Persistent Foamy Urine: Is It a Sign of Proteinuria? - Internal Medicine

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The first urine in the morning shows a slight foam that has not dissipated for a long time?


Hello Doctor: Recently, I have started to pay attention to the issue of foamy urine, so I have been carefully observing the characteristics of each urination daily.
Since I am currently waiting to continue my education, I spend more time at home and can sleep longer, about eight hours.
I understand that the first morning urine tends to be more concentrated, and due to the larger volume and the impact from a height, there are more bubbles (visually, the amount of bubbles is about half of the toilet water).
The color is also darker.
However, I have noticed that the bubbles dissipate slowly, taking about five minutes for most of them to disappear.
This morning, after urinating and not flushing, I went back to sleep for about two hours.
When I woke up and checked again, I found a small amount of light-colored substance floating on the urine, and upon closer inspection, I realized it was very fine bubbles.
I would like to ask the doctor if this situation indicates an abnormal amount of urinary protein.
Aside from the first morning urine, the urine at other times, regardless of concentration, almost disappears quickly; the dilute urine lasts about a few seconds, while the concentrated urine lasts about two minutes.

Medication situation: Because I have been frequently observing the bubbles in my urine, I have been quite anxious, leading to significant emotional fluctuations, which often cause discomfort in my stomach, bloating, and nausea after meals.
Therefore, the day before, I took a total of five stomach medications (two after breakfast, two after lunch, and one after dinner).

Past examination status: (1) Due to a family history of diabetes, three weeks ago, I went to a family clinic for preventive testing along with my family.
The blood sugar two hours after a meal was normal, and urine glucose was normal, but there was one positive for urinary protein and one positive for occult blood.
The family doctor suspected I had urethritis and prescribed medication, but that was three weeks ago, and I have already finished the medication.
(2) Five years ago, I underwent two full-body health checks within the same year due to military service and graduate school entrance exams, with about six months apart between the two.
During the military health check, everything was normal, but the entrance exam check showed elevated uric acid and positive urinary protein (the report did not specify how many positives).
At that time, I did not understand the causes of urinary protein, and my family dismissed my concerns by saying I was eating too well, so I did not follow up on it.

I kindly ask the doctor for clarification on the above matters.

Mr. Wang, 20~29 year old female. Ask Date: 2016/06/05

Dr. Huang Yaoxuan reply Internal Medicine


Hello Mr.
Wang: The presence of bubbles in your urine may indicate proteinuria, but it could also be caused by other substances.
Clinically, only proteinuria is known to affect health, so when we encounter bubbly urine, we typically conduct a test for urine protein.
Urine protein levels can be influenced by other factors that may interfere with accuracy, such as physiological proteinuria (which can occur after intense exercise), urinary tract infections (such as cystitis or urethritis), hematuria, etc.
Even if elevated urine protein is detected in these situations, it may not necessarily indicate a problem.
Since you had a test three weeks ago suggesting possible inflammation and received treatment, I recommend that you bring your previous test results to your physician for further evaluation to determine if additional follow-up testing is necessary.
Thank you.

Reply Date: 2016/06/05

More Info


Foamy urine can indeed be a sign of proteinuria, which is the presence of excess protein in the urine. This condition can be indicative of underlying kidney issues, as the kidneys are responsible for filtering waste products from the blood while retaining essential proteins. When the kidneys are damaged or diseased, they may allow proteins, particularly albumin, to leak into the urine, leading to foamy urine.

In your case, you mentioned that you have observed foamy urine, particularly in the morning, which is often more concentrated due to overnight fluid retention. The persistence of bubbles in your urine, especially if they take longer to dissipate, could suggest that there is a higher concentration of protein present. Normal urine typically does not produce significant foam, and if it does, it usually dissipates quickly. The fact that you noticed a layer of fine bubbles remaining after some time could be a cause for concern.

You also mentioned previous tests that indicated the presence of protein and blood in your urine. The presence of protein (even at a trace level) can be a sign of kidney dysfunction, and the presence of blood (hematuria) can indicate a variety of conditions, from urinary tract infections to more serious kidney issues. Given your family history of diabetes and your recent symptoms, it would be prudent to follow up with a healthcare provider for further evaluation.

To assess for proteinuria more accurately, a 24-hour urine collection test is often recommended, as it provides a comprehensive view of protein excretion over an entire day. However, spot urine tests, such as the protein-to-creatinine ratio, can also be useful. A ratio greater than 0.15 g/g is typically considered abnormal and warrants further investigation.

In addition to proteinuria, it is essential to consider other factors that could contribute to your symptoms. For instance, your gastrointestinal discomfort and anxiety about your urinary symptoms could be interrelated. Stress and anxiety can exacerbate gastrointestinal issues, leading to symptoms such as bloating and nausea. It is essential to address both your physical and emotional health, as they can significantly impact one another.

Given your history of urinary symptoms and the recent observations of foamy urine, I recommend scheduling an appointment with a nephrologist or a urologist. They can perform a thorough evaluation, including urine tests, blood tests, and possibly imaging studies, to determine the underlying cause of your symptoms. Early detection and management of any kidney issues are crucial, especially considering your family history of diabetes, which can increase the risk of kidney disease.

In summary, while foamy urine can indicate proteinuria and potential kidney issues, it is essential to conduct further tests to confirm the diagnosis and understand the underlying causes. Your previous urinary symptoms and family history warrant a comprehensive evaluation to ensure your kidney health is monitored and managed appropriately.

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