Table 2.

Common Causes of Glomerular Proteinuria

CauseRenal ManifestationClinical PresentationLaboratory/Imaging
Diabetes mellitus type 1/type 2Ranging from microalbuminuria to nephrotic range proteinuria; most common etiology of end-stage renal disease in the USPolyuria, polydipsia, nocturia, weight lossFasting plasma glucose ≥126 mg/dL (7.0 mmol/L)
HypertensionProtein excretion is usually less than 1 g/day13Often asymptomatic (excluding hypertensive crisis)Retinopathy, LVH, atherosclerosis, small kidneys
Pre-eclampsiaNephrotic syndrome,* decreased GFR compared to healthy pregnant women14EdemaHypertension
Multiple myelomaSCr is increased in 50% of patients15; urine protein is not detected on urine dipstick; sulfosalicylic acid test and UPCR detect proteinuriaPallor, radiculopathy, peripheral neuropathy, bone pain in the back or chest is present in 60% of patients27Monoclonal protein in serum and/or protein electrophoresis, lytic lesions and fractures on x-ray, hypercalcemia
Light chain deposition diseaseMost commonly associated with multiple myeloma; in rare cases it is occurs with lymphomaRelated to renal, cardiac, or hepatic involvementTissue deposition of kappa light chains, urinary light chain excretion
Primary amyloidosisNephrotic syndrome with or without renal insufficiencyPeripheral neuropathy, macroglossia, hepatomegalyAmyloid deposition on biopsy; evidence of a clonal plasma cell proliferative disorder
HIV nephropathyNephritic syndrome, slowly progressive renal dysfunctionMore common in African-American patients; nephritic syndromeHIV positive, normal to big kidney size
Immunoglobulin A nephropathyNephritic syndromeHematuriaRenal immunoglobulin A deposition; active urine sediment, decreased GFR
Minimal change disease and membranous glomerulonephritisNephritic syndromeEdema, anasarca, foamy urineHypercholesterinemia, hypoalbuminemia, proteinuria; diagnostic renal biopsy findings
Streptococcal glomerulonephritisRanging from microscopic hematuria to acute nephritic syndromeRecurrent episodes of hematuria 1 to 3 days after URIKidney biopsy with immunofluorescence shows immunoglobulin A deposits
Rare forms of glomerulonephritis, other infectious or systemic diseasesDepending on underlying disease patients may have proteinuria with or without an active urinary sediment (red blood cell casts, dysmorphic erythrocytes)Depending on underlying diseaseANA, complement C3 and C4, VDRL, hepatitis serology, cryoglobulins
  • * Nephrotic syndrome= more than 3.5 g proteinuria/day, hypoalbuminemia, edema, hyperlipidemia, lipiduria.

  • Nephritic syndrome = red to brown urine, proteinuria (usually <3.5 g/day, edema, hypertension, and acute renal failure).

  • Active urine sediment = red blood cell casts or dysmorphic erythrocytes.

  • RBC, red blood cell; GFR, glomerular filtration rate; ANA, antinuclear antibodies; HIV, human immunodeficiency virus; LVH, left ventricular hypertrophy; SCr, serum creatinine; URI, upper respiratory tract infection; VDRL, Venereal Disease Research Laboratory.