Dear Dr. Roach: How dangerous is protein in the urine?
M.G.
That’s a simple question with a complicated answer. All of us have trace amounts of protein in our urine, but if there is enough to show up on a dipstick — the usual screening test for urine protein — that isn’t normal.
There are many possible causes. It can be benign, called isolated proteinuria, if the amount of protein is small (less than three grams a day), the kidney function and urine are normal and you have no high blood pressure or diabetes. Also, there must be normal blood protein level and no swelling (edema) of the body, especially around the ankles or eyes.
High blood pressure by itself rarely causes high levels of urine protein, but diabetes is a major cause. High amounts of urine protein in a diabetic predict a higher likelihood of developing progressive kidney injury, resulting in dialysis. Doctors trained in diabetes should check for urine protein periodically, and it can be treated with ACE inhibitors, as these help protect the kidney from further damage.
Many kidney diseases show protein in the urine. Some blood diseases, such as multiple myel-oma, first show as urine protein.
The evaluation of urine protein requires an extensive evaluation of your entire history and physical and laboratory testing. The results often are completely benign, but occasionally can be serious. So take it seriously and get evaluated.
Dear Dr. Roach: My 46-year-old son has been diagnosed with diffuse idiopathic skeletal hyperostosis. Is there anything he can do to prevent its progression and alleviate his pain? He says that the doctor tells him there’s nothing he can do.
L.Z.
First off, let me tell you how much I dislike hearing doctors say, “There’s nothing we can do.” There is always something we can do. We may not be able to cure the condition or even prevent its progression, but we can always, to the best of our ability, explain what is happening and to ease the suffering that is associated with the condition. Physicians have done that for thousands of years, and these are worthy goals in themselves.
Diffuse idiopathic skeletal hyperostosis is an abnormality of ligaments, which connect bones to each other. In DISH, the ligaments themselves become calcified and become bone spurs. The bone spurs can press on nerves and, if they are in the neck, can make swallowing difficult.
The mainstay of treatment is physical therapy and physical exercise. Swimming is particularly recommended. Heat and ultrasound are useful. Pain relievers are sometimes necessary. Steroid injections occasionally ease the pain as well. Surgery is rarely necessary, usually for compression of an important structure by the bone spurs.
Dear Dr. Roach: I read today’s column concerning Alzheimer’s prevention. I, too, am very interested in this subject. Have you read the studies linking coconut oil and improved mental function in Alzheimer’s patients? It sounds very promising.
L.B.
Axona, a prescription-only “medical food,” contains medium-chain triglycerides, a certain type of fat, and a study showed that it improved brain function in people with Alzheimer’s disease. Because Axona is expensive and available only by prescription, some people have tried substituting coconut oil, as it contains a type of fat similar to, but not exactly the same as, the fat found in Axona. It is unknown if coconut oil improves brain function in Alzheimer’s disease. Both coconut oil and Axona can cause stomach cramps and diarrhea.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu
