- Albumin (Urine)
- Urine albumin
- Protein (Urine)
- Urine protein
- 10-20 mL urine in a disposable sterile plastic container or plain tube
- Midstream random urine sample to be collected
Additional information
- Use a freshly voided specimen
- Send specimen to lab immediately
- If delay of >1hr is expected, refrigerate the specimen
- Attention should be given to avoid having skin epithelium, secretions, hair, lint, etc from contaminating the sample
- Avoid preservatives or any other contamination
- Instructions for clean catch midstream urine collection:
- For male
- Wash hands thoroughly
- Cleanse the meatus
- Void a small amount into the toilet
- Then, void directly into the specimen container
- For female
- Wash hands thoroughly
- Cleanse the labia from front to back
- While keeping the labia separated, void a small amount into the toilet
- Without interrupting the urine stream, void directly into the specimen container
- Urine protein dipstick test is a qualitative or semi-quantitative assessment of protein concentration in the urine
- Detection of urine protein is based on the color change with an indicator dye, bromphenol blue, which is most sensitive to albumin but does not detect globulins and other proteins (Bence-Jones protein)
- In a normal healthy person, the urine contains no protein or only trace amounts, which is chiefly albumin (one third of normal urine protein) and globulins from the plasma
- Normally, the glomeruli prevent passage of protein from the blood to the glomerular filtrate. However, in pathological conditions proteins appear in urine, with albumin more readily filtered than globulin.
- The clinical utility of urine protein dipstick testing includes:
- As a screening test, whenever urinalysis is performed as a part of
- Routine physical examination
- Pregnancy workup
- On admission to a health care facility
- Before surgery
- Diabetic patients for proteinuria (24 hour collection needed for microalbuminuria evaluation)
- To evaluate kidney function
- It is done when a previous dipstick has been positive for protein, to see if the protein excretion persists
- The urine protein results should always be interpreted in conjunction with the urine specific gravity and pH
- It is a good screening test for detecting a large amount of protein in the urine (> 300 mg/24 hours) but not effective for smaller amounts
- Increased leukocytes accompanying proteinuria is suggestive of infection at some level in the urinary tract, and large numbers of both leukocytes and erythrocytes is suggestive of noninfectious inflammatory disease of the glomerulus
- Proteinuria is often associated with the finding of casts on sediment exam because protein is necessary for cast formation
- Proteinuria is mainly of three types:
- Transient proteinuria:
- Occurs in 4-7% of general population on a single examination and resolves on subsequent examinations in almost all patients
- Seen after heavy exercise or severe stress
- Orthostatic proteinuria:
- Occurs in 2-5% of adolescents, but is unusual in people over the age of 30.
- A patient's protein excretion is increased in the upright position, but normal when the patient is lying down
- Persistent proteinuria
- Reflects underlying kidney disease or systemic disorder
- Related laboratory tests includ
- Antiglomerular basement membrane antibody
- Blood and urine amino acids
- Blood and urine creatinine
- Blood and urine electrolytes
- Blood and urine urea nitrogen
- Blood and urine uric acid
- Blood protein immunofixation electrophoresis
- Complete blood count
- Microalbumin (24 hour urine collection)
- Serum protein electrophoresis
- Urine culture
- Urine osmolality
Urine Protein: Negative or none
The urine dipstick values can be negative (none), trace, 1+, 2+, 3+ or 4+.
When results are elevated, the following results equate to the following concentration of protein in the urine:
| Dipstick Value | mg/dL |
|---|---|
| Trace | 5-15 |
| 1+ | 30 |
| 2+ | 100 |
| 3+ | 300 |
| 4+ |  1000 |
Conditions associated with proteinuria include:
- Glomerular damage
- Primary glomerulonephropathy
- Minimal change disease
- Idiopathic membranous glomerulonephritis
- Focal segmental glomerulonephritis
- Membranoproliferative glomerulonephritis
- IgA nephropathy
- Secondary glomerulonephropathy
- Nephrotic syndrome
- Systemic lupus erythematosus (SLE)
- Malignant hypertension
- Amyloidosis
- Diabetes mellitus
- Polycystic kidney disease
- Renal transplant rejection
- Infection
- HIV
- Hepatitis B
- Hepatitis C
- Poststreptococcal illness
- Syphilis
- Malaria
- Infective endocarditis
- Lymphoma
- Cancers of the
- Lungs
- Gastrointestinal tract
- Drugs (as mentioned below)
- Diminished tubular reabsorptio
- Cystinosis
- Fanconi's syndrome
- Hypertensive nephrosclerosis
