Patient education: Split urine collection for orthostatic proteinuria (Beyond the Basics)

INTRODUCTION — If your doctor finds you have protein in your urine on more than one occasion, you may be asked to do a split urine test. A split urine test is used to determine whether the protein in your urine is caused by a condition called orthostatic proteinuria. For reasons that are not well understood, proteinuria (protein in the urine) occurs in some people while standing or sitting, but not while lying down. This is called orthostatic proteinuria.

Orthostatic proteinuria is a harmless condition that can occur in young people. Generally, no further testing or treatment is necessary after diagnosis. More detailed information about orthostatic proteinuria is available by subscription. (See "Orthostatic (postural) proteinuria".)

EQUIPMENT — You will need to collect all of your urine for 24 hours. Pick a day when this would be convenient. Men may want to ask their doctor for a urinal for easy collection; women may ask their doctor for a urine hat, which fits over the toilet.

You will also need two jugs and a funnel, which will usually be provided by your doctor. Label the two jugs:

●Daytime urine

●Nighttime urine

PROCEDURE — Perform the following steps on the day that you are going to collect the urine:

●When you first get up, urinate and flush this urine down the toilet.

●For the rest of the day, collect all of the urine each time you go to the bathroom. Put this urine into the daytime urine jug. You can do your normal daily activities, but strenuous exercise should be avoided.

●In the evening, lie down two hours before you go to sleep. Just before sleeping, go to the bathroom for the last time and add this urine to the daytime jug. Lying down for two hours helps to avoid mixing urine made at night with urine made during the day.

●If you need to go to the bathroom during the night, be sure to collect this urine and put it in the nighttime urine jug.

●The next morning (approximately eight hours after going to sleep), collect the first morning urine and put in the nighttime urine jug.

●Take the two jugs to the laboratory.

●The laboratory will measure the urine protein from the daytime and from the nighttime to see if proteinuria is occurring all of the time or only during the day.

Your doctor or nurse's office will notify you when the results are available.

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Chronic kidney disease (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Protein in the urine (proteinuria) (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Assessment of urinary protein excretion and evaluation of isolated non-nephrotic proteinuria in adults
Orthostatic (postural) proteinuria
Overview of heavy proteinuria and the nephrotic syndrome