Can Proteinuria Be Reversed?

 



Can It Be Reversed or Controlled?

In Many Country, many patients are often confused about the concept of proteinuria—whether it can be reversed or controlled. This confusion stems from a mix of misinformation, cultural beliefs, and limited awareness. I struggled with the decision of what to title this video, but eventually decided to address this widespread question: Can Proteinuria Be Reversed or Controlled?

The Reality of Proteinuria and Kidney Disease

In the modern world, it's a well-known fact among educated individuals that the core issue of kidney disease is proteinuria. If proteinuria is not reversed or controlled, the damage to the kidneys will only progress. In today's video, I will explain the basics of proteinuria, how it can be managed, and what benefits controlling proteinuria can bring to your kidneys and overall health.

Greetings! I am Dr. Vaska from Expert Kinds Clinic in Lahore, specializing in nephrology. I am sharing this information from my studio while traveling, as I feel it’s crucial to address the confusion surrounding proteinuria, especially considering the impact of non-certified healers who spread misinformation about this condition. Unfortunately, they have convinced many people that proteinuria is something that cannot be controlled or reversed.

The Misconceptions Surrounding Proteinuria in Pakistan

In Pakistan, there is a prevalent notion that once you have proteinuria, it cannot be controlled or reversed. This misconception has become deeply rooted, primarily because of the limited capacity of nephrologists in the country and the lack of proper follow-up by patients. As a result, many patients are unable to control their proteinuria effectively. I have discussed the reasons behind this in detail in previous discussions, and I will continue to do so in the future.

However, it is essential to understand that controlling and reversing proteinuria is the cornerstone of managing kidney disease. If your nephrologist cannot control your proteinuria, then nothing else they do will be effective. Eventually, your kidneys will continue to deteriorate. Therefore, it is vital to learn everything you can from today’s video and demand from your nephrologist to understand your proteinuria levels, why they aren't under control, and how they can be managed or reversed.

What is Proteinuria?

Let’s begin by understanding what proteinuria is and how much protein should normally be present in the urine. The kidneys filter blood through tiny structures called nephrons, which consist of two main parts: the glomerulus and the tubules. The glomerulus filters blood, and the resulting fluid, known as filtrate, passes through the tubules, where essential substances like proteins are reabsorbed back into the blood.

Typically, the tubules reabsorb most of the proteins, leaving only a negligible amount in the urine. This is why routine urine analysis usually shows negative for protein. However, when you undergo a 24-hour urine protein test, urine protein-to-creatinine ratio, or urine albumin-to-creatinine ratio, small amounts of protein are always present, and they should be.

If these tests show zero protein, it likely indicates that the test was not conducted correctly. The normal levels are:

  • 24-hour urine protein: Less than 200 mg
  • Urine albumin: Less than 30 mg
  • Urine protein-to-creatinine ratio: Less than 200 mg/g
  • Urine albumin-to-creatinine ratio: Less than 30 mg/g

I have a separate video that explains the units related to proteinuria, and I will provide the link in the description below and tag it at the top of this video.

Causes of Proteinuria: Why Does It Happen?

Now, let's discuss why proteinuria occurs and what it means when excess protein starts appearing in the urine, often accompanied by foamy urine. There are two main sources:

  1. Tubular Proteinuria: This is rare and its causes are not well understood. It does not cause significant kidney damage.

  2. Glomerular Proteinuria: This is the main type associated with kidney damage. It indicates that the glomeruli (the filtering part of the nephrons) are damaged, leading to significant amounts of protein leaking into the urine. This type of proteinuria not only signals kidney damage but also contributes to further kidney deterioration.

Common Causes of Glomerular Proteinuria

The most common cause of glomerular proteinuria is diabetes, which accounts for approximately 40-45% of all chronic kidney disease (CKD) cases. Diabetes is primarily a glomerular disease, and when protein starts appearing in the urine, it means the glomeruli are severely damaged and need to be managed immediately.

If your nephrologist confirms that your proteinuria is due to diabetes, the next step is to control your diabetes effectively. However, many patients become confused at this stage, unsure of what "controlling diabetes" really means.

Controlling Diabetes to Manage Proteinuria

Controlling Diabetes: This can be approached in two main ways:

  1. Medications: Using medication to keep your blood sugar levels under control, ideally keeping your Hemoglobin A1c (HbA1c) below 7%.

  2. Diabetes Reversal: This is a newer approach that I strongly recommend, which involves adopting a healthy lifestyle that can potentially reverse diabetes, eliminating the need for medication altogether. There are various mechanisms for achieving this, and I have created a separate video on the topic.

Importance of Managing Blood Pressure

In addition to managing diabetes, it’s crucial not to overlook blood pressure control. Often, this aspect is either forgotten or not emphasized enough. When kidney disease from diabetes is accompanied by high blood pressure, it’s like adding fuel to the fire. Both high blood pressure and diabetes are individually damaging to the kidneys, and when combined, their damaging effects multiply exponentially.

If your kidneys might deteriorate over 5-10 years with only diabetes or high blood pressure, the combination can cause significant kidney damage within just 1-2 years. This is why it is so important to manage both diabetes and blood pressure simultaneously.

The Role of Lifestyle in Managing Proteinuria

Beyond medication, lifestyle changes are equally important. A healthy lifestyle is essential for controlling blood pressure and diabetes, even if you are on medication. Without lifestyle modifications, the underlying inflammation and disease progression continue, leading doctors to label it a “progressive disease.”

To effectively manage proteinuria and protect your kidneys, you must improve your lifestyle, in addition to controlling your diabetes and blood pressure.

Other Causes of Glomerular Disease

Beyond diabetes, other glomerular diseases can cause proteinuria, such as infections, medications, and autoimmune disorders. These include:

  • Focal Segmental Glomerulosclerosis (FSGS)
  • Membranous Nephropathy
  • IgA Nephropathy
  • Lupus Nephritis
  • C3 Glomerulopathy
  • Fabry Nephropathy

Each of these conditions requires specific treatments depending on the severity and findings from a kidney biopsy. These diseases are complex, and their management is tailored to each patient’s specific condition.

Conclusion: Proteinuria Can Be Controlled and Reversed

Whether your glomerular proteinuria is due to diabetes or another glomerular disease, it is possible to control and even reverse it with the right approach. Managing proteinuria is essential for preventing further kidney damage and improving your overall health. Remember, controlling proteinuria involves a comprehensive approach: managing your diabetes and blood pressure, adopting a healthy lifestyle, and addressing any underlying glomerular diseases.

If you have any questions or need further clarification, please leave a comment below, and don’t forget to subscribe for more detailed videos on kidney health.

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