Protein in urine

[Savreen1]

Hello everyone, this time found protein in my urine first time. Never found since diagnosed with CKD. Can you share some ideas plz to reduce protein from urine???

Thanks

[Skeptix]

Are you aware of latest guidelines regarding diet and CKD? And if so, are you on a plant based low/very low protein diet? What is you protein spillage level (ACR or PCR)? What eGFR are you? Are you on an ACE/ARB med?

[Savreen1 in reply to Skeptix]

Thanks for reply Skeptix. I’m vegetarian from last 12 years. I just drink tea with cow milk in mng. No eggs, no meat. My gfr is 30. Creatinine 1.82. But protein in urine trace just this time 52.4 mg.

[Skeptix in reply to Savreen1]

Out of interest, was that veg diet driven by your ckd or something you did for other reasons?

Plant fits into the scheme well (I've milk in my coffee and the odd egg every now and then) but the other central plank is protein intake (as in seriously limiting it). You any idea what that intake is g protein/kg body weight? Like, you could be horsing protein down, even though on a plant diet!

Me, for example, am running 0.43g/kg as part of a very low protein diet (same eGFR as yourself). Very low protein diets are showing demonstrable promise according to the very latest NKF KDOQI guidelines (2020).

It's early days (I'm only on the vegan / lo protein diet about 6 months) but protein spillage in urine has dropped like a stone. I've to tease out how much of that improvement is due to a moderate ACE medication increase and how much due to diet but I'm suspecting diet is the big influencer.

Proteinuria, along with high BUN are two big drivers of CKD progression.

Your doctor suggesting a med for protein in urine?

You got an ACR or PCR figure (both expressed as a ratio. mg/mmol, for instance)? What was the 54mg, a 24 hour test or something? You under nephrologist care?

[Bond-007 in reply to Savreen1]

Dr Greger recommended a whole food plant based diet in his book, “how not to die”. It excludes dairy. Do you want to try eliminating cow’s milk? Another book by a person with kd said that plant protein was ok, but animal protein was not so not all protein is bad. Everything points to a whole food plant based diet as good, except Greger admits rarely about inadequate iron from this diet i believe. Recent research seemed to suggest overall for all cause mortality that a plant based diet with a little fish was best. I think that may be due to the omega free fatty acids in fish oil. I gave that diet a try and my acid reflux was cured and my mom had no more edema or acid reflux.

[Sophiebun11]

Hi Savreen,

Are you on a plant based diet. Reducing the animal protein in your diet will reduce the protein in your urine.

Here's a link explaining a plant based diet, what to eat for each stage of CKD, and meal plans:

kidney.org/atoz/content/pla...

You could also ask your primary Dr. or Nephrologist for a referral to a renal dietician to help you work out a specific meal plan for you depending on your other health issues.

Best of luck.

🐇

[userotc in reply to Sophiebun11]

Re "Reducing the animal protein in your diet", you seem to advocate just reducing animal?

The link you provided refers to the 50/50 guidance so half of your protein should come from “high biological value” (HBV) sources, which are almost entirely animal sources (meat, fish, poultry, egg whites, dairy).

[Sophiebun11 in reply to userotc]

Hi userotc, The link I provided has many links on it that show a variety of diets to try to address the initial question. I later down the thread read the poster is a vegetarian so there are links within that link on CKD vegetarian foods as well since you still need to limit salt, potassium, phosphorous and other nutrients. I hadn't known that when I posted.

I was just giving it as an example of ways to reduce protein in urine. Reducing animal protein is the easiest way to reduce protein in the urine.

I think the percentages are that 80% of plant protein is absorbed by the body and only 30% of animal protein is absorbed and the kidneys must work hard to remove the rest. So if you eat plant protein your kidneys are working 50% less.

I think my math was right on that LOL Everyone decides to eat differently and even just eliminating or drastically reducing red meat will make a difference. Anything you do to remove animal protein will create an easier job on the kidneys.

A plant based diet is recommended for cardiac patients, diabetics and those with CKD.

Best wishes.

[Savreen1]

Thanks Sophiebun, I’m vegetarian from last 12 years. I’m just drink tea once a day in mng with cow milk. No eggs, no meat. I don’t have any other health issues. I had preeclampsia in 2020.

[Skeptix in reply to Savreen1]

Your BP is okay now I take it? Meds required to maintain it?

[Savreen1 in reply to Skeptix]

Yes my bp is perfect. Taking one medicine(telmirstan 40 mg) at night time.

