Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Latest Proteinurea Lecture PPT
PROTEINUREA.
? Manifestation of glomerular disease,
characterised by nephrotic range proteinurea
and a triad of clinical finding associated with
large urinary losses of protein :
hypoalbuminaemia, edema and
hyperlipidemia.
? Urine dipstick.
? Urinary pr./cr. Ratio.
? 24 hrs urine collection.
PROTEINUREA.
? The presence of abnormal quantities of
protein in the urine is called proteinurea.
? Evaluation of proteinurea--
? HISTORY--
? Symptoms of renal failure.
? Past history of DM, HTN, CCF.
? Drug history---NSAID, Captopril.
? Family history of PCKD.
Examination.
? Look for sign of Nephrotic syndrome.
? Urine dipstick test to check for microscopic
hematurea.
? If present go for urine microscopy.
? Rule out Diabetes and UTI.
Quantification for proteinurea.
? 24 hrs urine collection.
? Spot urine protein to creatinine ratio.(PCR).
? Albumin to creatinine ratio. (ACR).
? More than 150 mg in 24h(PCR) is abnormal.
? Nephrotic range > 3.5 g/24h or ratio of 3500.
? Check for serum albumin and cholesterol.
URINE DIPSTICK TEST.
? Positive:
? If proteinurea 1+ (30mg/dl with sp.g <1.015.
? ....................... 2+ (100mg/dl)............> 1.015.
? Less sensitive
? LMWP
? Bence jones protein.
? Gamma globulins.
? It mainly detects albumin.
Urine dipstick test.
? Classification of proteinurea?
? Negative----no protein.
? Trace -------10--20 mg/dl.
? 1+ --------30-100 mg/dl.
? 2+ ---------100- 300 mg/dl.
? 3+ --------300- 1000 mg/dl.
? 4+ --------> 1000mg/dl.
Urine dipstick test.
? False negative
? Diluted urine
? Disease in which predominant urinary protein is
not albumin.
? False positive
? Concentrated urine
? Urine PH > 7.
? Gross hematurea.
? Antiseptic contamination.
Urinary protein/creatinine ratio.
? First morning voided urine should be tested.
? This ratio is age dependent:
? < 2 years < 0.5
? > 2 years < 0.2
? Nephrotic range......... 3.
24 hours urine collection.
? Normal proteinurea
? < 4mg/m2/hours
? Abnormal proteinurea
? > 4mg/m2/hours
? Nephrotic range proteinurea
? > 40 mg/m2/hours
Types of proteinurea.
? Transient proteinurea.
? Postural proteinurea.
? Persistent proteinurea.
? transient proteinurea---
? High fever, exercise, dehydration, stress, etc.
? Note-
? Does not exceed 2+
? It is benign.
? No need to any evaluation.
POSTURAL PROTEINUREA.
? Morning voided urine- absent/ traces of protein.
? Urine pr./cr. < 0.2 for 3 consecutive days.
? Most common cause:
? In 60 % of school age and adolescent children.
? Usually asymptomatic.
? Usually not exceed 1g/m2/day.
? No BP INCREASE, azotemia, oedema,
hypoalbuminemia.
Persistent proteinurea.
? Necessary to R/O postural proteinurea.
? Exact cause unknown.
? Possible cause --
? Altered renal hemodynamic
? Partial renal vein obstruction.
? If persists-
? Long term follow up for renal disease
detection.
Fixed proteinurea.
? Significant proteinurea in first morning
voided urine for 3 consecutive days.
? > 1+ on dipstick.
? > 0.2 U pr./U.cr.
? It usually indicates renal disease.
? Classified on the basis of site of origin:
? Glomerulous.
? Tubular
Glomerular proteinurea.
? Due to increased glomerular capillary
permeability.
It is always selective.
? Selective proteinurea
? Excretory protein molecular wt. albumin.
? Non selective proteinurea
? Excretory protein, molecular wt. > albumin.
Glomerular proteinurea
? Suspect if
? U pr./cr. Ratio > 1.0
? Associated with hypertension, Azotemia,
oedema, hematurea.
? Causes are
? FSGN,,PSGN,IGA nephropathy, HSPN.
Tubular proteinurea.
? MW< albumin, protein filter---- reabsorb.
? Reabsorption reduces in proximal tubular injury
disease.
? Low MW proteins.
? < 1g/d.
? Urinary Pr./cr. < 1.0
? Oedema absent.
? Cause-
? cystinosis, ATN, PCKD.
NEPHROTIC SYNDROME.
? Incidence: 2-3/100,000 children/year.
? 15 times more common in children.
? Characterised by
? Heavy proteinurea > 40mg/m2/ hrs.
? Hypoalbuminemia < 2.5 mg/dl.
? Oedema
? Hypercholestremia/Hyperlipidemia > 200
mg/dl.
Classification of Nephrotic
syndrome.
? 1.Ideopathic(90%).
? -Minimal change 85%.
? Mesengial proliferative 5%.
? FSGN 10%.
? 2.Secondary (10%).
? Membranous nephropathy
? Membranoproliferative glomerulonephritis.
? 3.Congenital.
PATHOLOGY.
Due to
Then
inflammation of
Abnormal
protein(Albumin) is
glomerular
permeability of
filterate in
capillaries.
GBM.
urine(proteinurea)
Decrease serum
albumin level.
PATHOLOGY.
Due to albumin decreases in blood
Oncotic pressure in blood
Also decreases.
So, fluid comes out to extracellular space.
edema
Orbital edema
then
Generalised edema
ANASARCA.
Sign/symptoms of Idiopathic NS.
? Periorbital oedema.
? Pedal oedema.
? Ascites and pleural effusion.
? General oedema.
? Hematurea in few cases.
MCNs(Lipoid Nephrosis)
? Commenest cause of nephrotic
syndrome(70%).
? Common in male M:F 2:1
? Common age 2-7 years.
? 15 Times more common in children.
? Oedema , anorexia, irritability, abdominal
pain, diarrhoea.
Diagnosis of MCNS.
? Urine analysis : Protein urea 3-4+(selective).
? Microscopic hematurea 10-20 %.
? Spot urine-urinary pr./cr. 2.
? 24 hrs urine collection > 40 mg/m2/h
proteinurea .
? S.albumin < 2.5 mg/dl.
? High cholestero and triglycerides > 200 mg/dl.
? S. Urea, creatinine, C3, C4, levels normal
? Renal biopsy E/M fusion of epithelial cells foot
process.
This post was last modified on 30 November 2021