Which Is More Serious, Urine Protein Or Serum Creatinine? 4 Questions To Sort Out The Relationship Between The Two!

Many patients with kidney disease do not know what is the relationship between urine protein and serum creatinine. Which one will drop first? Next, we will clarify the relationship between the two through these four questions.

1 High proteinuria, driving up serum creatinine

The capillary wall of the glomerulus is like a sieve with mesh, which screens out small waste and excess water, and retains useful and large protein. When the glomerulus is attacked by immune complexes, the mesh of this layer of the sieve is destroyed and enlarged, and urine protein will leak out.

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After the urine protein leaks from the glomerulus, it passes through the renal tubules and will attack the renal tubules and the renal interstitium around the renal tubules, causing them to vibrate and atrophy. Both glomeruli and renal tubules are damaged, the filtration capacity of the kidneys decreases and renal failure occurs, at which time the serum creatinine increases. Therefore, high urine protein is the cause of high blood creatinine, and high blood creatinine is the result of high urine protein.

2 In the absence of urinary protein, creatinine can be elevated alone

Urinary protein is one of the reasons for abnormal creatinine, but not the only reason.

Most of the pathogenic factors first attack the glomerulus, but some pathogenic factors (such as nephrotoxic drugs, heavy metals, organic solvents, etc.) attack the renal tubules and renal interstitium. The first is the damage and loss of function of the renal tubules.

In this case, before the sieve of the glomerulus is damaged and leaks protein, it is implicated by the renal tubules and hardens. Excess water, creatinine, etc. in the body cannot leak out, and the creatinine will be very high.

In this case, there is only a small amount of urinary protein from beginning to end, and there will be no obvious edema until uremia.

3 High proteinuria or high serum creatinine, which is more serious?

Answering this question mainly depends on what is the main cause of the disease development.

If urinary protein persists or recurs repeatedly, and creatinine only slightly increases, then the main cause of the disease is urinary protein, and high proteinuria is more serious.

If the urine protein is low and the creatinine has reached more than 200 μmoI/L, then the main cause of the disease progression is the progress of renal failure itself and the invasion of complications. At this time, the high creatinine is more serious.

Some people think that high proteinuria represents nephritis, and high creatinine represents renal failure, so high creatinine is more serious than proteinuria. This view has some truth, but it ignores the future development trend of the disease. High creatinine indeed indicates that kidney disease has progressed to a later stage, but it depends not only on the current stage but also on the outcome of the disease in the future. If the urinary protein is not under control, even if the creatinine is temporarily normal, it is likely to develop uremia in the future, which is more serious than mildly elevated creatinine.

4 Urinary protein and serum creatinine, which one should be lowered first?

Lowering of urinary protein and serum creatinine can be done at the same time without prioritization.

Urinary protein is one of the main reasons for the development of the disease. It must be controlled as soon as possible to block the progress of renal failure.

Once the serum creatinine rises for more than 3 months, it will change irreversibly, and the longer the time, the harder it will be to lower it, so it must be lowered as soon as possible and stabilized.

Moreover, some drugs have the effect of reducing urine protein and serum creatinine. Therefore, urine protein and serum creatinine must be controlled as soon as possible, without priority.

for more information: Ali.ma@wecistanche.com