Proteinuria: When to Stop Medication After Normal Results

Urinary protein has turned negative, doctor: You can stop the medication now?

Hello, Doctor Wu:
Over three months ago, during a routine check-up, I was found to have trace proteinuria with results of "PCR 189, uACR 54.8, creatinine 1.1, and urea nitrogen 7." The doctor prescribed me "Blood Li" enteric-coated tablets for one month.
Upon follow-up after a month, my results were "uPCR 126.5, uACR 15.6, creatinine 1.1, and urea nitrogen 13.6," and the same medication was prescribed for three months (chronic prescription).

Two months later, I noticed white cloudy substances floating in my urine, and there were more bubbles than before.
I rushed back to the outpatient clinic, but my original nephrologist was unavailable, so I consulted a urologist.
The test results were as follows: "uPCR 100.9, uACR 14.5, creatinine 1.1, and urea nitrogen 11." The doctor said everything was normal and that I did not need to continue medication, so no prescriptions were given.
However, after returning home and researching online, I found that the treatment for chronic kidney disease requires ongoing medication.

I would like to ask the doctor: Is it correct that since the data is normal, I do not need to continue medication? My family has a history of diabetes, and I regularly check my HbA1c levels, with the most recent result in January being 5.5, which is normal.
I have been checking my kidney function every two months, and the results have always been normal.
The last urine protein test was conducted ten days before my company’s health check, and the results were also normal.

I have heard that if proteinuria is detected, it is best to wait for a period before rechecking to draw a conclusion.
Is this statement correct? If so, can my situation (having only tested once) confirm kidney inflammation, or can I follow the urologist's advice and stop the medication? I apologize for bothering you during your busy schedule, and I hope you can help clarify my doubts.
Thank you!

A Liao, 50~59 year old female. Ask Date: 2019/03/22

Dr. Wu Hongjie reply Internal Medicine

A single urine test for protein is convenient and sufficiently accurate, but it is often best to use the first morning urine.
If you want to accurately determine whether protein in the urine has completely disappeared, you may consider a 24-hour urine protein test.
If the result is still <150 mg/day, then the protein level in the urine is considered normal, and you may consider reducing or discontinuing medication.
Wishing you health and peace.

Reply Date: 2019/03/22

More Info

When it comes to managing proteinuria and the decision to stop medication, it is essential to consider various factors, including the underlying cause of the proteinuria, the results of recent tests, and the overall clinical picture. In your case, you initially presented with proteinuria, which was treated with medication, and subsequent tests showed improvement. However, the question of whether to discontinue medication is nuanced and requires careful consideration.

Firstly, the presence of protein in urine (proteinuria) can be indicative of various conditions, ranging from benign to serious. In your case, the initial lab results showed a protein-to-creatinine ratio (PCR) of 189 and an albumin-to-creatinine ratio (uACR) of 54.8, which are elevated and suggest significant proteinuria. After treatment, your follow-up results indicated a reduction in protein levels (PCR of 126.5 and uACR of 15.6), and further tests showed even lower levels (PCR of 100.9 and uACR of 14.5). These improvements suggest that the treatment was effective.

The decision to stop medication should be based on a combination of factors, including the stability of your kidney function (as indicated by creatinine and urea nitrogen levels), the persistence of proteinuria, and any underlying conditions such as diabetes, which you mentioned runs in your family. Regular monitoring of kidney function and protein levels is crucial, especially in individuals with a family history of diabetes, as they are at a higher risk for developing kidney disease.

Regarding the recommendation to repeat urine tests after an initial finding of proteinuria, it is indeed a common practice to confirm the results. A single test may not provide a complete picture, as transient proteinuria can occur due to various factors such as dehydration, exercise, or infection. Therefore, it is advisable to conduct repeat testing over a period of time to establish whether the proteinuria is persistent or transient. Typically, if protein levels remain elevated over multiple tests, further investigation may be warranted to determine the underlying cause.

In your situation, since your recent tests have shown normal results, it may be reasonable to consider discontinuing medication, especially if your healthcare provider believes that your kidney function is stable and there are no other concerning symptoms. However, it is essential to maintain regular follow-up appointments and continue monitoring your kidney function and protein levels. If you experience any new symptoms or changes in your health, it is crucial to consult your healthcare provider promptly.

In summary, while your recent test results are encouraging and suggest that it may be safe to stop medication, it is vital to continue monitoring your health closely. Regular follow-ups and open communication with your healthcare provider will help ensure that any potential issues are addressed promptly. If you have any concerns or uncertainties about your treatment plan, do not hesitate to discuss them with your doctor, as they can provide personalized advice based on your specific health situation.

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