Protein in urine during pregnancy and after childbirth: reasons, what to do

Doctors always carefully study urine tests in pregnant women and are very wary of the appearance of protein in urine in late pregnancy

. Normally, the structure of a healthy kidney assumes that strictly defined substances with a certain size and mass of molecules are released into the urine. Protein molecules are quite large, so normally a healthy wall of kidney capillaries practically does not allow them to pass from the bloodstream into the urine. The appearance of protein in the urine always indicates some pathological process in the kidney tissue, due to which its filtration function suffers. The causes of kidney damage in pregnant women can be very diverse.

What does high protein mean?

Every woman should be aware of the dangers of having protein, so she should be examined regularly.

What does high protein in urine mean:

A low protein content may indicate the presence of diseases of the genitourinary system - the analysis can preliminarily indicate the nature of the disorders.
An increased value of proteins may indicate the development of pyelonephritis - an inflammatory kidney disease of an infectious nature (there is an increase in leukocytes). The pathology is accompanied by lower back pain and increased body temperature.
The analysis often indicates the development of glomerulonephritis - an inflammatory pathology of the renal glomeruli, which is also determined by an increased number of red blood cells in the urine.

Tests with an increased protein content in the urine should be fundamental in case of previously identified gestosis - a disease of women during pregnancy, accompanied by edema and increased blood pressure. Preeclampsia often manifests itself with characteristic symptoms after childbirth - this is also dangerous, which mothers in labor do not think about.

Causes

This pathology appears against the background of serious illnesses. The main reason for the presence of protein in urine is gestosis, which is very dangerous for both the expectant mother and the fetus.

Preeclampsia can also be detected by other signs: increased swelling, dizziness, tinnitus, fatigue and severe fatigue. Usually this disease appears after the 20th week of pregnancy. The consequences of this disease are quite dangerous, since in some cases miscarriage, premature birth, and even stillbirth of the baby are possible.

If the expectant mother is suspected of having gestosis, the doctor will insist on urgent hospitalization. This is due to the fact that the symptoms of gestosis and proteinuria are similar, so the exact disease can only be identified with constant monitoring by doctors.

Kidney diseases, for example, pyelonephritis, provoke the appearance of protein in urine. A characteristic feature of pyelonephritis is discomfort in the lumbar region and bladder. This disease also requires treatment, so do not hesitate, go to the hospital immediately for an appointment.

About the norms

It is possible to accurately determine the reasons for the increase in protein in a urine test after childbirth only through a comprehensive examination. But first, the doctor examines the protein content in accordance with accepted standards.

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The following numbers stand out here:

The norm for proteins in urine per day is 0.08 g. But doctors begin to act once the content is determined to be 0.033 g/l. Women are prescribed additional examination to exclude kidney pathology. Secondary indicators are also examined - the content of leukocytes, erythrocytes and other substances.
Immediately after physical activity or stress, up to 0.2 g/l of proteins can be detected in the analysis. This should not happen for the reason that tests are taken in the morning immediately after sleep, and not after physical activity.
Protein levels of 0.14 g/l accurately indicate the development of kidney pathology. Elevated proteins in tests always indicate an inflammatory process, so treatment should begin immediately.

Practical advice: Test results may be affected by improper urine collection. Urine should be collected in a clean container immediately after sleep (breakfast should be absent) and thoroughly washed, but without hygiene products or other ingredients. Women should cover their vagina to prevent discharge from getting into the test vessel.

Physiological and functional proteinuria

Being in certain normal conditions, the kidneys can secrete a small amount of albumin, but this happens for a short time. Physiological reasons for the appearance of protein in urine include:

taking a cold shower/bath;
increased muscle tension;
severe nervous shock.

It is normal for protein to appear in the urine due to heavy physical work, including sports training. The urine of patients with epilepsy contains a lot of proteins immediately after the attack stops. Stress and low temperature provoke increased protein breakdown due to increased energy expenditure by the body. Impairment in the functioning of the kidneys is also observed due to changes in the process of their blood supply.

The listed situations, as a rule, lead to the release of a small amount of proteins and do not cause massive proteinuria. This phenomenon is considered short-lived and disappears with the disappearance of the causative factor.

What to do?

