Air Kencing Berbuih (Foamy Urine): Punca & Bila Perlu Risau

Air kencing berbuih (foamy urine) is usually harmless when it only happens now and then, and it can come from a fast stream, toilet cleaner or concentrated urine. It needs checking when the foam is regular, gets worse, takes more than one flush to clear, or comes with swelling or tiredness, because it may mean protein is leaking into your urine. A simple urine test can tell the difference. About one third of people who see a doctor about foam are found to have abnormal protein levels, so most are not, but looks alone cannot tell you which group you are in (Khitan and Glassock, 2019). This guide covers the causes, the warning signs, pregnancy, the tests used in Malaysia and how to read your results.

Buih biasa atau perlu risau?

Some bubbles are normal. The difference is mostly in how often it happens, how long the foam stays and what else you are feeling (Cleveland Clinic; UPMC):

This table is a guide, not a diagnosis. Foam is hard to measure and varies from person to person (Khitan and Glassock, 2019). And the opposite also applies: having no foam does not prove there is no protein in your urine. Early kidney disease usually has no symptoms (NHS), and you are unlikely to notice protein in your urine during pregnancy (NHS).

Punca air kencing berbuih

Punca yang biasanya tidak bahaya

• Kencing laju. The speed and force of the stream can create bubbles (Cleveland Clinic).
• Pencuci tandas. Toilet cleaner left in the bowl can make urine foam until the chemicals are flushed away (Cleveland Clinic; UPMC).
• Kurang minum air. Concentrated urine can foam more (UPMC; Cleveland Clinic). If your pee is also dark, you may simply need more water.

Punca yang menaikkan protein buat sementara

These can raise the amount of protein in your urine for a short time, so one positive test does not always mean a kidney problem (CPG, 2018; MedlinePlus):

• hard exercise;
• fever or an acute illness;
• a urine infection (UTI);
• your period, or blood in the urine;
• pregnancy;
• stress, dehydration and diet.

Punca yang perlu rawatan

Some medicines for urine infection pain, such as phenazopyridine, can also cause foam (Cleveland Clinic). In men, semen that goes back into the bladder (retrograde ejaculation) can do the same (Cleveland Clinic).

Kenapa protein boleh keluar dalam air kencing

Healthy kidneys keep protein in your blood. When the kidneys are damaged, some protein can leak through, which is what people often mean by buah pinggang bocor (see our guide to sakit buah pinggang). Protein can act like soap: it helps trap air in liquid, which is how foam forms (Khitan and Glassock, 2019). Normal urine also contains small amounts of similar substances, which may be why some people see a thin layer of foam when their urine is concentrated (Khitan and Glassock, 2019).

This matters in Malaysia because kidney disease is common and often silent. A national study estimated that 15.48% of Malaysian adults had chronic kidney disease in 2018, up from 9.07% in 2011, and that high blood pressure and diabetes were strongly linked to it (Saminathan et al., 2020).

Bila perlu jumpa doktor

Book a visit if (Cleveland Clinic):

• the foam lasts more than a few days or gets worse;
• it happens regularly, takes more than one flush to clear, or looks very frothy and white;
• you also have swelling (especially in your hands or feet), extreme tiredness, nausea or vomiting, or poor appetite;
• your urine is dark or cloudy, or there is blood in your urine.

Ask for a urine test even without foam if you have diabetes or high blood pressure. Malaysia’s guideline says you should be screened for kidney disease at least once a year (CPG, 2018). Screening may also be considered if you are obese, have heart disease, metabolic syndrome, gout, lupus, kidney stones or a family history of kidney disease, or if you are older than 65 or take certain long-term medicines (CPG, 2018).

Get urgent help if you are pregnant or gave birth in the last few weeks and have the pre-eclampsia symptoms listed below (NHS).

Air kencing berbuih semasa mengandung

Pregnancy can raise the amount of protein in urine (CPG, 2018; MedlinePlus). We did not find a health authority that says foam on its own is normal or abnormal in pregnancy, so mention it to your doctor or midwife rather than guessing. Urine and blood pressure checks at antenatal visits are how pre-eclampsia is picked up early, because you are unlikely to notice these early signs yourself (NHS).

Get urgent help if you are pregnant or gave birth in the last few weeks and have any of these (NHS):

• a severe headache that does not go away with simple painkillers;
• vision problems, such as blurred vision or flashing lights;
• pain just below your ribs;
• sudden swelling of your face, hands or feet (see our guide to kaki bengkak);
• heartburn that does not go away, vomiting, or feeling very unwell.

Pre-eclampsia is most likely from 20 weeks of pregnancy onwards, and it can also develop in the days or weeks after birth (NHS). In Malaysia, call your labour ward or go to the nearest hospital.

If you already have kidney disease and want to get pregnant, ask for pre-pregnancy care first. Malaysia’s guideline recommends it for all women of reproductive age with kidney disease, and says ACE inhibitors and ARBs, common kidney and blood pressure medicines, should be avoided in pregnancy (CPG, 2018). Do not stop any medicine on your own; speak to your doctor early.

Ujian di klinik

You cannot tell from the toilet bowl whether foam contains protein, but the tests are simple. Under Malaysia’s guideline (CPG, 2018):

1. Urine dipstick. This is the screening test for protein and blood. A positive result should be confirmed by a repeat test within 3 months. If you do not have diabetes, protein on 2 out of 3 tests leads to further checks.
2. Urine ACR (albumin:creatinine ratio). This finds smaller amounts of protein. An early morning sample is preferred. People with diabetes should have this if the dipstick is negative.
3. uPCR or 24-hour urine collection. These measure how much protein you are passing. An early morning uPCR can be used instead of collecting urine for a whole day.
4. Blood test (eGFR). This shows how well your kidneys filter. A creatinine result should not be used alone. An eGFR of 60 or more is normal, and below 60 may mean kidney disease (NIDDK).
5. Ultrasound, if your doctor thinks it is needed.

Dipsticks mainly pick up albumin and can miss some other proteins, so specialists suggest a uPCR when foam is new and the dipstick is negative or only shows a trace (Khitan and Glassock, 2019).

Sebelum ujian

You do not need special preparation, but tell the staff if you are having your period or have bleeding piles (MedlinePlus). Mention recent hard exercise, a fever or infection too, as these can raise the result (CPG, 2018).

Cara baca keputusan ujian

These are the values in Malaysia’s guideline for women (CPG, 2018). Your doctor will read your results together with your symptoms and other tests.

You may see slightly different numbers elsewhere. The NHS uses an ACR below 3 mg/mmol as the lowest category for everyone, while NIDDK reports 30 mg/g or less as normal, because some labs use mg/g. Ask your doctor which range your lab uses.

If your repeated tests show no protein, that is good news. Most cases of foamy urine are never explained, and kidney specialists do not recommend investigating foam further when there is no protein (Khitan and Glassock, 2019).

Rawatan dan apa yang boleh dibuat

There is no treatment for foam itself. Treatment targets the cause.

• If the cause is harmless: drink enough water, flush after cleaning the toilet and see whether it settles.
• If you have a urine infection: your doctor may prescribe antibiotics, then recheck if needed.
• If you have lasting protein with diabetes or high blood pressure: doctors commonly use an ACE inhibitor or ARB and aim for good blood pressure and blood sugar control. In Malaysia’s guideline, the blood pressure target for kidney disease with diabetes, or with protein loss of 1 g a day or more, is 130/80 mmHg or lower, and the HbA1c target for diabetic kidney disease is usually 7% or lower, adjusted to the person (CPG, 2018).
• If your protein loss is heavy or keeps going despite treatment: you may be referred to a kidney specialist (CPG, 2018). This also applies if you have both blood and protein in your urine, your kidney function is falling quickly, or you are pregnant or planning to be and have kidney disease.

Berhati-hati dengan ubat dan herba

Do not try to treat foam with herbal remedies. Certain herbal products, including those containing aristolochic acid, are linked to kidney disease (CPG, 2018). If you already have kidney disease, painkillers such as ibuprofen (NSAIDs) are a common trigger for a sudden drop in kidney function, so ask before taking them (CPG, 2018).

Frequently asked questions (FAQ)

Air kencing berbuih bahaya ke (is foamy urine dangerous)?

Usually not. Occasional bubbles are common and can come from a fast stream, toilet cleaner or concentrated urine (Cleveland Clinic; UPMC). It needs checking if the foam happens regularly, gets worse, takes more than one flush to clear, or comes with swelling or tiredness, because it may mean protein is leaking into your urine (Cleveland Clinic). About one third of people who see a doctor about foamy urine are found to have abnormal protein levels (Khitan and Glassock, 2019).

Air kencing berbuih tanda sakit buah pinggang ke (is it a sign of kidney disease)?

It can be, but foam alone cannot tell you. Regular foam may mean protein in the urine (proteinuria), which can be a sign of kidney damage (Cleveland Clinic; UPMC). Only a urine test can confirm this. Early kidney disease usually has no symptoms (NHS), so people with diabetes or high blood pressure should be screened at least once a year even without foam (CPG, 2018).

Kencing berbuih tanda kencing manis ke (is foamy urine a sign of diabetes)?

It can be linked. Diabetes can cause protein to leak into the urine, and uncontrolled diabetes raises the amount of protein passed (Cleveland Clinic; CPG, 2018). But foam is not a test for diabetes, and many things can cause it. If you are worried, ask for a urine test and a blood sugar test.

Air kencing berbuih semasa mengandung normal ke (is it normal in pregnancy)?

Pregnancy can raise the amount of protein in urine (CPG, 2018; MedlinePlus), but we did not find a health authority that says foam itself is normal in pregnancy. Mention it at your next antenatal check. Protein in urine with high blood pressure can be an early sign of pre-eclampsia, which you are unlikely to notice yourself (NHS). Get urgent help if you also have a severe headache, vision problems, pain below the ribs or sudden swelling (NHS).

Berapa lama air kencing berbuih baru perlu jumpa doktor (how long before I see a doctor)?

See a doctor if foamy urine lasts more than a few days or keeps getting worse (Cleveland Clinic). Go sooner if you have swelling, extreme tiredness, nausea, loss of appetite, or dark, cloudy or bloody urine (Cleveland Clinic). If you are pregnant or gave birth in the last few weeks and have symptoms of pre-eclampsia, get urgent help (NHS).

Ujian apa untuk air kencing berbuih (what test is done)?

The first test is usually a urine dipstick, which checks for protein. A positive result should be repeated within 3 months to confirm it (CPG, 2018). Your doctor may then measure the amount with an albumin:creatinine ratio (ACR), a protein:creatinine ratio (uPCR) or a 24-hour urine collection, and check your kidney function with a blood test (CPG, 2018).

Kurang minum air boleh buat kencing berbuih ke (can dehydration cause foamy urine)?

Yes. Urine can look foamy when it is more concentrated (UPMC; Cleveland Clinic). Your pee may also look darker. Drink more water and see whether the foam settles. If it keeps coming back when you are drinking normally, get a urine test.

Kenapa air kencing berbuih waktu pagi (why is it foamy in the morning)?

Normal urine contains substances that can form a single layer of foam, especially when it is concentrated (Khitan and Glassock, 2019). Your first pee of the day has often built up overnight without much drinking, so a little foam in the morning is not usually worrying. Get checked if it happens regularly or looks very frothy and white (Cleveland Clinic).

Minum protein shake boleh buat kencing berbuih ke (can protein shakes cause foamy urine)?

We did not find good studies on protein shakes and foam. MedlinePlus lists diet among the things that can temporarily raise urine protein. Rather than guessing, ask for a urine test if the foam continues.

Air kencing berbuih boleh hilang ke (can foamy urine go away)?

Yes. Foam from a fast stream, toilet cleaner or dehydration goes away by itself, and a temporary rise in protein from exercise, fever or a urine infection can settle too (Cleveland Clinic; CPG, 2018). If the test shows lasting protein, treatment depends on the cause. If repeated urine tests show no protein, the foam is often never explained, and specialists do not recommend further investigation (Khitan and Glassock, 2019).

Disclaimer

This article is for general information only and is not a substitute for advice from a doctor. Ask your doctor to explain your own results, and do not start or stop any medicine without medical advice. If you are pregnant and have symptoms of pre-eclampsia, get urgent medical help.

References

• Clinical Practice Guidelines: Management of Chronic Kidney Disease in Adults, Second Edition (2018) — Ministry of Health Malaysia (MaHTAS)
• Khitan ZJ, Glassock RJ. Foamy Urine: Is This a Sign of Kidney Disease? Clin J Am Soc Nephrol. 2019;14(11):1664-1666.
• Saminathan TA, et al. Prevalence of chronic kidney disease and its associated factors in Malaysia; findings from a nationwide population-based cross-sectional study. BMC Nephrol. 2020;21(1):344.
• Foamy urine — Cleveland Clinic
• Why is my urine foamy? — UPMC
• Protein in urine — MedlinePlus, US National Library of Medicine
• Chronic kidney disease tests and diagnosis — National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Nephrotic syndrome in adults — NIDDK
• Pre-eclampsia — NHS
• Chronic kidney disease — NHS
• Chronic kidney disease: diagnosis — NHS