Could Intermittent Proteinuria Indicate Multiple Myeloma Risk?

Is intermittent proteinuria possible in multiple myeloma?

Hello, I am currently 19 years old and have been experiencing intermittent proteinuria for the past four years, during which I have undergone regular monitoring (at laboratories and large hospitals).
My kidney function and liver function have consistently been normal, as well as my serum protein levels.
The presence of urinary protein has been intermittent, usually ranging from 0 to +, but occasionally reaching +++ (as it did this time).
Today, I went to a large hospital for testing, and my urinary protein has returned to normal (with kidney function also normal).
A few days ago, I researched proteinuria online and found that it could potentially be caused by multiple myeloma.
I am wondering how likely it is that this intermittent proteinuria could be related to that condition.

Cai, 10~19 year old female. Ask Date: 2016/03/14

Dr. Lai Yicheng reply Oncology

Hello Mr.
Cai,
Thank you for your letter.
Here are my responses:
1.
Regarding your inquiry about the intermittent presence of protein in your urine and its possible relation to multiple myeloma, this is unlikely.
The hallmark of multiple myeloma is persistent proteinuria.
The proteinuria associated with multiple myeloma is due to the presence of a specific protein called "Bence Jones protein," which requires specialized cancer screening tests to detect.
2.
Your routine urinalysis shows proteinuria ranging from 0 to ++, occasionally reaching +++.
This is a qualitative assessment.
I recommend that you undergo a quantitative proteinuria test to determine the exact amount of protein excreted in your urine daily.
3.
Bladder or urethral infections can also lead to proteinuria.
I believe that the proteinuria you are experiencing is likely due to a simple infection.
Thank you for reaching out for consultation.

Sincerely,
Dr.
Lai Yi-Cheng
Department of Radiation Oncology
Changhua Hospital

Reply Date: 2016/03/14

More Info

Intermittent proteinuria, which refers to the presence of protein in urine that fluctuates between normal and abnormal levels, can be concerning, especially in the context of potential underlying conditions such as multiple myeloma (MM). However, it is essential to understand that proteinuria can arise from various causes, and not all instances of proteinuria indicate a serious condition like multiple myeloma.

Multiple myeloma is a type of blood cancer that affects plasma cells, which are responsible for producing antibodies. One of the hallmarks of multiple myeloma is the presence of monoclonal proteins (also known as M-proteins) in the blood and urine. These proteins can lead to kidney damage and result in proteinuria. However, the presence of protein in urine alone is not sufficient to diagnose multiple myeloma.

In your case, you mentioned that you have been experiencing intermittent proteinuria for four years, with normal kidney and liver function tests throughout this period. This is a crucial point because persistent normal kidney function suggests that any proteinuria you experience may not be due to significant kidney damage, which is often seen in more severe conditions, including multiple myeloma. The fact that your protein levels fluctuate and that you have periods of normal protein levels further indicates that this may not be a straightforward case of a serious underlying condition.

It is also important to consider other potential causes of proteinuria. Conditions such as orthostatic proteinuria (which occurs when protein is excreted in urine when standing but not when lying down), transient proteinuria due to dehydration, fever, or exercise, and benign conditions related to stress or infections can all lead to intermittent proteinuria. Additionally, certain medications and dietary factors can influence protein levels in urine.

Given your age (19 years old) and the normal results of your kidney function tests, the likelihood of having multiple myeloma is relatively low. Multiple myeloma is more common in older adults, typically those over the age of 65. However, it is essential to maintain regular follow-ups with your healthcare provider, especially since you have a history of intermittent proteinuria. Your healthcare provider may recommend periodic urine tests, including a 24-hour urine collection for protein, and possibly serum protein electrophoresis to monitor for any changes in your condition.

If you experience any new symptoms, such as unexplained bone pain, fatigue, frequent infections, or significant changes in your kidney function, it is crucial to seek medical attention promptly. These symptoms could indicate a more serious condition that requires further investigation.

In summary, while intermittent proteinuria can be associated with multiple myeloma, your normal kidney function and the intermittent nature of your proteinuria suggest that it may not be a significant concern at this time. Continue to work closely with your healthcare provider to monitor your condition and address any concerns you may have. Regular follow-ups and communication with your doctor will help ensure that any potential issues are identified and managed appropriately.

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