Proteinuria <3 on urine dipstick

Maintain TKI dose.

Urine should be tested for proteinuria every 3 months as usual (when the patient comes for results of evaluation scans)

Proteinuria ≥3 on urine dipstick

1) Maintain TKI dose.
2) Measurement of 24 hour urine protein within 1 week. If > 3.5 g/24 hours, TKI must be paused, and the patient should start treatment with ACE inhibitor (25–50 mg).
3) Monitor proteinuria/24 hour urine protein weekly until <3+ or <3.5 g/day. TKI can be resumed at a reduced dose. 4) If proteinuria again >3+ or 24-hour urine protein > 3.5 g/24 hours, TKI should again be paused and proteinuria/24 hour urine protein should be monitored weekly. In the event of a decrease, TKI can be resumed at a further reduced dose.

Blood pressure should be checked frequently. If the blood pressure is too high, adjust the antihypertensive treatment.
Book telephone appointment for follow-up of 24-hour urine and blood pressure and arrange a new 24-hour urine collection if necessary.
Consider referral to nephrologist.