Synonym/Acronym
TP, SPEP (fractions include albumin, alpha1-globulin, alpha2-globulin, beta-globulin, and gamma-globulin).
Rationale
Blood: To assess nutritional status related to various disease and conditions such as burns, edema, dehydration, and malabsorption. Urine: To assess for the presence of protein in the urine toward diagnosing disorders affecting the kidneys and urinary tract, such as cancer, infection, and pre-eclampsia.
Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction. For urine studies, usually a 24-hr urine collection is ordered. As appropriate, provide the required urine collection container and specimen collection instructions.
Normal Findings
Method: Blood and Urine: Spectrophotometry for total protein, electrophoresis for protein fractions.
Blood: Total Protein
Age | Conventional Units | SI Units (Conventional Units × 10) |
---|---|---|
Newborn5 days | 3.86.2 g/dL | 3862 g/L |
13 yr | 5.97 g/dL | 5970 g/L |
46 yr | 5.97.8 g/dL | 5978 g/L |
79 yr | 6.28.1 g/dL | 6281 g/L |
1019 yr | 6.38.6 g/dL | 6386 g/L |
Adult | 68 g/dL | 6080 g/L |
Values may be slightly decreased in older adults due to insufficient intake or the effects of medications and the presence of multiple chronic or acute diseases with or without muted symptoms.
Blood: Protein Fractions
Conventional Units | SI Units (Conventional Units × 10) | |
---|---|---|
Albumin | 3.44.8 g/dL | 3448 g/L |
alpha1-Globulin | 0.20.4 g/dL | 24 g/L |
alpha2-Globulin | 0.40.8 g/dL | 48 g/L |
beta-Globulin | 0.51 g/dL | 510 g/L |
gamma-Globulin | 0.61.2 g/dL | 612 g/L |
Values may be slightly decreased in older adults due to insufficient intake or the effects of medications and the presence of multiple chronic or acute diseases with or without muted symptoms.
Normal 24-Hour Urine Volume
The ranges are very general averages and were not calculated on the basis of normal average body weights. Literature shows that the expected urinary output can be estimated by formula where the expected output is as follows:
Infants: 12 mL/kg/hr Children and adolescents: 0.51 mL/kg/hr Adults: 1 mL/kg/hr | |||
Newborns | 1560 mL | ||
Infants | |||
310 days | 100300 mL | ||
1159 days | 250450 mL | ||
212 mo | 400500 mL | ||
Children and adolescents | |||
13 mo4 yr | 500700 mL | ||
57 yr | 6501,000 mL | ||
814 yr | 8001,400 mL | ||
Adults and older adults | 8002,500 mL (average 1,200 mL) |
24-Hr Total Urine Protein | Conventional Units | SI Units (Conventional Units × 0.001) |
---|---|---|
Normal excretion | 30150 mg/24 hr | 0.030.15 g/24 hr |
Proteinuria | Greater than 300 mg/24 hr | Greater than 0.3 g/24 hr |
The 24-hr urine volume is recorded and provided with the results of the protein measurement. Electrophoresis for fractionation is qualitative: No monoclonal gammopathy detected. (Urine protein electrophoresis should be ordered along with serum protein electrophoresis.)
Spot or Random Urine Protein/Creatinine Ratio (useful in situations where 24-hr urine collection is not feasible, e.g., urgent such as with pre-eclampsia, patients unable to reliably cooperate such as pediatric patients, etc.) | ||
---|---|---|
Age | Male | Female |
79 yr | 61220 mg/g | 70548 mg/g |
1012 yr | 59220 mg/g | 57334 mg/g |
1315 yr | 41371 mg/g | 33307 mg/g |
1617 yr | 31242 mg/g | 36329 mg/g |
Greater than 17 yr | 1568 mg/g | 10107 mg/g |
(Study type: Blood collected in a gold-, red-, or red/gray-top tube; Urine from an unpreserved random or timed specimen collected in a clean plastic collection container; related body system: ) .
Protein is essential to all physiological functions. Proteins consist of amino acids, the building blocks of blood and body tissues. Protein is also required for the regulation of metabolic processes, immunity, and proper water balance. Total protein includes albumin and globulins. Albumin, the protein present in the highest concentrations, is the main transport protein in the body. Albumin also significantly affects plasma oncotic pressure, which regulates the distribution of body fluid between blood vessels, tissues, and cells.
Globulin is calculated from the following formula: Total protein - Albumin = Globulin
Globulins
After an acute infection or trauma, levels of many of the liver-derived proteins increase, whereas albumin level decreases; these conditions may not reflect an abnormal total protein determination.
Most proteins, with the exception of the immunoglobulins, are synthesized and catabolized in the liver, where they are broken down into amino acids. The amino acids are converted to ammonia and ketoacids. Ammonia is converted to urea via the urea cycle. Urea is excreted in the urine. Normally, proteins do not pass from the blood through the kidneys filtration process into the urine. The presence of protein in the urine (proteinuria) is a significant indication of kidney disease. Proteinuria is defined as greater than 300 mg/day on a 24-hr urine or 30 mg/dL on a random or spot urine.
The predominant causes of proteinuria are (1) lack of filtration due to damaged glomeruli and (2) a breakdown in the kidneys tubular reabsorption process. Chronic conditions such as diabetes, hypertension, and sickle cell anemia cause incremental and potentially irreversible kidney damage. Proteinuria is present in many cases of pre-eclampsia, especially those with associated hypertension. Acute conditions such as urinary tract infections and kidney stones can also damage the kidneys. Collection of 24-hr urine samples in certain urgent conditions may not be feasible (e.g., pre-eclampsia); spot urine protein/creatinine ratios are considered reliable indicators of proteinuria. Proteinuria can also be the result of extremely elevated serum protein levels, as seen with immunoglobulin-secreting malignancies such as multiple myeloma. The kappa and lambda light chain portions of the immunoglobulins, also known as Bence Jones proteins, are detected using electrophoresis techniques and are classic findings in conditions such as myeloma, Waldenström macroglobulinemia, and lymphoma.
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Before the Study: Planning and Implementation
Teaching the Patient What to Expect
Potential Nursing Actions
After the Study: Implementation & Evaluation Potential Nursing Actions
Treatment Considerations
Nutritional Considerations
Clinical Judgement
Follow-Up Evaluation and Desired Outcomes