Common Causes of Glomerular Proteinuria
| Cause | Renal Manifestation | Clinical Presentation | Laboratory/Imaging |
|---|---|---|---|
| Diabetes mellitus type 1/type 2 | Ranging from microalbuminuria to nephrotic range proteinuria; most common etiology of end-stage renal disease in the US | Polyuria, polydipsia, nocturia, weight loss | Fasting plasma glucose ≥126 mg/dL (7.0 mmol/L) |
| Hypertension | Protein excretion is usually less than 1 g/day13 | Often asymptomatic (excluding hypertensive crisis) | Retinopathy, LVH, atherosclerosis, small kidneys |
| Pre-eclampsia | Nephrotic syndrome,* decreased GFR compared to healthy pregnant women14 | Edema | Hypertension |
| Multiple myeloma | SCr is increased in 50% of patients15; urine protein is not detected on urine dipstick; sulfosalicylic acid test and UPCR detect proteinuria | Pallor, radiculopathy, peripheral neuropathy, bone pain in the back or chest is present in 60% of patients27 | Monoclonal protein in serum and/or protein electrophoresis, lytic lesions and fractures on x-ray, hypercalcemia |
| Light chain deposition disease | Most commonly associated with multiple myeloma; in rare cases it is occurs with lymphoma | Related to renal, cardiac, or hepatic involvement | Tissue deposition of kappa light chains, urinary light chain excretion |
| Primary amyloidosis | Nephrotic syndrome with or without renal insufficiency | Peripheral neuropathy, macroglossia, hepatomegaly | Amyloid deposition on biopsy; evidence of a clonal plasma cell proliferative disorder |
| HIV nephropathy | Nephritic syndrome,† slowly progressive renal dysfunction | More common in African-American patients; nephritic syndrome | HIV positive, normal to big kidney size |
| Immunoglobulin A nephropathy | Nephritic syndrome | Hematuria | Renal immunoglobulin A deposition; active urine sediment,‡ decreased GFR |
| Minimal change disease and membranous glomerulonephritis | Nephritic syndrome | Edema, anasarca, foamy urine | Hypercholesterinemia, hypoalbuminemia, proteinuria; diagnostic renal biopsy findings |
| Streptococcal glomerulonephritis | Ranging from microscopic hematuria to acute nephritic syndrome | Recurrent episodes of hematuria 1 to 3 days after URI | Kidney biopsy with immunofluorescence shows immunoglobulin A deposits |
| Rare forms of glomerulonephritis, other infectious or systemic diseases | Depending on underlying disease patients may have proteinuria with or without an active urinary sediment (red blood cell casts, dysmorphic erythrocytes) | Depending on underlying disease | ANA, 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.