Urine Protein Creatinine Test interpretation

[LilF]

In May of this year I found out that JJ, 14 year old neutered Shar Pei Mix with spondylosis but pretty good blood results, has some protein loss in the urine. I would like to go over the results since May and wondering if he is improving or not.

In May: Urine Creatinine was 61.6, Urine Protein was 57.5 The urinalysis showed a protein level of 2+ But his UPCR was a .9 Those are high creatinine and protein levels that seemingly lead to a better ratio than his latest testing (September ) where the creatinine and protein levels are MUCH less Thus I am confused to say the least as to how to interpret how he is doing.

In June: Urine Creatinine was 44.3, Urine Protein was 34.8 the urinalysis showed a protein level of 1+ But his UPCR was a .8

In July: Urine Creatinine was 45.6, Urine Protein was 49.7 the urinalysis showed a protein level of 2+ His UPCR was a 1.1

In September: Urine Creatinine was 14.8, Urine Protein was 16.6 the urinalysis showed a TRACE of protein Yet his UPCR was a 1.1

So in May his Urine and Protein levels were super high and yielded a lower ration than now when his urine and protein levels are super low in comparison but now his UPCR is 1.1 still

I don't get it and what numbers are important to gauge if what I am doing is working. I thought his latest values were good, a trace in the urinalysis and low creatinine and protein but the ratio is still high. I usually understand things but this doesn't make sense.

Thanks for your help when you get a chance!

 

[Dr. Jeff]

Hey Lil!

It's the ratio that's most important so it looks like a bit of progression since June.

Do you have any UPC results from 2020?

 

[Dr. Sara]

Dear Lil,
UPCR is an objective measure of the amount of 'good' protein present in the urine. Creatinine is normal waste protein, and is normal in urine. The other protein that is measured is 'good' protein that is leaking through the filtering units (glomeruli). There should not be much of this 'good' protein in the urine compared to the amount of creatinine. Normally the creatinine (waste protein) should be more than double the 'good' protein.

The dipstick gives a qualitative amount of protein, from trace to 3+. This is greatly affected by the concentration of the urine. A trace protein in a dilute urine with a low specific gravity (USG) of, say 1.012, is more likely to have a high UPCR, than a 1+ protein with a highly concentrated urine with high specific gravity of 1.040.
[The urine specific gravity must be above 1.030 in dogs, (1.035 in cats) to demonstrate adequate renal tubular concentrating ability. ]

I suspect, from the raw numbers for protein and creatinine above, that this last sample from JJ was pretty dilute. Hence the trace protein was more significant, as evidenced by the higher UPCR.
These values show a mild increase in the UPCR, likely indicating a mild worsening of the ability of JJ's glomeruli to keep the 'good' protein in the blood.
Dr. Sara

 

[LilF]

Thank you all for the explanation of this test. Yes it is true that JJ's ratio was a .8 in June. In July though it was a 1.1 and the latest here in September was also a 1.1 If the ratios were the same the past two testings doesn't that mean that he has not gotten worse. I do realize he did get worse since June but is he holding his own the last two testings (July and September)? He was taking some chinese herbs to bring down the UPCR. I mention this because if the ratio remains at 1.1 I don't know if I should stay the course with these chinese herbs.
Is there anything else that can help with this ratio and does this have anything to do with his incontinence at times (a lot of drinking and needs to go out more often and seems to urinate a FLOOD each time). Thank you all, so appreciated to understand things better for JJ.

 

[Dr. Sara]

Dear Lil,
Kidney disease can affect the filtering units / glomeruli (which filter out waste protein and retain valuable protein) or the collecting tubules (which concentrate the urine) or both parts of the kidney. Most elderly dogs like JJ with chronic renal disease have compromise of both parts of the kidney. They also often develop anemia, as the kidney produces the hormone that stimulates red blood cell production. It isn't easy getting old, and a 14 year old SharPei is a Super Senior.

The production of huge amounts of urine is the way the kidney accommodates for its inability to concentrate the urine. By producing a lot of urine, the kidney can still do a reasonable job of eliminating wastes. This keeps the BUN in a range that will not cause depression or loss of appetite. I know that some of my clients with male dogs with chronic renal disease use double belly bands, or belly bands with oversize bitch panties on top to help them stay dry overnight.

Traditional Chinese herbal medicines may result in a lower UPCR or improved concentrating ability by improving kidney function. You want to take to your herbal prescriber, as sometimes a different formula, or an additional formula, will provide more benefit. Sometimes there is no residual kidney function left to stimulate, and the herbs may be minimally effective.
I hope this helps,
Dr. Sara