Side Effect: Proteinuria (excessive protein in the urine)

What is Proteinuria (excessive protein in the urine)?

• Proteinuria is a condition characterized by the presence of an excessive amount of protein in the urine.
• Normally, only a small amount of protein (less than 150 mg/day) is excreted in the urine. In cases of proteinuria, the amount of protein excreted may be significantly higher and can be indicative of underlying kidney damage or disease.

What does Proteinuria (excessive protein in the urine) look like?

Proteinuria most commonly is a laboratory finding and does not cause any obvious symptoms. However, some individuals may experience:

• a change in urine color
• frothy urine
• presence of sediment in the urine

Who gets Proteinuria (excessive protein in the urine)?

Populations who are at a higher risk for proteinuria include individuals with:

• hypertension
• diabetes
• a family history of kidney disease.

Patients with cancer may be at higher risk for proteinuria due to the potential nephrotoxicity of certain cancer treatments. Most vascular endothelial growth factor (VEGF) inhibitors can increase risk of proteinuria.

Some commonly used VEGF inhibitors are:

• Bevacizumab (Avastin®, Mvasi®, Zirabev®)
• Ramucirumab (Cyramza®)
• Regorafenib (Stivarga®)
• Lenvatinib (Lenvima®)
• Axitinib (Inlyta®)
• Cabozantinib (Cabometyx®, Cometriq®)
• Pazopanib (Votrient®)
• Sunitinib (Sutent®)
• Fruquintinib (Fruzaqla®)
• Tivozanib (Fotivda®)

How to prevent Proteinuria (excessive protein in the urine)

• Preventing proteinuria involves careful monitoring of kidney function and protein levels in the urine.

Patients undergoing cancer treatment known to increase the risk of proteinuria are often regularly monitored for proteinuria.

• This typically involves a urine sample that is either tested bedside, known as a urine dipstick test, or analyzed via a urinalysis in a lab.
• If protein levels are found to be elevated, patients may be asked to collect their urine over a 24-hour period to have it analyzed to get a more accurate amount of protein that is being excreted into the urine throughout the day.

How to treat Proteinuria (excessive protein in the urine)

• If proteinuria occurs, the suspected medicagion is stopped until protein levels in the urine return to normal and kidney function improves. Afterwards, the medication may be resumed at the same dose or at a reduced dose under the direction of the doctor.
• In severe cases, switching to alternative treatment agent may be necessary.

In some cases, additional medications, such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), may be necessary.

• ACE inhibitors:
  • Lisinopril (Prinivil®, Zestril®)
  • Enalapril (Vasotec®)
  • Ramipril (Altace®)
  • Captopril (Capoten®)
  • Benazepril (Lotensin®)
  • Quinapril (Accupril®)
• ARBs:
  • Losartan (Cozaar®)
  • Valsartan (Diovan®)
  • Irbesartan (Avapro®)
  • Candesartan (Atacand®)
  • Olmesartan (Benicar®)
  • Telmisartan (Micardis®)