Proteinuria pathway

A measurement of proteinuria should be made prior to each cycle for all patients receiving aflibercept and bevacizumab.  Measurement should be considered for other oral VEGFi’s depending on the primary cancer, and clinical context – please see individual MPCs. Refer to specific study protocol for all patients receiving VEGF-i in a clinical trial. Otherwise please see box notes about measuring proteinuria.

Measuring protein

• If eGFR>10 the obtain 4ml of urine in a sterile container. Send to Biochemistry - request urinary protein, creatinine and UPCR (urinary protein creatinine ratio)
• If eGFR<10 then ask patient to collect urine over a full 24 hours. Send to Biochemistry - request a 24-hour urinary protein level and a creatinine clearance.

Measured urine protein results

• Urine protein creatinine ratio (UPCR, mg/mmol): 
  • normal ratio is <15mg/mmol
  • nephrotic when ratio >350mg/mmol.
• 24 hour protein (g/24hour): 
  • normal <0.15g protein/L
  • nephrotic >3.5g protein/L.