Proteinuria is the presence of excessive protein in the urine, usually greater than 30mg/dl on a spot sample or more than 150 mg/24 hours in adults. It is generally an unwelcome surprise in underwriting, because many times it is a finding in an otherwise healthy and asymptomatic individual who was headed straight for a standard or preferred policy issue that is suddenly derailed. Proteinuria can be persistent (present in all samples) or intermittent (caused by a transient illness or an acute problem).

When proteinuria is constant, it is usually a sign of underlying kidney disease, and secondarily a cause of increased mortality. Insurance studies have shown a mortality of almost 200% in applicants with significant proteinuria in those who had no symptoms of disease, and far greater than that in those where the protein in the urine was in large amounts. Diseases of the heart and circulatory system were the most important causes of eventual mortality in these people. Additionally kidney failure was a leading cause of illness as well.

Proteinuria can be the result of advanced or end stage disease from a different systemic illness. Diabetes is the most important of these. In diabetes, the presence of protein in the urine generally means advanced or uncontrolled disease. The blood vessels in the kidneys are affected, but it is important to realize that if this is happening on the level of the excretory system, it is also happening in other blood vessels in the body as well, such as the heart. Uncontrolled high blood pressure also is a significant cause of unexplained protein in the urine, and the same changes that narrow the vessels within the kidney and cause the individual apparatus of filtration to be damaged also happen in other vital blood vessels throughout the body and are causes of excess and early mortality.

There are sometimes explainable causes of proteinuria that are transient and may actually disappear, such as after an illness that a person has recovered from or as a result of muscle breakdown. In these cases, an underwriter may ask for repeat urine specimens to verify that the protein in the urine has a benign cause and has disappeared. While these may seem like an inconvenience during the underwriting process, they may save a standard or preferred issue. And as sometimes it is a sign of illness that has gone undetected, it may also be a fortuitous finding when presented early to an attending physician so that the problem may be treated before permanent damage occurs.

Proteinuria may cause the issuance of a rated policy when there is a long-term mortality consequence associated with it. Sometimes this is obvious from an already known chronic illness. Proteinuria in substantial amounts may result in postponement of issuance until the previously undiagnosed cause is identified and treated. Proteinuria that is massive or associated with potentially life threatening diseases, such as uncontrolled hypertension or diabetes, generally represents a worse prognosis than the underlying disease would have if the protein were not present and these cases may be declined.

The information contained on this page is not intended to provide medical advice, which should be obtained directly from your physician.