Hi Ginger, thank you so much for the warm welcome and for sharing your experience. It’s incredibly helpful to hear how others have navigated complex diagnostic paths.

This was my first 24-hour urine protein electrophoresis and it revealed a globulin predominant profile, specifically elevated alpha and beta globulins, with no monoclonal spike. My nephrologist wasn't concerned and felt no further workup was needed but encouraged me to seek a second opinion if I remained uneasy. My GI doctor, who is also board certified in internal medicine, ordered a follow-up 24-hour urine protein test. It again showed mild elevation, slightly higher than what was seen on the electrophoresis.

Given this, my primary care physician is now referring me to hematology. The thinking is that this pattern could point to abnormal globulin production. I’m hopeful hematology will evaluate further even though my SPEP was within normal limits.

My concern is that globulins are typically too large to be freely filtered and are usually reabsorbed in the tubules, so their presence in significant amounts could reflect either a tubular dysfunction or an overproduction issue. I’ve also developed persistent foamy urine this year, which has been consistent and is unlike anything I’ve experienced before. On top of that, I have multiple kidney cysts that haven’t yet been fully characterized.

My eGFR has remained stable, and other labs like creatinine, CBC, and CMP have generally looked fine. I haven’t had any recent infections that I know of, though I’ve had COVID at least twice, most recently in January. I’ve also been experiencing a range of systemic symptoms including night sweats, cold extremities, and appetite loss, and overall I just haven’t felt well since summer 2023.

I’m very interested in repeating the 24-hour collection and pursuing more targeted testing such as markers of tubular injury to get closer to understanding what’s going on.

Thanks again for your support and guidance. It really means a lot.

Mark