Urine · 3 analyses
Protein/creatinine ratio
Measures total protein and creatinine in urine and calculates the protein/creatinine ratio. To follow up protein in the urine or monitor protein loss.
€ 23,00
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Kidneys and electrolytes · Urine
Total protein (urine)
The amount of protein in a urine sample, as a number; a measure of protein loss through the kidneys.
At a glance
- Measured in urine
- In 1 test panel
- Check the preparation
Explanation
Total protein (urine): what is measured?
Healthy kidneys retain the proteins in the blood; only very little ends up in the urine. This analysis measures the concentration of all proteins together in a urine sample, so albumin and also other proteins that a urine dipstick detects poorly. This makes the measurement suitable for following up a positive urine dipstick and for monitoring protein loss. The concentration also depends on how much you have drunk; that is why total protein is usually divided by the creatinine in the same urine (the protein/creatinine ratio).
What can it detect?
- Protein loss through the kidneys, for example due to kidney damage in diabetes or high blood pressure or due to inflammation of the kidney filters (glomerulonephritis)
- Temporary protein loss due to heavy exercise, fever or a urinary tract infection
- Proteins other than albumin in the urine, which a urine dipstick can miss
Result
What does the result mean?
Total protein (urine) too high
A raised concentration may point to protein loss through damaged kidney filters, usually due to diabetes or high blood pressure, sometimes due to a kidney disease such as inflammation of the kidney filters. Often a rise is temporary: after heavy exercise, with fever, dehydration or a urinary tract infection, or in some young people only after standing for a long time. Blood or discharge in the urine and highly concentrated urine also give a higher value. Rarely, proteins end up in the urine because the body makes too much of an abnormal protein; this calls for further testing. With a lot of protein loss, swollen ankles and foamy urine can develop.
Total protein (urine) too low
A low or unmeasurable concentration is normal: healthy kidneys retain proteins. In very diluted urine, for example after drinking a lot, a small amount of protein can be missed; the protein/creatinine ratio corrects for this. A normal value does not rule out early kidney damage: a small amount of albumin gets lost among the other proteins, and the albumin/creatinine ratio is more sensitive for that.
After an abnormal result
With a raised value, the GP rules out a urinary tract infection, repeats the measurement in morning urine, usually as the albumin/creatinine ratio, and has the eGFR in blood measured. With a lot of protein, a rapidly declining kidney function or protein together with blood in the urine, referral to an internist-nephrologist may follow.
Reliability
How reliable is the test?
The concentration of total protein in a single urine sample depends on how concentrated the urine is and therefore mainly means something together with creatinine in the same urine. The measurement detects all proteins, including proteins that a urine dipstick misses, but it is less sensitive to early kidney damage than albumin in urine; the Dutch GP guideline (NHG) on chronic kidney damage therefore uses the albumin/creatinine ratio to diagnose kidney damage. Because protein in the urine is often temporary, an abnormality only counts if it persists on repeat testing.
What can affect the result?
- Heavy exercise in the day before the sample, fever, a urinary tract infection, dehydration and menstruation can raise the value temporarily.
- How much you have drunk determines the concentration; a single value without creatinine is hard to compare with another measurement.
- In some young people, protein only appears in the urine after standing for a long time (orthostatic proteinuria); morning urine is then normal.
- Measurement methods for total protein do not react equally strongly to all proteins, so results can differ between laboratories.
Preparation
- Preferably use morning urine.
- Do not do heavy exercise in the 24 hours before collecting the urine; it temporarily raises protein in the urine.
- Do not collect urine during your period.
Who it is for
Who is the test useful for?
Useful for
Useful for following up a positive urine dipstick or for monitoring known protein loss, together with creatinine in the same urine. For detecting early kidney damage in diabetes, high blood pressure or cardiovascular disease, the albumin/creatinine ratio is more sensitive. In healthy people without symptoms or risk factors, the chance of an abnormality is small and a slightly raised value is often temporary.
How common is it?
Chronic kidney damage affects about 1 in 10 adults in the Netherlands, more often at older ages and in people with diabetes and high blood pressure. Protein in the urine is often the first sign. In about 5 in 100 Dutch people, chronic kidney damage is known to the GP; so many people with kidney damage do not know it.
NHG guideline on chronic kidney damage; NIVEL primary care registrations (2021)
Drawbacks and risks
- A temporarily raised value after exercise or with an infection can wrongly look like kidney damage and cause unnecessary worry.
Get tested
Total protein (urine): test panels
Total protein (urine) is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.
Evidence
Sources
This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.
More about risks and resultsMore explanations
Other tests: Kidneys and electrolytes
- Albumin (urine)
- Albumin/creatinine ratio
- BUN/creatinine ratio
- Chloride
- CO2 (bicarbonate)
- Creatinine
- Creatinine (urine)
- Cystatin C
- eGFR
- Phosphate (inorganic)
- Potassium
- Protein/creatinine ratio