AboutNewell R. Falkinburg, M.D., FACP Expertise I am a board certified nephrologist and emeritus professor of medicine at a major medical school and past Director of Nephrology & Hypertension at a university affiliated hospital. I have expertise in all areas of clinical nephrology, dialysis, transplantation and plasmapheresis.
Experience Professor of medicine
Director of Nephrology
Question QUESTION: After reading the many questions and posted answers, I'm still confused. I had a urine test - not first in the morning, just on an empty stomach(coffee only). My creatinine registered 19.1mg/dl and is notated Low. My protein, however, is 7 mg% and considered normal. But when they calculated the Prot/Creat (MG/MGCR) that came out at .37 and is notated High compared the the range of 0.00 to 0.20. Blood work done on a sample taken the same day showed Creatinine normal at .8 .
Does this indicate something I should check into further, or could this be reflecting the fact that I was not to eat any food and instructed to only drink. I drank water and coffee from 7 am until 11:30 am when the tests were taken. During that time I also urinated so I'm thinking that these things affected the concentration of the tiny urine sample I was able to produce for the test.
I look forward to hearing what you think. I don't want to ignore this finding if it is actually something to have looked at.
Thank you,
ANSWER: Dear Kate,
The relationship between creatinine, protein and urine concentration is very complex. The test you had is a screening test for elevated protein excretions into the urine and relating the amount of protein to the creatinine in the same specimen corrects the the highly dilute urine that you passed at that time. The protein should have been low as your creatinine was. Elevated protein excretion is one of two red flags for kidney disease. The other is blood in the urine which you don't have.
The question now is what to do. As I mentioned, the test that you had is only a screening test and now it must be confirmed with a full 24 hour urine collection to measure the total amount of protein excreted in a day. This is the "gold standard" for proteinuria. Since protein/creatinine ratio is for screening only, you need to have the definitive test. Also, at the same time, a creatinine clearance can be performed. This is a better estimation of kidney function then a simple serum creatinine. Hopefully, both will be normal.
I hope this helps you understand what is happening. I realize that it is very complex so if you have any further questions please feel free to follow up.
Sincerely,
Dr. Falkinburg
PS I'm curious as to what prompted your physician to perform a urine protein/creatinine ratio in the first place???
---------- FOLLOW-UP ----------
QUESTION: I continue researching information regarding the results from these random blood and urine screens. If I'm reading correctly, it seems that these numbers are somehow also related to my cholesterol levels as well. Am I correct in what I seem to understand from my research that:
Low creatinine/high protein in urine is not uncommon when high cholesterol levels are present?
High protein, in connection with high cholesterol/low HDL levels point to cardiovascular disease?
Finally, since I am 5'5", 112 lbs, active and eat a healthy diet that contains little or no fat; its not uncommon that my cholesterol difficulties have not changed with diet changes. Since I have a strong family history of high cholesterol, high blood pressure (I don't have that) and heart attacks, most likely I will require medication to bring it down from its current 240?
While I understand this is not necessarily within your area of expertise, but since they are very complicated issues and possibly interrelated, I am hoping you can help me to unravel it a little more.
Thanks,
Kate
I am trying to become well informed before I take this situation to a Dr. for help in correcting these issues.
Answer Dear Kate,
There is a kidney condition called the nephrotic syndrome which is characterized be massive amounts of protein in the urine (proteinuria) (up to 50-60 grams/day), low concentrations of protein in the blood, fat in the urine, massive swelling of the face and legs, and a greatly elevated cholesterol. It is often associated with an underlying process that over time destroys the kidney and causes kidney failure. I don't believe that you have anything like the nephrotic syndrome.
Aside from this association, there is no relationship between proteinuria and the cholesterol concentration. Certainly, with only a perturbed protein:creatinine ratio, any proteinuria that you have is very scant at best. This does not mean that it needs no attention however. It does need to be worked up.
Your elevated cholesterol, especially in view of your family history, is perfectly consistent with familial hypercholesterolemia, an inherited disease associated with accelerated hardening of the arteries and premature cardiac disease. This can be treated with any "statin" or related medicines. You need to take these along with a low saturated fat diet. If you do, you will live a long happy life. Your cholesterol should be less than 200 mg% and your "bad cholesterol" or low density lipoproteins (LDL cholesterol) less than 100. I like mine less than 70 mg%.
You need a doctor... and I'd be inclined to see a nephrologist first to get your proteinuria squared away.