[Skeptix in reply to Savreen1]

For the BP I take it? It's an ARB which is also prescribed for proteinuria (I take ACE for both BP and proteinuria).

Might be that without the ARB you'd be leaking more protein than you currently are. Dunno whether 40mg is a big or little dose but you could ask about bumping it up if the spillage was rising. One for your doc to consider and advise on

P.S. the latest KDIGO guidelines have revised down target BP in CKD. Used to be systolic 130. Now 120 is the new perfect!

[Sharam]

Hello!

Is that 52 mg in a 24 h sample or a random sample?

Cause mine was 45 mg/24h last year and the normal range read less than 150 mg/24h!

My random sample three weeks ago showed 5 mg/dl which is still normal according to the lab normal range! But now I'm a little scared!

[userotc in reply to Sharam]

Why are you scared at urinary total protein (utp) of 5mg/dl? I dont know what your lab normal range is(?) but it seems that it is well within the "healthy" range at <20mg/dl healthcheckup.com/general/p...

My mum's utp is also within that "healthy" range at 8mg/dl even though her 24h figure continually rises with latest 440mg.

[Sharam in reply to userotc]

Well, I know, it's in the normal range. But the test was a urine protein electrophoresis (random, and not 24h) ordered by my hematologist, after I told him about my kidney problems, and after seeing the results he said "You have albumin in your urine. consult your nephrologist!"The result reads 'Albumin: 2.7 mg/dl (Normal Range: 0 — 3.8)

Total protein: 5 mg/dl (Normal Range: 0 — 10)

The nephrologist said a 24-h urine protein electrophoresis test was supposed to be ordered not a random one.

Then I tried to do the math! (I know of course it's not how they do it, but thought to myself maybe I can have an estimation)

I thought 5 mg/dl equals 50 mg/l, and if my normal 24-h urine volume is 1.5 liters (which is usually the case for me!), then there must be 75 mg protein in my urine in 24 hours! Lol

I know it sounds ridiculous, but I tend to read the results and do stuff like this to stress myself out!

Unfortunately, my nephrologist didn't even read the results closely, at first!

At first, after looking at my urine protein electrophoresis she said "Most people normally pass 30 mg protein a day into urine."

Then I told her it wasn't a 24 hr test. Then she took another look and creatinine increasing levels (1.1, 1.17, 1.24) and was like "We usually order a 24-h urine protein electrophoresis test, not a random test. Your kidneys seem not to be working as well as they should. You need to have a test to make sure it's not above 1.3 now. Then twice a year, you need to have the same test."

Last year my first nephrologist said I probably have ckd but an early stage. But didn't do anything.

[userotc in reply to Sharam]

If confirmed in further tests, I doubt that youll get much support from medics whilst youre in the normal range. We get none and mum's urinary protein is well above range and climbing!

The good news is you can do plenty yourself with diet and wellbeing. We are doing it ourselves with mum as nephro appears to know nothing about those things and no renal dietician has been appointed. You can seek help via an RD (if medics agree!), support on this forum, contracting a specialist naturopathic nutritionist and/or doing your own research. Good luck in which choice you make.

[RoxanneKidney]

Even if you do not have high blood pressure, the protein leakage can possibly be stopped by an ACE or ARB med. Mine has been for now...because my bp was not high to begin with I am on a really low dose, but I also stay away from animal protein and salt. THis seems to work for now.

[Stage1]

I would be leery of any advice advocating a strict plant-based diet. Vegans like to talk about the good stuff in plants, but they never talk about the bad stuff, such as oxalates, or the lack of nutrients in plants. My doctor's advice after losing a kidney was to eat a heart healthy diet and the amount of protein in my diet should be based on my body's needs. If I'm working out regularly, then more protein is fine. If I'm living life as a couch potato, then less protein is better.

[Skeptix in reply to Stage1]

It's less vegans talking about the good stuff in plants and more people who look at the science concluding they'd better go vegan. I'd like a 1/4lb-er with bacon and cheese just like the next man but it just isn't advisable.

The very latest science and the guidelines deriving from that (KDOQI 2020) advocate very low protein diets as most kidney preserving, starting early stage. That necessarily means meat has to go - its too protein rich for such diets.

Now, one size doesn't fit all but that's the general recommendation. It's given a 1A grade recommendation, this kind of diet. That translates to 'no brainer' such is the clarity and breadth evidence supporting it. Your kidney doc, like lots of kidney docs, aren't necessarily with the programme, aren't necessarily up to speed. Not least because diet isn't their thing at early stage. This is all going to take time to implement in practice.

Whilst there are issues with plant, there are, it seems bigger issues with animal.