Download MBBS Proteinurea Lecture PPT

PROTEINUREA.

? Manifestation of glomerular disease,

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characterised by nephrotic range proteinurea

and a triad of clinical finding associated with

large urinary losses of protein :

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hypoalbuminaemia, edema and

hyperlipidemia.

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? Urine dipstick.
? Urinary pr./cr. Ratio.
? 24 hrs urine collection.
PROTEINUREA.

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? The presence of abnormal quantities of

protein in the urine is called proteinurea.

? Evaluation of proteinurea--

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? HISTORY--
? Symptoms of renal failure.
? Past history of DM, HTN, CCF.
? Drug history---NSAID, Captopril.
? Family history of PCKD.

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Examination.

? Look for sign of Nephrotic syndrome.
? Urine dipstick test to check for microscopic

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hematurea.

? If present go for urine microscopy.
? Rule out Diabetes and UTI.
Quantification for proteinurea.

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? 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.

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? Nephrotic range > 3.5 g/24h or ratio of 3500.
? Check for serum albumin and cholesterol.
URINE DIPSTICK TEST.

? Positive:

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? If proteinurea 1+ (30mg/dl with sp.g <1.015.
? ....................... 2+ (100mg/dl)............> 1.015.
? Less sensitive
? LMWP
? Bence jones protein.

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? Gamma globulins.
? It mainly detects albumin.


Urine dipstick test.

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? Classification of proteinurea?
? Negative----no protein.
? Trace -------10--20 mg/dl.
? 1+ --------30-100 mg/dl.

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? 2+ ---------100- 300 mg/dl.
? 3+ --------300- 1000 mg/dl.
? 4+ --------> 1000mg/dl.
Urine dipstick test.

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? False negative
? Diluted urine
? Disease in which predominant urinary protein is

not albumin.

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? False positive
? Concentrated urine
? Urine PH > 7.
? Gross hematurea.

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? Antiseptic contamination.
Urinary protein/creatinine ratio.

? First morning voided urine should be tested.
? This ratio is age dependent:

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? < 2 years < 0.5
? > 2 years < 0.2
? Nephrotic range......... 3.
24 hours urine collection.

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? Normal proteinurea
? < 4mg/m2/hours
? Abnormal proteinurea
? > 4mg/m2/hours
? Nephrotic range proteinurea

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? > 40 mg/m2/hours
Types of proteinurea.

? Transient proteinurea.
? Postural proteinurea.

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? Persistent proteinurea.

? transient proteinurea---
? High fever, exercise, dehydration, stress, etc.
? Note-

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? Does not exceed 2+
? It is benign.
? No need to any evaluation.
POSTURAL PROTEINUREA.

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? 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.

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? Usually not exceed 1g/m2/day.
? No BP INCREASE, azotemia, oedema,

hypoalbuminemia.
Persistent proteinurea.

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? Necessary to R/O postural proteinurea.
? Exact cause unknown.
? Possible cause --
? Altered renal hemodynamic

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? Partial renal vein obstruction.
? If persists-
? Long term follow up for renal disease

detection.

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Fixed proteinurea.

? Significant proteinurea in first morning

voided urine for 3 consecutive days.

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? > 1+ on dipstick.
? > 0.2 U pr./U.cr.
? It usually indicates renal disease.
? Classified on the basis of site of origin:

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? Glomerulous.
? Tubular
Glomerular proteinurea.

? Due to increased glomerular capillary

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permeability.

It is always selective.

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? Selective proteinurea
? Excretory protein molecular wt. albumin.
? Non selective proteinurea
? Excretory protein, molecular wt. > albumin.
Glomerular proteinurea

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? Suspect if
? U pr./cr. Ratio > 1.0
? Associated with hypertension, Azotemia,

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oedema, hematurea.

? Causes are
? FSGN,,PSGN,IGA nephropathy, HSPN.
Tubular proteinurea.

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? MW< albumin, protein filter---- reabsorb.
? Reabsorption reduces in proximal tubular injury

disease.

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? Low MW proteins.
? < 1g/d.
? Urinary Pr./cr. < 1.0
? Oedema absent.

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? Cause-
? cystinosis, ATN, PCKD.
NEPHROTIC SYNDROME.

? Incidence: 2-3/100,000 children/year.

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? 15 times more common in children.
? Characterised by
? Heavy proteinurea > 40mg/m2/ hrs.
? Hypoalbuminemia < 2.5 mg/dl.
? Oedema

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? Hypercholestremia/Hyperlipidemia > 200

mg/dl.
Classification of Nephrotic

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syndrome.

? 1.Ideopathic(90%).
? -Minimal change 85%.
? Mesengial proliferative 5%.

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? FSGN 10%.
? 2.Secondary (10%).
? Membranous nephropathy
? Membranoproliferative glomerulonephritis.
? 3.Congenital.

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PATHOLOGY.

Due to

Then

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inflammation of

Abnormal

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protein(Albumin) is

glomerular

permeability of

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filterate in

capillaries.

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GBM.

urine(proteinurea)

Decrease serum

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albumin level.
PATHOLOGY.

Due to albumin decreases in blood

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Oncotic pressure in blood

Also decreases.

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So, fluid comes out to extracellular space.

edema

Orbital edema

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then

Generalised edema

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ANASARCA.
Sign/symptoms of Idiopathic NS.

? Periorbital oedema.
? Pedal oedema.

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? Ascites and pleural effusion.
? General oedema.
? Hematurea in few cases.
MCNs(Lipoid Nephrosis)

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? Commenest cause of nephrotic

syndrome(70%).

? Common in male M:F 2:1

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? Common age 2-7 years.
? 15 Times more common in children.
? Oedema , anorexia, irritability, abdominal

pain, diarrhoea.

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Diagnosis of MCNS.

? Urine analysis : Protein urea 3-4+(selective).
? Microscopic hematurea 10-20 %.
? Spot urine-urinary pr./cr. 2.

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? 24 hrs urine collection > 40 mg/m2/h

proteinurea .

? S.albumin < 2.5 mg/dl.

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? High cholestero and triglycerides > 200 mg/dl.
? S. Urea, creatinine, C3, C4, levels normal
? Renal biopsy E/M fusion of epithelial cells foot

process.

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