Protein in the urine should be investigated for a cause

Dear Dr. Roach: My husband had many tests for bacteria in his urine. Three months ago, he had no protein in the urine; two months ago, the number of protein was 20; one month ago, the number was 100. His urologist is not concerned. My sister, who had amyloidosis that eventually took her life, always said, “You don’t want to see protein in your urine.” Could there be a nonserious reason for all this protein? His kidney function is excellent for a 76-year-old. Should the protein be investigated? — R.S.

Answer: I agree with your instincts that protein in the urine should be investigated. While none of the 40 types of amyloidosis are common, your sister was right that protein in the urine might represent a serious condition. Nephrologists are the experts in evaluation of abnormal protein in the urine.

Usually, the first step in evaluation is determining how much protein there really is. The definitive test is a collection of all urine for 24 hours. Depending on the amount of protein, different conditions can be searched for. Unsuspected diabetes, autoimmune diseases and some cancers all may cause protein in the urine.

It’s very good news that your husband’s kidney function is excellent; however, there are still kidney-related conditions that cause protein in the urine but that may not have caused abnormal kidney function results on a blood test.

In my experience as a general doctor, small amounts of protein in the urine are only infrequently serious. It’s not uncommon, especially when a person has been fasting for a lab draw. If the urine is concentrated, it can cause the urine dipstick to read positive for protein when there is only a small amount of protein in the urine.

Dear Dr. Roach: I’m a retired nurse anesthetist. Having spent my entire adulthood in medicine, I retired at 70 years old. The reason? Intermittent memory loss.

At 74 years old, last year, I signed up for an Alzheimer’s disease research program. I believe in these programs for various reasons. I was shocked to learn that I have plaque in my brain with no family history.

I wish you would encourage more people to volunteer, if for no other reason than they could get cutting-edge therapy for free. What better way to help your family, friends and society at large? For free?

Studies are being done all over the country. Volunteer and be part of the cure. — C.C.

Answer: Thank you for writing. Very few people sign up for clinical trials, but they are necessary for scientific advancement. Almost every column I write, I base my answer on the results of controlled clinical trials.

For my own patients who are considering enrolling in a trial — I work at a major research center with many other research venters nearby — I emphasize not the possibility of a miracle cure or even cutting-edge therapy, but the benefit to society through the advancement of knowledge. Few clinical trials result in new treatments being approved, but many trials need to be done in order to have a chance to make the next big advance. Altruism, in my opinion, is the best reason for participating in a clinical trial.