Urinary Protein Can Not Come Down? Find Out Which Treatment Is Right For You!

The kidney is the excretory organ of the human body, and many metabolic wastes are excreted through the kidney. Under normal circumstances, the filter pores of the kidney only allow electrolytes such as water, sodium, potassium, and chlorine, and metabolic wastes such as blood creatinine, urea nitrogen, and uric acid to pass through, while cells in the blood and substances such as proteins and fats with large molecular weights cannot pass through. Filtered through the pores, it remains in the blood, so there is no protein in the urine.

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If kidney damage is caused by various reasons, the filtration pores of the kidney will increase, and some macromolecular substances that cannot be filtered out, such as protein, will leak into the urine, which is urine protein. Egg whites are a good thing, however, should not appear in the urine. There is the protein in the urine, which means that the kidneys are damaged. Generally speaking, the greater the amount of urine protein, the more serious the kidney damage.

Proteinuria is the result of glomerular damage. At the same time, proteinuria aggravates renal tubular damage, which in turn aggravates glomerular damage. Therefore, long-term proteinuria is also harmful to the kidney itself, so don't ignore proteinuria.

Generally speaking, if the urine protein can be effectively lowered, the kidneys can be effectively protected. Methods for checking proteinuria include urine routine, urine protein quantification, and urine protein-to-creatinine ratio.

How to lower urine protein?

1. Improve your lifestyle

No matter what the cause of proteinuria is, the diet should be low in salt and high-quality protein and avoid fatigue. The more proteinuria, the more attention should be paid to rest. A large amount of proteinuria may lead to hypoproteinemia. Some patients mistakenly think that their blood protein is low, so they supplement a large amount of protein in their diet. This approach is wrong.

First of all, the reason for low protein is more "leakage" rather than eating less. If you don't "plug the leak", protein supplementation will not help; secondly, a large amount of protein supplementation will aggravate protein leakage and aggravate renal tubular damage. Therefore, patients with proteinuria can take an appropriate amount of protein. If there is a person with impaired renal function at the same time, not only a low-salt but also a low-fat and high-quality low-protein diet is required. Eat less protein and eat good protein.

So what is high-quality protein? Milk, eggs, lean meat, and some fish are all high-quality proteins. In addition, soybean protein is also a high-quality protein, which may subvert the traditional perception of the public.

2. the cause of treatment

Urinary protein only indicates that the kidneys have been damaged. However, it is difficult to judge the cause of kidney damage from proteinuria alone, and the method of reducing urinary protein is different for different causes.

According to the latest research statistics, the most common cause of kidney damage in Chinese residents is glomerulonephritis (primary kidney disease), followed by diabetic nephropathy, and other causes include hypertensive kidney disease, autoimmune Kidney damage caused by diseases (systemic lupus erythematosus, systemic vasculitis, rheumatoid arthritis, etc.), purpuric nephritis, drug-induced nephritis, gouty nephropathy, etc.

1. Diabetic nephropathy

Diabetic nephropathy lowers urinary protein, the first choice is the antihyperglycemic drugs of the class of antihyperglycemic agents, including canagliflozin, dapagliflozin, and empagliflozin. It is the drug of choice for the treatment of diabetes mellitus with chronic kidney disease and cardiovascular disease. In addition to the antihyperglycemic agents of the antihyperglycemic agents, GLP-1 receptor agonists such as liraglutide and dulaglutide also have a certain effect on reducing urinary protein, but the renal protection effect is not as good as that of the antihyperglycemic agents.

2. Glomerulonephritis and autoimmune disease kidney damage

Most of the occurrence of glomerulonephritis is the result of autoimmune damage, similar to the "rebellion" of our own National Defense Forces, killing the enemy outside and harming our "nationals" at the same time. The same is true for purpura nephritis, especially for autoimmune disease kidney damage. To treat these diseases, hormones, or immunosuppressants are the most effective means.

Hormones or immunosuppressants suppress the immune system, reduce the immune system’s damage to the kidneys, restore glomerular filtration pores, and reduce urine protein. Commonly used hormones are methylprednisolone, prednisone (prednisone), triamcinolone, and so on. Commonly used immunosuppressants are cyclophosphamide, cyclosporine, tacrolimus, and so on.

3. Other kidney diseases

If it is gouty nephropathy, you need to lower uric acid treatment; if it is kidney damage caused by multiple myeloma, you need to use chemotherapy drugs in addition to hormones; if it is virus-related nephropathy, you need antiviral treatment; damage, the drug should be discontinued in time.

Both sartan-type antihypertensive drugs and pril-type antihypertensive drugs have clear proteinuria-lowering and renal-protective effects while lowering blood pressure. Commonly used sartan antihypertensive drugs include valsartan, candesartan, irbesartan, telmisartan, losartan, alisartan, olmesartan, etc.

Commonly used pril-type antihypertensive drugs are benazepril, captopril, lisinopril, fosinopril, ramipril, perindopril, enalapril, and so on. The most common IgA nephropathy in China, as well as another glomerulonephritis, if the indications for the use of hormones cannot be met, then the main treatment drugs are sartan or pupil antihypertensive drugs.

Diabetic nephropathy lowers urine protein, but also choose sartan or pupil antihypertensive drugs, and the dosage of individual patients should be increased by 2~4 times. For hypertensive kidney disease, sartan or pupil antihypertensive drugs are the first choices for lowering urinary protein, which can treat both the symptoms and the root cause. For other kidney diseases, when the etiology cannot be determined, sartan or pupil antihypertensive drugs can also be used to reduce urinary protein.

In other words, as long as there is proteinuria, it is generally no problem to choose sartan or Prix antihypertensive drugs for treatment. However, these two types of drugs cannot be used together, only one of them can be selected.

For diabetic nephropathy, the combined use of sartan or pril-type antihypertensive drugs and Login-type hypoglycemic drugs also has a synergistic effect, and the mechanisms are complementary and have the same effect. The DAPA-CKD study has confirmed that antidiabetic drugs can also be used for the treatment of urinary protein in non-diabetic nephropathy.

What should be the target for proteinuria?

Of course, the lower the better, it will be perfect if it can turn cloudy! However, the ideal is very full, but the reality is very skinny. The proteinuria of many patients, even through various efforts, sometimes it is difficult to turn negative. However, generally speaking, it is safer if the urine protein quantity is reduced to below 0.3g/24h.

for more information:Ali.ma@wecistanche.com