Small amount of protein in one’s urine does not necessarily give a call for alarm.

 

Brett was coming in for his high school physical.Because of the covid-19 (coronavirus)shutdownboth parents were able to come with him. He was going to be a junior in the fall and was hoping to get a lot of playing time on the varsity football team. The first part of the visit was spent discussing whether or not there WOULD be a football season because of the pandemic. After musing about the prospects of a football season we all agreed that we had NO idea about what was going to happen and left it at that.  

I was amazed how much Brett had grown over the past year and how much he had matured. He had a perfectly normal exam and just when we were finishing the nurse knocked on the door and brought in the results of his urine test. The look on my face concerned the parents and they asked if everything was all right. I said that it looked fine with the exception of 2+ protein in the urine which was not to be ignored. Mom and dad sat up abruptly with a worried look on their faces. Brett’s uncle had a kidney transplant six months ago and dad recalled that the uncle had protein in his urine.
 

Sensing their fear and concern I jumped right in and said that this was a common finding at the yearly physicals in pediatrics. Most often it is a benign condition.

 

Brett’s blood pressure was normal and he had a completely routine exam. Nevertheless, I wanted to test him for a benign condition called postural proteinuria.

 

I gave the parents two different containers for urine collection. Brett was to urinate before he went to bed and then flush that urine. The first thing in the morning before he actually got up he was to void in a container and label it AM Urine. For the rest of the day until he went to bed he was to collect all of the urine in the second container and label that specimen Day Urine. The parents were to bring both specimens to the office so we could test each for protein. They were so concerned that they did the urine collection that night and next day. They were at the office the following day waiting for the office to open.
 

We tested the specimens immediately and sure enough…the first morning urine (AM Urine) had NO protein, and the second daytime specimen had 2 + protein. This confirmed that Brett had postural proteinuria, also known as benign orthostatic proteinuria.

 

This is a condition that has been well-known for many years, but there is no clear understanding as to why it occurs. When a person with postural proteinuria is upright and on their feet they spill a modest amount of protein in the urine. It is enough that can be measured by a routine urinalysis but not enough to do any harm. When they lay flat to sleep (supine) for some unknown reason they do NOT spill any protein in the urine. Regardless, this has been well described and is known to be a benign condition that requires no intervention or close follow up. In the majority of cases, the patient will outgrow this.  

Both parents were greatly relieved with the news. I filled out Brett’s physical form for sports and was sure it had our office stamp on it. As I handed the form to dad, he was wearing a mask because of the covid-19 recommendations.
 

But I could see his eyes and they had a resigned look of wishful thinking as he asked, “Doc, they should be able to play football this fall…right?” All I could say was that I certainly hoped so.