When doctors discover a bad urine test, they immediately send the woman for a repeat test. Often, during the second study of the collection, the absence of protein deviations from the norm is revealed. In this case, the woman is advised to reconsider her diet, since the increased protein content may be associated with excessive consumption of a harmful product.

For the rest, the following actions are carried out:

To begin with, the doctor conducts a visual examination of the woman and determines the presence of secondary signs of pathology. As a rule, by palpation the doctor can already determine the inflammatory process.
To accurately determine the diagnosis, the woman is sent for additional examination. This includes ultrasound, radiography, computed tomography and other types of examination. Based on the results obtained, a treatment regimen is drawn up.
Based on the results of the tests and examination performed, doctors prescribe appropriate treatment. Kidneys are often treated with anti-inflammatory drugs. Diuretics are a separate group - it is important to provide the organs with adequate circulation to avoid stagnation of urine, which contributes to the further development of diseases.

Doctors always prescribe a woman to follow an effective diet that helps reduce protein. Here, protein products, alcohol (it is strictly prohibited for women in labor during breastfeeding), spicy foods and other foods that put a strain on the organs are excluded from the diet as much as possible. During treatment, salt is completely excluded from the diet - even the addition of herbs and spices is prohibited during cooking, since they all provoke fluid retention in the body. Women who have been diagnosed with gestosis during pregnancy should take treatment responsibly - the protein content can be 10-20 times higher than normal. This pathology provokes disturbances in the development of the placenta, which has a detrimental effect on the development of the child - often leading to abruption, miscarriage or premature birth.

The disease is also dangerous after childbirth - there is a high risk of eclampsia. This stage of gestosis can result in cerebral edema, coma or death. Do not neglect the urine tests you receive - this is not just a product of a person’s vital activity, but an accurate reflection of the beginning development of pathology. Diseases can lead to tragic outcomes. But if you undergo a timely examination after childbirth, you can easily cope with the current situation.

Possible reasons for detecting protein in urine after childbirth

Proteinuria means that there is protein in the urine in an amount that exceeds the normal level.
In pregnant women, it is often associated with late toxicosis, but often laboratory changes persist or occur after childbirth.

The causes are functional (non-hazardous, temporary) and pathological, which requires urgent treatment. At the same time, symptoms do not always develop that would indicate a problem.

Causes of proteinuria after childbirth

Normally, protein, which is divided into many fractions, should not be lost in the urine.

The kidneys are designed in such a way that these organic substances are reabsorbed when filtered, returning to the systemic circulation.

Some women develop late toxicosis during pregnancy, which can lead to renal dysfunction. With a mild course, everything gradually returns to normal for postpartum women, but, unfortunately, not for everyone.

Physiological

The reasons for detecting protein in the urine after childbirth do not necessarily indicate a disease. The following physiological prerequisites exist:

the first days after childbirth are adaptive; in fact, the body is still trying to cope with the consequences of pregnancy, and also compensates for energy losses;
errors during collection, transportation and storage of biological material;
excessive consumption of protein foods (meat, cottage cheese, milk);
laboratory error;
prolonged stay in a heating microclimate (solar insolation, bathhouse) or, conversely, hypothermia;
neuropsychic stress;
heavy physical activity;
allergic reactions;
disturbed sleep and wakefulness;
prolonged standing (in some people, due to constitutional characteristics, this is fraught with congestion in the vessels of the kidneys due to compression of the inferior vena cava).

Pathological

Protein in the urine after childbirth most often indicates that an inflammatory focus has developed in the body (first of all, they will think about the urinary system). Most often this indicates the following diseases:

Kidney damage:
glomerulonephritis due to autoimmune disorders (vasculitis, systemic lupus erythematosus), arterial hypertension or infectious and allergic agents;
interstitial nephritis;
exacerbation of urolithiasis;
renal artery stenosis;
Inflammation of the bladder (cystitis) and/or the final part of the urethra (urethritis).
Late gestosis in pregnant women - eclampsia (in severe cases, persists after childbirth).
Use of pharmaceutical drugs (antimicrobials, diuretics, non-steroidal anti-inflammatory drugs, hormones).
Endocrine diseases (often first identified during pregnancy or after childbirth):
pheochromocytoma;
hyperaldosteronism;
Itsenko-Cushing syndrome;
pathology of the thyroid gland.
Extrarenal inflammatory diseases of any location (ARVI, pneumonia, endometritis, burns, colpitis).

