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
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
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
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'
Nephrology & Internal Medicine
MBBS (IIUM), MMED (Int Med) (UKM),