Is proteinuria a contraindication for cataract surgery?

Proteinuria is NOT a Contraindication for Cataract Surgery

Mild proteinuria (15 mg/dL, equivalent to trace on dipstick) does not contraindicate cataract surgery and the procedure can proceed safely. The provided evidence addresses proteinuria in contexts of kidney disease management, pregnancy, and major surgeries (cardiac, renal, abdominal), but contains no guidelines or research suggesting proteinuria is a contraindication for cataract surgery—an outpatient ophthalmologic procedure with minimal systemic stress.

Clinical Context and Risk Assessment

Understanding the Proteinuria Level

• A value of "15" likely refers to 15 mg/dL, which corresponds to trace proteinuria on dipstick testing 1
• This level is below the threshold for clinically significant proteinuria (≥30 mg/dL or 1+ on dipstick) 1
• Trace proteinuria can be transient and may result from benign causes including dehydration, fever, exercise, or orthostatic proteinuria 2

Proteinuria as a Surgical Risk Marker

The available evidence demonstrates that proteinuria serves as a risk marker primarily for major surgeries with significant hemodynamic stress:

• Cardiac surgery (CABG): Preoperative proteinuria predicts postoperative acute kidney injury, long-term mortality, and progression to dialysis 3
• Major inpatient surgery: Proteinuria is associated with postoperative AKI and 30-day readmission in a dose-dependent manner 4
• Nephrectomy: Severe proteinuria (>500 mg/day) is associated with worse overall survival 5, 6

However, cataract surgery differs fundamentally from these procedures:

• It is an outpatient procedure lasting 15-30 minutes
• It involves minimal hemodynamic stress
• It requires no general anesthesia in most cases
• It has negligible impact on renal perfusion or systemic physiology

Recommendation for Proceeding

The Surgery Can Proceed

• Cataract surgery should not be delayed or cancelled based on trace proteinuria alone
• The level of proteinuria described (15 mg/dL) is minimal and does not indicate contraindication to any elective surgery, let alone a low-risk ophthalmologic procedure

Appropriate Clinical Actions

While the surgery can proceed, consider these steps for comprehensive care:

• Document the finding: Note the trace proteinuria in the preoperative assessment
• Assess for underlying conditions: If not already evaluated, consider whether the patient has diabetes, hypertension, or known kidney disease that might explain the proteinuria
• Postoperative follow-up: Recommend the patient follow up with their primary care physician to evaluate persistent proteinuria if it has not been previously investigated 2

Common Pitfalls to Avoid

• Do not over-interpret trace proteinuria: Values of 15 mg/dL represent trace amounts that may be physiologic or transient 1
• Do not apply risk stratification from major surgery: The evidence linking proteinuria to surgical complications applies to procedures with significant physiologic stress (cardiac surgery, major abdominal surgery), not to cataract surgery 3, 4
• Do not delay necessary vision restoration: Cataract surgery significantly improves quality of life, and delaying it based on minimal proteinuria would cause unnecessary harm through prolonged visual impairment