Haimchand Barran
Internal Medicine / Infectious Diseases MMSc
Fellowship – Nephrology
Department of Nephrology – GPHC

As mentioned in previous articles, some patients with COVID-19 have exhibited kidney damage through acute kidney injury (AKI), mild proteinuria (urine protein), hematuria (blood in the urine), or small elevation in creatinine (blood marker tests for kidney function). Today we will cover protein and blood in the urine in our ongoing series.

Protein in urine
People with proteinuria have unusually high amounts of protein in their urine. The condition is often a sign of kidney disease. Your kidneys are filters that don’t usually allow a lot of protein to pass through. When the kidney is damaged, then proteins like albumin can leak from your blood to your urine. You can also get proteinuria when your body is making too much protein.
Kidney disease often has no early symptoms. Protein in your urine may be one of the first signs. Your doctor may see proteinuria on a urine test during normal physical. Over time, as it gets worse, you may have symptoms including foaming or flushing urine; swelling (edema) in your hands, feet, abdomen and face; urination more often; shortness of breath; tiredness; loss of appetite; stomach upset and vomiting; and muscle cramps at night.
Proteinuria can be caused by some common things including dehydration, inflammation, low blood pressure, fever, intense activity, high stress, kidney stones, daily aspirin intake, and very low temperatures.
Conditions that damage your kidneys can also cause you to have too much protein in your urine. The two most common are diabetes and high blood pressure.
Other serious conditions that can cause proteinuria include immune disorders such as lupus, kidney inflammation (glomerulonephritis), blood cancer called multiple myeloma, preeclampsia (affecting pregnant women), protein build-up in your organs ( amyloidosis), cardiovascular disease, intravascular hemolysis, a condition in which red blood cells are destroyed, kidney cancer, and heart failure.
Factors that may make you more likely to have protein in your urine include obesity, being over 65, a family history of kidney disease, and being of African American / Native American / Hispanic / or Pacific Islander origin.
Some people get more protein for their urine when standing than lying down. This condition is called orthostatic proteinuria. A urine test, called urinalysis, can tell if you have too much protein in your urine.

Blood in urine
Having blood in your urine can be a sign that something is wrong with your kidneys or other part of your urinary tract. The medical name for blood in your urine is hematuria.
There are two types of hematuria: if you can see the blood in your urine, it’s called gross hematuria; and if you can’t see the blood in your urine without looking at it under a microscope, it’s called microscopic hematuria.
Anyone can have hematuria, but you may be more likely to have it if you have a family history of kidney disease; having an enlarged prostate (in men); have a history of having kidney stones; take certain medicines, such as pain relief, blood thinners and antibiotics; engaging in active (difficult) exercise; or have recently had, or had an infection.
There are many reasons you may have blood in your urine. Having blood in your urine does not necessarily mean you have kidney disease. Some common causes are periods; vigorous exercise (difficult); sexual activity; and have a virus, injury or infection, such as a urinary tract infection (UTI).
Other more serious problems can also cause blood in your urine. Some of these problems include kidney or bladder cancer; inflammation or swelling in your kidneys, prostate (in men) or other part of your urinary tract; polycystic kidney disease; blood clots or diseases that cause problems with blood clotting; and sickle cell disease
You may not notice any symptoms if you have microscopic hematuria. If you have gross hematuria, you may notice that your urine is pink, red or brown. This happens because the blood in your urine makes it a different color. If you have gross hematuria, you may have blood clots in your urine, which can be painful.
If you notice that your urine is a different color than usual, or if you experience urine pain, tell your healthcare provider. He or she may do some tests to find out why you have blood in your urine or what causes the pain and what treatment would be best for you.
The treatment for getting blood in your urine depends on what is causing the problem. For example, if you have blood in your urine because of an infection, your doctor may tell you to take antibiotics. If you have blood in your urine for another reason, you may need a different type of treatment.
To find out why you have blood in your urine, your doctor may ask you for a urine sample. The urine sample can be used to test for signs of infection, kidney disease or other problems. Your doctor will use the results of the urine test to decide if you need more tests or whether you can start treatment.

Article submitted as part of the Ministry of Health’s COVID-19 public information and education program. For questions, please email [email protected]

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