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Bubbles in My Urine! by Dr Shafira binti Dato' Mohamad Sha

Posted in ARTICLE on 12:00AM, 30 March, 2021

Bubbles in My Urine!

“I’ve been well all this time doctor, and I don’t have diabetes or hypertension. How can my kidney fail?” This question is often asked by young patients who are suddenly diagnosed as end-stage renal disease (ESRD) requiring long term renal replacement therapy (RRT). This is most likely due to missed glomerulonephritis, in which patients don’t even realise they have an underlying kidney problem until it’s too late. The majority of the population are aware that general health screening is a tool which can detect chronic diseases such as diabetes, hypertension and dyslipidaemia in asymptomatic patients. Unfortunately, most of us are only obsessed with the blood results that we often forget about our urine tests.

Frothy urine is one of the signs of kidney disease. It is worthwhile for us to take a peek at our urine each time we go to the toilet. If there are bubbles in our urine, and when I say bubbles, I mean really bubbly, it should ring a bell in our head that something is wrong. This should prompt us to visit our doctor so that further tests can be conducted. However, we should keep in mind that the presence of bubbles in urine usually occurs when there is a significant amount of protein in our urine. If the protein content is not as high, our urine will be normal. In such cases, this protein can be detected with a simple urine test. Hence it is important that we include urine analysis during our general health screening. Do not ignore the presence of protein or blood in the urine as this may be the tell-tale sign that you may have kidney disease.

What’s Next?
If protein is detected during the initial screening, do not ignore it. Proceed with protein quantification. This can be done by the 24-hour urine protein (24 HUP) test or a spot urine test; the urine protein creatinine ratio (UPCR), the former being the preferred choice. A referral to the nephrologist is warranted for further investigations i.e. renal biopsy if indicated by the 24 HUP results and a more detailed blood investigation to determine the cause of the significant proteinuria.

What if there is Only Blood?
The presence of only haematuria should not be ignored as well, and persistent haematuria should be further investigated. If the red blood cells (RBCs) are dysmorphic, patients should be referred to a nephrologist as it is most likely glomerular in origin. Isomorphic RBCs on the other hand needs further evaluation by urologists.

Why is it Important?
Generally, the amount of protein in the urine helps provide prognostication of the kidney life span in a patient. The heavier the protein is, the faster the deterioration of the kidney. As mentioned earlier, most patients who present at a young age with ESRD would most probably have an underlying glomerular disease which was not detected prior. In this situation, ignorance is not bliss as it will lead to continuous heavy protein excretion, hence shortening the life of the kidney. Therefore, it is of utmost importance to include a simple urine test in our health screening programmes. Crying over spilt milk is not an option here, as ignoring the presence of protein can lead to life-long renal replacement therapy at an early age, paving a path of no return to the damage done on the kidneys.

Dr Shafira binti Dato' Mohamad Sha
Nephrology & Internal Medicine

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