Proteinuria (Albuminuria/Microalbuminuria)

Availability

North South North West Statewide

Pre-referral work-up

History

Who should be referred with Proteinuria?  

  • Nephrotic Syndrome:Oedema, Hypoalbuminaemia or suggestive symptoms with >3.5g/24hr protein
  • Consider referral for patients with>0.5g/24hr proteinuria - Not explained by correlating   diabetic history - especially if associated with progressive decline in kidney function

Quantifying Proteinuria:

  • Urine ACR (random or first morning) is generally a sufficient screen for albuminuria/microalbuminuria in diabetic and non-diabetic populations and is a useful test in most Renal Clinic referrals (First morning specimens increase specificity - but not absolutely necessary)
  • Urine dipstick is not calibrated to detect microalbuminuria (<30ug albumin/24hr) but is useful in screening for proteinuria in those excreting >0.3g/L (1+ on dipstick)
  • 24 hour Quantification: Where urine ACR is significantly elevated (>100g/mol) consideration can be given to 24 hour urine protein collections (Not generally required in most low level albuminuria but is more likely to be helpful in those with suspected Nephrotic Syndrome)
  • Low level albuminuria/proteinuria can occur transiently during fever, cardiac failure, after strenuous exercise (usually no more than Trace on dipstick)
  • Haematuria and Proteinuria present together is strongly suggestive of a glomerular source for Haematuria

All referrals should comply to referral standards and include in particular:

  • Duration of haematuria
  • Associated symptoms including diabetes
  • Physical examination including blood pressure
  • Smoking history, occupational history especially exposure to chemicals
  • Past urological/renal history

Tests

  • FBC
  • UEC
  • LFT
  • Comprehensive metabolic panel (includes calcium, magnesium, phosphate, urea, bicarbonate, chloride, blood glucose)
  • Consider lipids
  • Urine Albumin/Protein Quantification (Generally Urine ACR)
  • Consider renal ultrasound if anatomical imaging needed

Interim/GP management

To refer a patient with this condition, please see the Nephrology (Renal) clinic page for the full referral process and templates.

Who does not usually need to be referred to a Nephrologist?

  • Stable eGFR 30–89 mL/min/1.73m2
  • Minor proteinuria (< 0.5 g/24hrs with no haematuria) - particularly in known diabetics
  • Controlled blood pressure

For more information please see the Tasmanian Health Pathways website.

Urgent / category 1

(Glomerular Haematuria) Presence of Proteinuria and Haematuria with associated rapid unexplained decline in kidney function (>25% decline in GFR over 6-12 weeks)

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

* Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention.  They may or may not indicate an emergency.

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED – Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6173 0489 OR contact Renal Advanced Trainee or Nephrologist on Service via RHH Switchboard (03) 6222 8303 to facilitate urgent review/advice

Urgent:

Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review and the referral must be faxed.

We will endeavour to see these patients within four weeks, or sooner if clinically indicated.

Semi-urgent:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment