Sulphosalicylic Acid Test for Proteinuria – Principle, Procedure, Result, Uses

The majority of plasma proteins are too big to pass through the kidney’s glomeruli. The limited quantity of protein that does filter through is often reabsorbed by the renal tubules back into the blood. Normal urine contains only trace levels of protein (less than 150 mg per 24 hours). Tamm-horsfall protein (up to 40%), albumin (20%), immunoglobulins, hormones, enzymes, and mucopolysaccharides are among these proteins.
Proteinuria is defined as the presence of greater than trace levels of protein in urine. Protein has a very low maximal tubular rate of reabsorption, making the detection of proteinuria an essential indicator of renal illness. The following tests are employed to detect proteinuria:

• Qualitative Tests:
  Heat and acetic acid test
  Sulphosalicyclic acid test
  Hellers nitric acid test
• Quantitative Tests:
  Esbach’s method
  Aufrecht’s method
• Other tests:
  Protein reagent strip test
  Biuret test
  Urine protein electrophoresis

Principle of Sulphosalicylic Acid Test

The 5-sulphosalicylic acid precipitates proteins. Any turbidity that results provides an estimate of the amount of protein in the urine, which can be visually quantified subjectively or photometrically quantified more precisely. Before conducting the test, the urine must be centrifuged to remove cells and casts. Albumin, haemoglobin, myoglobin, and Bence Jones proteins can be detected by the test.

Requirements for Sulphosalicylic Acid Test

• Specimen: Random urine
• Apparatus: Centrifuge, general purpose; Graduated pipettes/micropipettes; Measuring Cylinder; Test Tubes; pH paper/ pH meter
• Reagents: 5-sulphosalicylic acid solution-3%; Glacial acetic acid-10%

Procedure of Sulphosalicylic Acid Test

1. If a sample of urine has an alkaline or neutral pH, add 10% acetic acid solution drop by drop until it is just acidic (about pH 6).
2. If the urine is murky, it should be filtered or centrifuged (5 minutes, 2000-3000 rpm).
3. Collect 2 ml of urine in a test tube.
4. Mix with 2 ml of 5-sulphosalicylic acid solution. Do not shake. Examine for turbidity in the presence of a dark background.

Result and Interpretation

• Negative: There are no clouds
• Positive: A trace of turbidity

1+: definite turbidity
2+: Significant turbidity without flocculation
3+: Moderate turbidity with moderate flocculation.
4+: Severe turbidity and flocculation.

This approach does not detect any protein in normal urine. If a patient is getting tolbutamide, penicillin, and other medications, a false-positive result may be obtained. Due to the precipitation of urate in an acidic urine, a high concentration of urates in the urine may produce a false positive.

Applications of Sulphosalicylic Acid Test

Sulphosalicylic acid test is a commonly used laboratory test that is used for a variety of purposes, including:

1. Protein determination: The sulphosalicylic acid test is commonly used to measure the total protein concentration in a sample, such as blood or urine.
2. Detection of kidney disease: The sulphosalicylic acid test is often used as a preliminary test to screen for kidney disease, as it can detect the presence of protein in the urine, which can be a sign of kidney damage.
3. Detection of liver disease: The sulphosalicylic acid test can also be used to detect liver disease, as elevated levels of protein in the blood can be a sign of liver damage.
4. Diagnosis of certain infections: The sulphosalicylic acid test can be used to detect the presence of certain infections, such as tuberculosis, as increased levels of protein in the urine can be a sign of an active infection.
5. Monitoring the effectiveness of treatment: The sulphosalicylic acid test can also be used to monitor the effectiveness of treatment for various conditions, such as kidney disease or liver disease, by measuring changes in protein levels over time.

It’s important to note that the sulphosalicylic acid test should not be used as a standalone diagnostic tool and should be interpreted in conjunction with other clinical and laboratory findings.

Advantages of Sulphosalicylic Acid Test

1. Simple and convenient: The sulphosalicylic acid test is simple to perform and requires minimal sample preparation, making it a convenient option for routine laboratory testing.
2. Cost-effective: The sulphosalicylic acid test is relatively inexpensive compared to other laboratory tests, making it a cost-effective option for routine screening.
3. Sensitivity: The sulphosalicylic acid test is sensitive enough to detect small amounts of protein in a sample, making it useful for the early detection of kidney and liver disease.
4. Widely available: The sulphosalicylic acid test is widely available and can be performed in most clinical laboratories, making it accessible to healthcare providers and patients.

Disadvantages of Sulphosalicylic Acid Test

1. Limited specificity: The sulphosalicylic acid test is not specific to a particular type of protein, so it cannot be used to identify the specific type of protein present in a sample.
2. False positive results: The sulphosalicylic acid test can give false positive results if the sample contains other substances that interfere with the test, such as certain medications or high levels of glucose.
3. Poor accuracy: The accuracy of the sulphosalicylic acid test can be affected by a variety of factors, including the presence of interfering substances, the quality of the sample, and the skill of the technician performing the test.
4. Not a standalone test: The sulphosalicylic acid test should not be used as a standalone diagnostic tool and should be interpreted in conjunction with other clinical and laboratory findings to provide a complete picture of a patient’s health status.

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