foamy urine, help

Hello doc,

As the title say, I am experiencing foamy urine. I noticed it around April (2023) last year, I do not know when it begun. It is true foam not just bubbles, sometimes less sometimes more. Usually, after a meal it is more and after exercise too. At that time, I had a bad shoulder injury, and I was using advil topical and sometimes nsaids. I do not know if that was the reason for the foamy urine. Also, I was and am experiencing a lot of stress due to other factors but also due to the foamy urine. I am getting obsessed about it, and it is all I can think of. My shoulder got better after the shoulder rehab template. Now I am running the hypertrophy II template with no discomfort, training 6 days a week. I wrote about this in the fb group too. I went to two different GPs in June and September. The results are the following,

1st GP (June 2023): serum haematology, liver etc all fine. Sodium, potassium within normal range.
Creatinine = 1.25 mg/dl (upper limit 1.17)
Albumin (serum) = 47 g/l (35-55)
Fasting glucose = 5.4 mmol/l (4.0-6.4)

Urine (first void of the day but hours after I had woken up, was foamy):
Total protein = 0.06 g/l (<0.1)
Creatinine = 17.3 mmol/l (5-10)
PCR = 3 (<30)

For the test I had two days of rest and one day off creatinine.

2nd GP(September): He ran lots of tests. Kidney, upper and lower front belly ultrasound normal. I had high blood pressure at the doc (I think 14/8) and he told me to monitor at home for a week. I was taking 2-3 measurements at midday by following your instructions from an article. I was always below 12/8.

Blood work: RA factor negative (for the shoulder, I asked it because I was afraid), anti-something for RA also negative. Anti-dsdna for lupus non-existent. CRP 1.8 mg/L (0-5). Glucose normal, Cholesterol 226 mg/dl (<200) (I was on a bulk, maybe a dirty one. Maybe related to kidneys(?)). Triglycerides 63 mg/dl(<150). HDL 55 mg/dl (40-85). SGOT,SGPT,γ-GT all normal. ALP, LDH normal. Ferritin, Iron normal.

Kidneys (blood work): Urea normal, albumin 4.7 gl/dl (3.5-5), Total protein 7.5 g/dL (6.3-8.6), creatinine = 1.18 mg/dl (0.6-1.3), Cystatin C= 0.78 mg/l (0.31-0.79 mg/L weird range(?). I personally asked the lab for cystatin c and they had no clue about it except one person).

Urine (first void of the day, was foamy): microalbumin = <5 μg/mL (<20), creatinine= 144,8 mg/dl (22-392). UACR = <3.5 mg/g (<20) . Urine analysis with dipstick clear and negative to protein with red blood cells in the urine at 0 1.

Urine 24hour collection (that day I had bad sleep, and low mood. I only ate two protein meals.)
Urine volume = 2880 mL (drank lots of water, also when I do not sleep well i urinate more)
Creatine Clearance = 139 mL/min (85-125)
Protein = 141.1 mg (<150) (kept the collection outside fridge in room temperature and I read that it might increase protein)

For that test, I was off exercise and creatine for 6 days.

I am male 28yo, 170cm, 80 kg, body fat 15-20%, waist 77 cm. My creatinine for years was between 1.2 to 1.4. I still experience foamy urine. I understand that it might be difficult to answer in a forum post. When I asked the second GP what I should do in the future, he told me that I do not need further testing. The first GP told me that the foam might be from my high creatinine in the urine which I doubt. What should my steps be next? This thing is consuming all my mental energy. I feel in danger all the time.

This is well beyond the scope of what can be realistically addressed via the forum, but based on what you have laid out so far, I am inclined to agree with your physician that you do not appear to be in danger, and probably do not need further testing for this.

Only about one third of patients volunteering this complaint will ultimately be found to have abnormal proteinuria, so most cases of foamy urine remain unexplained. … With the current understanding and the available knowledge, we do not recommend investigating foamy urine in patients who lack proteinuria.

Source

Thank you. Do you believe that a consultation with bbm in the future for this is worth it?

I do not think I would have anything to add.

Thank you for your time. Is another pcr, acr test reasonable or should I ask for mental health support?

There is no reason to repeat the kidney/urine testing you’ve had so far unless something else changes. If you are struggling from the mental health standpoint, that would be a good next step.