Questions posted in the
The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.
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Subject: Re: Protein in urine Hello I have arthritis and am on Gold injections once every two weeks. Up until now i I went for blood work and urine test yesterday. My doctor has told me i have to stop the gold injections I guess what i am trying to find out is what kind of problems has this done to my kidneys and what does it mean by a 3.0 count for protein in my urine Any infor would be great as this has me worried. =
There is a well documented association between the use of gold salts used therapeutically for rheumatoid arthritis and protein in the urine. This is called "Gold Nephropathy." The kidney's nephrons (functional units) are designed to prevent protein from appearing in the urine. It does this at several sites. The first site is at the glomerular (tiny kidney filters) level. There is a barrier, the basement membrane of the glomerulus, which restricts protein from being lost in the urine based on the size and charge of the protein. The next site is at the tubular level which reabsorbs proteins which may make their way past the glomerulus. There is a mechanism which can result in proteinuria (protein in the urine) without damage to the glomerulus or the tubules. This is called overflow proteinuria in which the protein retaining properties of the kidney are overwhelmed. Normal healthy adults excrete 80-150 mg of protein in the urine daily, however, when protein is detected in the urine, renal disease should be suspected. The urine dipstick is used to detect protein in the urine. The results are graded from negative, to 2+ (100 mg/dl) to 4+ (greater than 2,000 mg/dl.) Thus, 3+ falls somewhere in between 2+ & 4+ with respect to the amount of protein lost. Now getting back to "Gold Nephropathy." About 3% of gold treated persons have proteinuria; most have 24-hour proteins of <3 grams. The gold has been shown to damage the membrane of the glomeruli in the majority of patients, however tubular damage has also been demonstrated. The mechanism of damage is immune mediated. Most patients who have this do not show a decline in kidney function. The protein in the urine usually resolves in 6 to 12 months after stopping the gold treatments. If the proteinuria resolves after stopping the gold treatment, ironically, the gold threapy can be restarted and the proteinuria does not reoccur. Lastly, oral gold salts are not as frequently associated with "Gold Nephropathy" as the injections. Thus, the pill form may be an option if what you are experiencing is truly "Gold Nephropathy." This information is provided for general medication education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
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