- Interstitial nephritis
- Pyelonephritis, acute and chronic
- Renal tubular disease
- Uric acid nephropathy
- Wilson's disease
- Congestive heart failure
- Increased serum protein levels
- Multiple myeloma
- Malignant lymphoma
- Waldenström's macroglobulinemia
- Nonrenal conditions ("functional proteinuria")
- Acute infection
- Eclampsia/Pre-eclampsia
- Septicemia
- Leukemia
- Hematologic disorders - sickle cell disease
- Hyperthyroidism
- Hypertension
- CNS lesions
- Hepatitis
- Trauma
- Poisoning from
- Turpentine
- Phosphorus
- Mercury
- Gold
- Lead
- Phenol
- Opiates
- Oxalosis
- Others
- Fever and dehydration
- Stress
- Non–IgE food allergies
- In the premenstrual period and immediately after delivery
- Strenuous exercise
- Exposure to cold
- Hematuria (protein present in RBCs)
- Hemoglobinuria
- Myoglobinuria
- Drugs
- Acetaminophen
- Acetazolamide
- Aldesleukin
- Aminophylline
- Aminosalicylic acid
- Amphotericin B
- Ampicillin
- Ampiroxicam
- Arsenicals
- Ascorbic acid
- Asparaginase
- Aspirin
- Auranofin
- Aurothioglucose
- Bacitracin
- Benazepril
- betaxolol
- Bevacizumab
- Bicarbonate
- Bismuth subsalicylate
- Candesartan Cilexetil
- Capreomycin
- Carbamazepine
- Castor oil
- Cefaclor
- Cefamandole
- Cefdinir
- Cephaloridine
- Cephalothin
- Chloral hydrate
- Chlorhexidine
- Chloroform
- Chlorpheniramine
- Chlorpromazine
- Chlorpropamide
- Chlorthalidone
- Cidofovir
- Cisplatin
- Clindamycin
- Clofibrate
- Codeine
- Colistin
- Corticosteroids
- Corticotropin
- Cyclosporine
- Dantrolene
- Demeclocycline
- Dihydrotachysterol
- Doxapram
- Doxycycline
- Enalapril
- Ergot preparations
- Ether
- Ethosuximide
- Etretinate
- Fenoprofen
- Foscarnet
- Furosemide
- Gabapentin
- Gemcitabine
- Gentamicin
- Glyburide
- Glycerin
- Gold
- Griseofulvin
- Hepatitis A vaccine
- Hydralazine
- Ibuprofen
- Ifosfamide
- Indomethacin
- Interferon
-2a - Iodine-containing drugs
- Iron
- Isoniazid
- Isotretinoin
- Kanamycin
- Ketorolac
- Lipomul
- Lithium
- Mefenamic acid
- Mercury compounds
- Mesalamine
- Metaxalone
- Methenamine
- Methicillin
- Mitomycin
- Mitotane
- Moxalactam
- Naphthalene
- Naproxen
- Neomycin
- Netilmicin
- Nifedipine
- Nitrendipine
- Norfloxacin
- NSAIDs
- Olsalazine
- Oxacillin
- Oxaprozin
- Palifermin
- Paraldehyde
- Paramethadione
- Paromomycin
- Pegaspargase
- Penicillamine
- Penicillin
- Phenazopyridine
- Phenolphthalein
- Phosphorus
- Piperacillin
- Piroxicam
- Plicamycin
- Probenecid
- Promazine
- Quinine
- Radiographic agents
- Ramipril
- Ranitidine
- Rifampin
- Salsalate
- Silver
- Sodium bicarbonate
- Statins
- Streptokinase
- Streptomycin
- Streptozocin
- Sulfadiazine
- Sulfamethoxazole
- Sulfasalazine
- Sulfisoxazole
- Sulindac
- Suprofen
- Tacrolimus
- Tenofovir
- Tetracycline
- Thallium
- Theophylline
- Thiabendazole
- Ticarcillin
- Ticlopidine
- Tobramycin
- Tolbutamide
- Tolmetin
- Tramadol
- Trifluoperazine
- Vancomycin
Causes of false positive urine protein dipstick testing include:
- Alkaline, highly buffered urine (pH >8)
- Radiographic contrast agents
- Highly concentrated urine
- Leaching of the citrate buffer occurs if the urine remains in contact with the pad for a long time
- Quaternary ammonium compounds and chlorhexidine in detergents
- Incorrect use and interpretation of the color reagent strip test
- Accidental proteinuria: Mixture of pus and RBCs in the urinary tract related to infections, menstrual or vaginal discharge, mucus, or semen
- Agarwal R et al. Dipstick proteinuria: can it guide hypertension management? Am J Kidney Dis. 2002 Jun;39(6):1190-5.
- Chandar J et al. Role of routine urinalysis in asymptomatic pediatric patients. Clin Pediatr (Phila). 2005 Jan-Feb;44(1):43-8.
- eMedicine®. Proteinuria. [Homepage on the Internet] ©1996-2006. Last updated on May 25, 2006. Last accessed on November 30, 2006. Available at URL: http://www.emedicine.com/ped/topic3048.htm
- Gangaram R et al. The accuracy of urine dipsticks as a screening test for proteinuria in hypertensive disorders of pregnancy. Hypertens Pregnancy. 2005;24(2):117-23.
- MedlinePlus Medical Encyclopedia®. Protein -Urine. [Homepage on the Internet]©2005. Last updated on February 3, 2006. Last accessed on November 20, 2006. Available at URL: http://www.nlm.nih.gov/medlineplus/ency/article/003580.htm
- Pugia M et al. Detection of low-molecular-weight proteins in urine by dipsticks. Clin Chim Acta. 2002 Dec;326(1-2):177-83.
- Simerville JA et al. Urinalysis: A Comprehensive Review. Am Fam Physician. 2005 Mar 15;71(6):1153-62.
- UTMB Laboratory Survival Guide®. URINALYSIS (Chemistry and Microscopic). [Homepage on the Internet]© 2006. Last reviewed on February 2006. Last accessed on November 22, 2006. Available at URL: http://www.utmb.edu/lsg/LabSurvivalGuide/chem/URINALYSIS.html