Katlyn had noticed bubbles in her urine for the past three months. At first, she thought it was "nothing," perhaps just a result of not drinking enough water or maybe even a side effect of her busy lifestyle, where she often held her urine for hours. Working as a nurse, it was common for Katlyn to take a bathroom break before lunch and after her 12-hour shift, but as the weeks passed, the bubbles in her continued and she began to worry.
Katlyn was a 26-year-old woman without significant medical history, who prided herself on her good health. She exercised 45 minutes to an hour three days a week, ate a “balanced diet,” and avoided any vices like vaping, drugs, or alcohol in excess.
She denied any recent illnesses or fevers, injuries, or intense physical activity, and had no known kidney disorders or diabetes in her family history and after home testing she denied being pregnant. She described her urine as a normal yellowish color, perhaps a little darker depending on the day.
She mentioned that on several occasions during her shift she would feel a sudden urgency to “go” as a result of holding her urine for so long and noticed that with a more intense flow and strain there were even more bubbles. She had no other urinary symptoms of pain or urgency.
Allergies? None.
Pertinent family history of illnesses? Clean slate.
Yet here she was with an unsettling sign that refused to go away.
Mornings had become particularly challenging. She noticed her hands and feet were swelling, a discomfort that would ease as the day went on but made her feel heavier, easily fatigued, and sluggish.
Seeking Answers
As she described her symptoms, I listened attentively for clues: persistent bubbles in the urine, morning swelling of her hands and feet, no urinary odor or pain, and no significant medical history. Her physical exam was unremarkable - nothing in particular stood out, so we opted to run a urinalysis.
Diagnosis and Treatment
Interestingly, Katlyn was noticed to have elevated levels of protein in her urine. Though present mostly in the blood, small amounts of protein, notably albumin, will filter through the kidney and spill into the urine—a condition known as proteinuria. While it is unusual to see protein in the urine it can be helpful in detecting kidney (renal) dysfunction when detected early.
Causes of Proteinuria
Chronic Causes:
Glomerulonephritis
Diabetes
Hypertension
Chronic urinary tract infections
Conditions such as congestive heart failure and eclampsia
Temporary Causes:
Dehydration
Intense exercise
High fever
Stress
Symptoms and Diagnosis
In early stages, proteinuria doesn't often cause any symptoms. However, as the condition progresses, patients may experience:
Foamy or frothy urine - more bubbles
Swelling in the hands, feet, or face (edema)
Weight gain due as a result of the fluid retention
When proteinuria is found on urinalysis, further blood testing and imaging studies are usually ordered to determine the underlying cause and the extent of the condition.
Although Katlyn's concern for bubbles in her urine seemed benign at first, developing without a clear cause, I referred her to a Nephrologist for a more comprehensive evaluation.
Managing Proteinuria
Katlyn was advised to lower her salt and protein intake to help ease the filtration burden on her kidneys. Her treatment plan also included lifestyle and dietary modifications such as drinking more water, avoiding intense workouts and taking more restroom breaks when at work.
As she adjusted to her new routine, she noticed gradual improvements. The swelling in her hands and feet subsided, and her energy levels increased. The bubbles in her urine didn't disappear entirely at first, but they became less frequent and on follow-up with the nephrologist, she was reassured that she was back on the right track.
Katlyn’s subtle findings of bubbles in her urine and a diagnosis of proteinuria might have sounded daunting at first, but with the right care and management, she learned where to make corrections and to be more proactive about managing her health overall. Her story reminds us to take notice of the subtle signs and signals our bodies send us and to be more attentive in our journey for better health and wellbeing.
*I am Elle, a Physician Assistant, Global Health Consultant and Founder of BHive Management Co, a personal health management medical practice in New York, NY.
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