For what symptoms is a test prescribed?

Minimal proteinuria may be asymptomatic. Often, women turn to us just a few weeks after childbirth, when significant inflammatory changes increase.

You can suspect a problem based on the following symptoms:

frequent urge to urinate, often painful (stinging, burning);
pain in the lumbar area, spreading to the sides or radiating to the groin;
nausea (less commonly, vomiting);
fever with chills;
headache, severe weakness;
urine may be pink-red (blood) or cloudy (pus);
increased blood pressure;
swelling - most often on both lower extremities or on the face;
thirst;
convulsions, loss of consciousness.

Attention! The more pronounced the clinical picture, the more severe the patient’s condition. Any delay threatens the development of severe complications and even death.

Diagnostics

To understand what to do with proteinuria, it is necessary to identify its cause.

In itself, it is not a diagnosis, so the doctor comprehensively evaluates the medical history (pregnancy and childbirth, previous diseases), complaints and symptoms. After this, a set of additional studies is prescribed.

An analysis of 24-hour urine is recommended, since the analysis of a single portion is not informative. If the result is questionable, it is repeated at intervals of several days.

Methodology

The basic test to evaluate kidney function is a complete urinalysis (UCA). It is mandatory to determine protein in the urine before and after childbirth (while the woman is in the maternity ward). The following parameters are also assessed:

daily diuresis (material is collected 24 hours);
color, transparency and reaction of urine;
glucose and other biochemical indicators (ketone bodies, creatinine, urea);
the number of formed elements (erythrocytes, leukocytes) and the composition of urinary sediment (casts, mucus, bacteria, salts).

Elevated protein levels are determined by chemical methods (interaction with reagents, dyes) or by using test strips (if rapid diagnostics are necessary, the result is 2-5 minutes).

Preparation

To avoid obtaining obviously incorrect results, the following rules for collecting urine must be observed:

1-2 days before the study, you need to stop taking medications, give up alcohol and smoking, and drink moderately (1.5 liters per day).
For general analysis, morning urine is most often used. It is not recommended to eat or drink 6-8 hours before, which is easily leveled out by nighttime sleep.
Before urinating, you need to toilet the external genitalia, that is, take a shower or wash yourself, carefully removing any remaining detergent.
During menstrual bleeding, urine tests are not performed unless indicated!
If there is vaginal discharge, the vestibule must be closed (with a regular tampon).
It is advisable to use disposable urine collection containers.
The first 10-20 ml are poured into the toilet, after which, without stopping urination, the container is placed, filling up to the indicated mark (100-150 ml).
Having collected the required amount of urine, remove the container and continue the process naturally.

Urine samples must be delivered to the laboratory within 1-1.5 hours, avoiding overheating and direct sunlight. You should also avoid strong shaking of the container.

Is additional research needed?

To determine the etiology (cause) of proteinuria, the doctor may prescribe the following diagnostic methods:

bacteriological examination of urine, Zimnitsky, Nechiporenko, Reberg samples;
calculation of glomerular filtration rate (GFR);
determination of various protein fractions of urine (clinical significance - albumin);
general blood test (6 standard indicators);
blood biochemistry (urea, creatinine, ALT, AST, glucose, bilirubin, albumin);
coagulogram (INR, fibrinogen, blood clotting time);
Ultrasound (+ biopsy if indicated) of the kidneys and their vessels, cystoscopy, urography;
ECG, CT/MRI of the abdominal and pelvic organs.

Also, postpartum women are referred for consultations to other specialists to rule out more serious diseases.

Decoding the results

Proteinuria in pregnant women (+ the first 28 days after birth) is considered to be the presence of protein in the urine ≥ 0.3 g/day or ≥ 1 g/l in a double analysis with an interval of 4 hours. Up to this level, changes are considered physiological.

In pregnant women, the presence of “traces” of protein is considered acceptable, especially in the third trimester. An increase in the following indicators presented in the table is considered pathological:

IndicatorNon-pregnant womenTrimester

I	II	III
Creatinine, µmol/l	73	65	51	47
Proteinuria, g/day	absent

If the presence of protein in the urine is ≥0.3 g/day, but ≤5 g/day, moderate changes in the kidneys are indicated, which may indicate the development of a severe disease.

