as blood, semen, or vaginal secretions in the urine. Since it measures primarily albumin, the dipstick may occasionally be normal when significant quantities of other proteins are present in the urine. A 24-hour urine sample gives the protein excretion rate over 24 hours. It will be accurate only if all of the urine is collected. The protein to creatinine ratio is more of a snapshot of how much protein is in the urine at the time the sample is collected. If it is elevated, then protein is present; if it is negative, it is possible that the patient was just not excreting measurable amounts of protein at that time

Common Questions
1. Can I test for protein in my urine at home? 2. Does kidney damage go away? 3. Should I eat more protein to make up for lost protein?

1. Can I test for protein in my urine at home?

Potentially yes. There are dipsticks available that allow patients to monitor the protein in their urine. This is usually not necessary, though, unless your doctor is monitoring a known kidney condition. (For more, see the article on Home Testing.) ^ Back to top

2. Does kidney damage go away?

In general, it does not. The goal is to detect kidney disease and damage early to minimize the damage and prolong kidney function. If the proteinuria detected is due to a kidney infection or urinary tract infection, the kidneys frequently will return to normal function as the infection resolves. If it is due to a medication, then in most cases the kidneys are likely to return to normal or near normal function when the medication is stopped. ^ Back to top

3. Should I eat more protein to make up for lost protein?

This is something to discuss with your doctor. If you have severe protein shortages, that will need to be addressed, but ingesting additional protein also puts additional stress on your kidneys.

Creatinine - blood
Creatinine is a breakdown product of creatine, which is an important part of muscle. This article discusses the laboratory test to measure the amount of creatinine in the blood. Creatinine can also be measured with a urine test. See: Creatinine - urine How the Test is Performed A blood sample is needed. For information on how this is done, see: Venipuncture How to Prepare for the Test The health care provider may tell you to stop taking certain drugs that may affect the test. Such drugs include:

Aminoglycosides (for example, gentamicin) Cimetidine Heavy metal chemotherapy drugs (for example, Cisplatin) Kidney damaging drugs such as cephalosporins (for example, cephalexin) Nonsteroidal anti-inflammatory drugs (NSAIDs) Trimethoprim

How the Test Will Feel When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing. Why the Test is Performed The test is done to see how well your kidneys work. Creatinine is removed from the body entirely by the kidneys. If kidney function is abnormal, creatinine levels will increase in the blood (because less creatinine is released through your urine). Creatinine levels also vary according to a person's size and muscle mass.

Normal Results A normal result is 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women. Females usually have a lower creatinine than males, because they usually have less muscle mass. The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results. What Abnormal Results Mean Higher-than-normal levels may be due to:

Acute tubular necrosis Dehydration Diabetic nephropathy Eclampsia (a condition of pregnancy that includes seizures) Glomerulonephritis Kidney failure Muscular dystrophy Preeclampsia (pregnancy-induced hypertension) Pyelonephritis Reduced kidney blood flow (shock, congestive heart failure) Rhabdomyolysis Urinary tract obstruction

Lower-than-normal levels may be due to:

Muscular dystrophy (late stage) Myasthenia gravis

Additional conditions under which the test may be performed:

Alport syndrome Amyloidosis Atheroembolic kidney disease Chronic kidney disease Cushing syndrome Dementia due to metabolic causes Dermatomyositis Diabetes Digitalis toxicity Ectopic Cushing syndrome Generalized tonic-clonic seizure Goodpasture syndrome Hemolytic-uremic syndrome (HUS) Hepatorenal syndrome Interstitial nephritis

Lupus nephritis Malignant hypertension (arteriolar nephrosclerosis) Medullary cystic kidney disease Membranoproliferative GN I and GN II Type 2 diabetes Polymyositis (adult) Prerenal azotemia Thrombotic thrombocytopenic purpura Wilms' tumor

Risks There is very little risk involved with having your blood taken. Veins and arteries vary in size from one patient to another and from one side of the body to the other. Taking blood from some people may be more difficult than from others. Other risks associated with having blood drawn are slight but may include:

Excessive bleeding Fainting or feeling light-headed Hematoma (blood accumulating under the skin) Infection (a slight risk any time the skin is broken)

Alternative Names Serum creatinine References Landry DW, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 116. Update Date: 8/20/2011 Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc

Urine 24-hour volume

The urine 24-hour volume test measures the amount of urine produced in a day. How the Test is Performed A 24-hour urine sample is needed.

On day 1, urinate into the toilet when you get up in the morning. Afterwards, collect all urine in a special container for the next 24 hours. On day 2, urinate into the container when you get up in the morning. Cap the container. Keep it in the refrigerator or a cool place during the collection period. Label the container with your name, the date, the time of completion, and return it as instructed.

