Does a female with a UTI and proteinuria require further evaluation of the proteinuria?

From the Guidelines

Yes, a female with a UTI and proteinuria requires further evaluation of the proteinuria.

Evaluation Approach

• The evaluation should include a spot urine protein/creatinine ratio to assess the level of proteinuria, as this is a convenient and accurate method for measuring proteinuria in clinical practice 1.
• A renal ultrasound should also be performed to evaluate for any underlying kidney damage or disease.
• Consider referral to a nephrologist for further evaluation and potentially biopsy, especially if the proteinuria is persistent or worsening over time 1.

Rationale

• Proteinuria is a marker of kidney damage, and further evaluation is necessary to determine the underlying cause and severity of the damage 1.
• The spot urine protein/creatinine ratio is a reliable and convenient method for measuring proteinuria, and it can provide meaningful information about the level of proteinuria and trends over time 1.
• A renal ultrasound can help to identify any underlying kidney disease or damage, and referral to a nephrologist may be necessary for further evaluation and management.

From the Research

Evaluation of Proteinuria in a Female with UTI

• Proteinuria can be associated with a renal or systemic disease, or it may be isolated 2
• In patients with a UTI, proteinuria may be a sign of an underlying renal disease, and further evaluation is necessary to determine the cause of the proteinuria 3, 4
• The presence of proteinuria, even in asymptomatic patients, requires careful evaluation to distinguish between benign and more ominous forms of proteinuria 2
• Proteinuria can be transient, orthostatic, or persistent, and persistent proteinuria may be indicative of a serious kidney pathology 5

Considerations for Further Evaluation

• The amount of protein excreted in the urine, as well as the presence of other abnormalities in the urine sediment, should be taken into account when evaluating proteinuria 2, 3
• Further evaluation should be undertaken to determine the most likely cause of the proteinuria, including consideration of glomerular disease, tubulointerstitial or vascular disorders, and other potential causes 2, 3
• The presence of both proteinuria and hematuria requires further workup and careful monitoring 5

Implications for Patients with UTI and Proteinuria

• Patients with a UTI and proteinuria should undergo further evaluation to determine the cause of the proteinuria and to rule out underlying renal disease 4
• Early recognition and treatment of proteinuria may help retard disease progression or offer an early cure, especially in older adults 6