Treatment

The choice and scope of treatment depends on the individual patient. Each case is individual, as there are other risk factors, concomitant diseases and features of the course of pregnancy/childbirth.

Etiological

The best way to get rid of unpleasant symptoms and normalize tests is to eliminate the immediate cause of the worsening condition. Your doctor may prescribe the following treatments:

Non-medicinal:
therapeutic and protective regime with moderate aerobic physical activity;
fluid intake of at least 1.5 l/day;
sufficient 8-10 hours of sleep at night;
quitting smoking and drinking alcohol;
The medication is chosen according to the cause. With minimal changes it may not be provided at all:
antiviral drugs.

Autoimmune diseases are poorly understood, so there is no etiological treatment. In case of allergic reactions or exposure to toxins (including medications), it is enough to remove the provoking factor.

Attention! Severe proteinuria with dysfunction of the glomerular apparatus of the kidneys requires hospitalization and complex treatment in a hospital setting.

Symptomatic

Since proteinuria does not develop on its own, it is sometimes necessary to restore or control other organ systems. The following pharmaceuticals may be required:

antihypertensives - ACE inhibitors (Enalapril), calcium channel blockers (Verapamil), beta-blockers (Nebivolol);
diuretics (diuretics) - Furosemide, Spironolactone, Hydrochlorothiazide;
anti-inflammatory - non-steroidal (Diclofenac) and glucocorticoids (Prednisolone, Dexamethasone);
anticoagulants and antiplatelet agents - Heparin, Acetylsalicylic acid;
probiotics – “Linex”;
antipyretic and painkillers - Paracetamol, Nimesil.

Conclusion

If proteinuria occurs during pregnancy, it is necessary to regularly see a doctor until laboratory parameters are completely normalized. There is no need to panic - protein in the urine is not always a symptom of severe pathologies and is often physiological in nature.

Source: https://UroMir.ru/diagnostika/issledovanija/belok-v-moche-posle-rodov.html

How to collect analysis correctly

Properly collected material for analysis is an important component of diagnosis. To exclude an erroneous result and avoid unnecessary repetitions of tests, you need to adhere to the rules for collecting a urine test:

clean dishes without traces of detergents (it is better to purchase a sterile jar for collecting urine at the pharmacy);
Morning urine is taken for analysis; you should not have breakfast before collecting it;
Before collecting urine, you need to wash the external genitalia; you should not use antiseptics (they destroy the protein);
It is better to cover the vagina with a tampon, so the discharge will not get into the urine;
an average portion of urine is collected (you need to start urinating in the toilet, then bring the container, not collecting until the end).

By following these guidelines, you can prevent foreign protein from entering your assay.

Treatment

Drug therapy is carried out taking into account the reason why the amount of protein in the urine increases after childbirth. Therefore, first you need to make an accurate diagnosis. If the fluid is collected incorrectly, the hospital will collect it again with a sterile catheter. To normalize indicators, medications and alternative medicine recipes are used. The woman is prescribed a strict diet that completely excludes salt and fatty foods. In severe forms, bed rest is recommended. Standard therapy involves taking medications such as:

Hormonal drugs are prescribed for infectious pathologies. They quickly relieve pain and eliminate the inflammatory process. Medicines from this group should be selected by a specialist - they should be harmless to the child and not require interruption of breastfeeding.
Antithrombosis drugs - normalize the functioning of the urinary organs.
Antibacterial agents - indicated for inflammation of bacterial origin. In some cases, it is possible to continue breastfeeding.
Probiotics – taken together with antibiotics to prevent dysbiosis.
Diuretic herbs and drugs - improve the outflow of urine.
Vitamin complexes - to strengthen the immune system.

Not all medications can be used after childbirth, so you should definitely consult a doctor and undergo a comprehensive examination. If the cause leading to an increase in protein is not eliminated in time, you may encounter a disease such as eclampsia. With this disease, blood pressure can reach its maximum level, which is life-threatening for the patient.

The birth of a baby radically changes a woman’s habits, but this is not a reason to forget about your health. Ignoring symptoms, late diagnosis and lack of adequate treatment can lead to negative health consequences.