Dear Dr. Roach: How dangerous is protein in the urine?
Dear M.G.: It’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 3 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 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 myeloma, first show as urine protein.
A urine protein evaluation requires an extensive evaluation of an entire history and physical and lab testing. The results often are completely benign, but rarely can be serious. 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.
Dear 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 progress, 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 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: Will colloidal silver (a suspension of ultra-fine silver) help a sore throat if sprayed or gargled? My camping friends say this will sanitize drinking water.
Dear J.E.: I am aware that other media doctors have recommended this product. However, I am unable to find enough evidence that it is safe and effective for me to do so, and I recommend against using it for either a sore throat or for sanitizing drinking water.
For sanitizing water, I recommend filtering with a 0.1 micron filter, available at camping supply stores.
Email questions to ToYourGoodHealth@med.cornell.edu.