Proteinuria: Key Questions About Kidney Health and Lifestyle

Q: Proteinuria: Key Questions About Kidney Health and Lifestyle

Q1. <br>News reports online indicate that some doctors state： "Chronic kidney failure typically takes 20 to 30 years from the initial damage to the kidneys until dialysis is needed." Dr. <br>Wu, is this statement accurate? Given that different stages of chronic kidney disease (st

Inquiry Consultation

Dear Dr.
Wu,
I had a health check-up in September 2015, during which my fasting blood glucose level was 95 mg/dL; my estimated glomerular filtration rate (eGFR) was 105 mL/min; my albumin level was 3.5 g/dL; and my albumin-to-globulin ratio was 1.6.
All of these values were within the normal reference range.
Since that health check-up in 2015, I have not undergone any further evaluations.

In the past 1 to 2 years, I have noticed an increase in bubbles in my urine, particularly in the first morning void, where the bubbles are most prominent.
I have observed that the bubbles gradually dissipate, but this process is slow and incomplete, leaving some bubbles behind.
However, if I drink more water during the day, my urine appears to be bubble-free, indicating that the presence of bubbles is intermittent.
Due to my concerns regarding proteinuria, I would like to ask you the following questions:
Q1.
I have read reports online stating that some doctors claim, "Chronic kidney failure typically takes 20 to 30 years from the initial kidney damage to the need for dialysis." Is this statement accurate?
Q2.
Following up on the previous question, if this statement is correct and my kidney-related test results were normal in 2015, it has only been about 7 years since then.
In your opinion, even if my kidneys have started to experience inflammation or damage in the past 1 to 2 years, is it unlikely that this would lead directly to the need for dialysis?
Q3.
If I were to be diagnosed with proteinuria, does the presence of proteinuria necessarily indicate kidney inflammation or damage? Or should we also consider blood glucose levels, eGFR, albumin levels, and the albumin-to-globulin ratio for a comprehensive assessment before making a judgment?
Q4.
For patients with proteinuria, can lifestyle changes help improve their condition? (For example: drinking more water, following a low-protein diet, losing weight, and increasing physical activity) Or is it necessary for patients diagnosed with proteinuria to start medication to prevent kidney damage?
Q5.
I have a habit of drinking tea (both black and green tea), with sugar levels ranging from lightly sweetened to unsweetened, and I control my intake to about 600 mL per day.
In your opinion, does my tea-drinking habit and content (both black and green tea, lightly sweetened and unsweetened, approximately 600 mL daily) pose a risk for proteinuria or kidney damage (or kidney stones)? (Note: I have been regularly monitoring my blood pressure over the past few years, and the readings have all been normal, with no hypertension.)
Thank you for your guidance, Dr.
Wu.

A-Xiang, 40~49 year old female. Ask Date: 2023/03/08

Dr. Wu Hongjie reply Internal Medicine

Q1.
News reports online indicate that some doctors state: "Chronic kidney failure typically takes 20 to 30 years from the initial damage to the kidneys until dialysis is needed." Dr.
Wu, is this statement accurate? Given that different stages of chronic kidney disease (stages 3, 4, and 5) and risk factors (such as blood sugar, blood pressure, high protein intake, pain medications, and other chronic diseases) vary in severity, it cannot be generalized.
Q2.
Following up on the previous question, if the statement is correct, my kidney-related test values were normal in 2015, and it has only been about 7 years since then.
Dr.
Wu, in your opinion, even if my kidneys have started to show inflammation or damage in the last 1 to 2 years, is it still unlikely to progress directly to needing dialysis? The previous statement may not necessarily be correct.
Q3.
If I do have proteinuria after testing, Dr.
Wu, does the presence of proteinuria always indicate inflammation or damage to the kidneys? Or should we also consider blood sugar levels, estimated glomerular filtration rate (eGFR), albumin, and the albumin-to-globulin ratio for a comprehensive assessment? Kidney disease staging indicates that an eGFR greater than 90 is stage 1, between 60 and 90 is stage 2, and between 30 and 60 is stage 3.
Persistent proteinuria indicates kidney damage.
Q4.
Dr.
Wu, for patients with proteinuria, can lifestyle changes help improve their condition? (For example: drinking more water, following a low-protein diet, losing weight, and increasing exercise) Or once proteinuria is detected, must patients necessarily undergo medication treatment to prevent further kidney damage? Low salt, low protein, controlling hypertension, weight loss, and avoiding pain medications can all lead to some degree of improvement.
Q5.
I have a habit of drinking tea (both black and green tea), with sugar levels ranging from lightly sweetened to unsweetened, and I control my intake to about 600 milliliters per day.
Dr.
Wu, in your opinion, does my tea-drinking habit and content (both black and green tea, lightly sweetened and unsweetened, approximately 600 milliliters per day) pose a risk for proteinuria or kidney damage (or kidney stones)? In the absence of diabetes, moderate sugar intake should not harm kidney function, but if blood sugar exceeds 100, it may start to cause health issues.
There are no reports linking healthy tea consumption to kidney damage.
Additionally, I have been regularly monitoring my blood pressure over the past few years, and the readings have all been normal, with no hypertension.
I appreciate your clarification, Dr.
Wu.
Thank you.

Reply Date: 2023/03/08

More Info

Understanding proteinuria and its implications for kidney health is crucial, especially for individuals who have noticed changes in their urinary patterns, such as increased foaming. Let's address your questions systematically.

Q1: Is it true that chronic kidney failure can take 20-30 years to develop before dialysis is needed?
Yes, this statement is generally accurate. Chronic kidney disease (CKD) often progresses slowly over many years, and many patients may not experience significant symptoms until the later stages of the disease. The timeline can vary significantly based on individual health factors, underlying conditions (like diabetes or hypertension), and lifestyle choices. Regular monitoring and early intervention can help slow the progression of kidney disease.

Q2: Given my normal kidney function tests in 2015, is it likely that I would need dialysis after only 7 years?
While it is possible for kidney function to decline over a relatively short period, especially if there are underlying risk factors or acute injuries, the fact that your previous tests were normal is reassuring. If you have not experienced significant health changes or risk factors since then, it is less likely that you would need dialysis so soon. However, the presence of proteinuria can indicate potential kidney issues that should be evaluated further.

Q3: Does the presence of proteinuria always indicate kidney inflammation or damage?
Not necessarily. While proteinuria can be a sign of kidney damage or inflammation, it is not definitive on its own. A comprehensive evaluation, including blood sugar levels, eGFR, and the albumin-to-globulin ratio, is essential to assess kidney health accurately. Sometimes, transient proteinuria can occur due to factors like dehydration, exercise, or stress.

Q4: Can lifestyle changes help manage proteinuria, or is medication always necessary?
Lifestyle modifications can significantly impact kidney health and may help manage proteinuria. Recommendations include:
- Hydration: Drinking adequate water can dilute urine and reduce protein concentration.

- Diet: A balanced diet with controlled protein intake can alleviate stress on the kidneys. For most individuals, a moderate protein intake is advisable, while those with kidney disease may need stricter limits.

- Weight Management: Maintaining a healthy weight can reduce the risk of diabetes and hypertension, both of which can exacerbate kidney issues.

- Exercise: Regular physical activity can improve overall health and help manage weight and blood pressure.

However, if proteinuria persists or worsens, medical treatment may be necessary to prevent further kidney damage.

Q5: Does my tea consumption affect proteinuria or kidney health?
Moderate tea consumption, particularly green and black tea, is generally considered safe and may even offer health benefits due to their antioxidant properties. However, excessive consumption of caffeinated beverages can lead to dehydration, which might exacerbate proteinuria. The key is moderation. Your current intake of around 600 ml per day seems reasonable, especially if you are mindful of sugar content and overall hydration.

Conclusion
In summary, while the presence of proteinuria can be concerning, it does not automatically indicate severe kidney damage. Regular monitoring and a holistic approach to health—incorporating lifestyle changes, dietary adjustments, and routine check-ups—are essential for maintaining kidney health. If you have ongoing concerns about your kidney function or proteinuria, consulting with a nephrologist for a thorough evaluation and personalized advice is highly recommended.

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