For an infant, thoroughly wash the area around the urethra. Open a urine collection bag (a plastic bag with an adhesive paper on one end), and place it on the infant. For males, place the entire penis in the bag and attach the adhesive to the skin. For females, place the bag over the labia. Diaper as usual over the secured bag. This procedure may take a couple of attempts -- lively infants can move the bag, causing the urine to be absorbed by the diaper. Check the infant frequently and change the bag after the infant has urinated into it. Drain the urine from the bag into the container provided by your health care provider. Deliver it to the laboratory or your health care provider as soon as possible upon completion. How to Prepare for the Test The health care provider will instruct you, if necessary, to stop taking any drugs that may interfere with the test results. If the collection is being taken from an infant, some extra collection bags may be needed. How the Test Will Feel The test involves only normal urination, and there is no discomfort. Why the Test is Performed Urine volume is normally measured as a part of the creatinine clearance test, or any test that measures the amount of a substance eliminated in a day. See also:

Sodium - urine Potassium - urine Urea nitrogen - urine

This test may also be done if you have polyuria (abnormally large volumes of urine), such as is seen in diabetes insipidus. Normal Results The normal range is 800 to 2000 milliliters per day (with a normal fluid intake of about 2 liters per day). The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results. What Abnormal Results Mean Disorders that cause reduced urine volume include dehydration, not enough fluid intake, or some types of chronic kidney disease. Some of the conditions that cause increased urine volume include:

Diabetes insipidus - renal Diabetes insipidus - central Diabetes

High fluid intake Some forms of kidney disease Use of diuretic medications

Alternative Names Urine volume; 24-hour urine collection References Landry DW, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 116. Update Date: 8/20/2011 Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc

Creatinine clearance
The creatinine clearance test compares the level of creatinine in urine with the creatinine level in the blood. (Creatinine is a breakdown product of creatine, which is an important part of muscle.) The test helps provide information on kidney function. See also:

Creatinine - blood test Creatinine - urine test

How the Test is Performed This test requires both a blood and urine sample. You will collect your urine for 24 hours, and then have blood taken.

For information on giving a blood sample, see: venipuncture. For information on how to collect the urine sample, see: 24-hour urine collection.

The samples are sent to a laboratory. The laboratory specialist measures the level of creatinine in both the urine and blood samples, and looks at how much urine you collected in 24 hours. The clearance rate is then calculated. The calculation is adjusted for your specific body size. The creatinine clearance appears to decrease with age (each decade corresponds to a decrease of about 6.5 ml/min./1.73 m2). How to Prepare for the Test If the collection is being taken from an infant, a couple of extra collection bags may be necessary. How the Test Will Feel The urine test involves only normal urination and there is no discomfort. When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the Test is Performed The creatinine clearance test is used to estimate the glomerular filtration rate (GFR). However, because a small amount of creatinine is released by the filtering tubes in the kidneys, creatinine clearance is not exactly the same as the GFR. In fact, creatinine clearance usually overestimates the GFR. This is particularly true in patients with advanced kidney disease. Normal Results Clearance is often measured as milliliters/minute (ml/min). Normal values are:

Male: 97 to 137 ml/min. Female: 88 to 128 ml/min.

The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results. What Abnormal Results Mean Abnormal results (lower-than-normal creatinine clearance) may indicate:

Acute tubular necrosis Bladder outlet obstruction Congestive heart failure Dehydration End-stage kidney disease Glomerulonephritis Kidney failure Renal ischemia (too little blood flow to the kidneys) Renal outflow obstruction (usually must affect both kidneys to reduce the creatinine clearance) Shock

Risks The risks of the test are minimal and are related to the blood draw process. Rarely, the following will occur:

Excessive bleeding at blood draw site Fainting or feeling light-headed Hematoma (blood accumulating under the skin) Infection (a slight risk any time the skin is broken) Multiple punctures to locate veins

Considerations Factors that may interfere with the accuracy of the test are as follows:

Incomplete urine collection Pregnancy Vigorous exercise

Drugs that can interfere with creatinine clearance measurements include: cimetidine, trimethoprim, and drugs that can damage the kidneys, such as cephalosporins. References Landry DW, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 116. Update Date: 8/21/2011 Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc

Creatinine - urine
Creatinine is a breakdown product of creatine, which is an important part of muscle. Creatinine is removed from the body entirely by the kidneys. This article discusses the test done to measure the amount of creatinine in your urine. A blood test can also be used to determine your creatinine level. See: Serum creatinine How the Test is Performed A random urine sample or a 24-hour collection may used. For information on how to collect a 24-hour urine sample, see: 24-hour urine collection. How to Prepare for the Test Your health care provider may tell you to temporarily stop taking certain medicines that may interfere with test results. Such medicines include:

Cephalosporins (cefoxitin) Cimetidine Cisplatin Gentamicin Trimethoprim

How the Test Will Feel The test involves only normal urination, and there is no discomfort. Why the Test is Performed This test can be used as a screening test to evaluate kidney function. It may also be used as part of thecreatinine clearance test. It is often used to provide information on other chemicals in the urine such as albumin or protein. Normal Results

Urine creatinine (24-hour sample) values can range from 500 to 2000 mg/day. Results depend greatly on your age and amount of lean body mass. Another way of expressing the normal range for these test results are:

14 to 26 mg per kg of body mass per day for men 11 to 20 mg per kg of body mass per day for women

The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results. What Abnormal Results Mean Abnormal results of urine creatinine are nonspecific, but may be due to any of the following conditions:

Glomerulonephritis High meat diet Kidney infection (pyelonephritis) Kidney failure Muscular dystrophy (late stage) Myasthenia gravis Prerenal azotemia Reduced kidney blood flow (as in shock or congestive heart failure) Rhabdomyolysis Urinary tract obstruction

Alternative Names Urine creatinine test References Landry DW, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 116. Update Date: 8/21/2011 Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc