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Hematuria& Proteinuria

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  • 1. Hematuria & Proteinuria
  • 2. Causes of hematuria
    • Infection: cystitis, prostatitis, urethritis, Tbe
    • Trauma: prolonged strenuous exercise, rapid emptying of
    • over distended bladder.
    • Inflammation: glomerulonephritis, IgA nephropathy,
    • polyarteritis, post-irradiation
    • Tumors: Renal, ureter, bladder, prostate, urethra
    • Structural: calculi, simple cyst, PCKD,vascular malformation
    • Hematological: coagulation disorder, anti-coagulant therapy
    • Surgery: invasive procedure to the prostate or bladder
    • Toxin: sulfonamides, N-SAID, cyclophosphamide
    • Note: Feature suggested renal cause:HT, proteinuria, known
    • previous renal problem, abnormal RFT,family history.
  • 3. Evaluation and investigation for hematuria
    • UA and microscopic exam
    • Blood test: CBC, clotting screen, RFT
    • US of urinary tract, IVP
    • Cystoscopy
    • Renal angiogram or CT
    • Renal Bx
    • Note: If definit diagnosis cannot be made,
    • investigation should be repeated after
    • 4-6 month. Occult cancer will usually
    • become evident within one year.
  • 4. Approaching Patients with Microscopic Hemuturia Dipstick Positive Exclude menstruation MSU confirm trauma, recent sexual activity, UTI,viral infection High risk Low risk *Male, age> 40 Treatment *Heavy smoking *Occupation exposure Ultrasound Repeat MSU of dye,aromatic amine *Voiding symptom Negative Positive *Hx urologic disorder *Hx pelvic RT Positive Negative Solved FU MSU ± US Fully investigation 6-12months * cystoscopy *IVP, US, CT
  • 5. Proteinuria
    • Definition:
    • Microalbuminuria: urine protein 30-30 0 mg/day.
    • Gross albuminuria: Urine protein> 150 mg/d or
    • > 100 mg/m 2 /d,correlated with urine dipstick ≥ 1+
    • Transient proteinuria: การพบ protein ในปัสสาวะชั่วคราวจากภาวะต่างๆ
    • เช่นไข้ UTI exercise, post convulsion, CHF
    • Persistent proteinuria: การพบโปรตีนในปัสสาวะ ≥ 1+ ตั้งแต่ 2 ครั้งขึ้นไป
    • โดยตรวจห่างกันอย่างน้อย 6 ชั่วโมง
  • 6. Causes of proteinuria
    • Glomerular causes : (increase filtration)
    • Primary glomenulonephritis: IgA nephropathy, minimal
    • change GN, MGN, FSGS, MPGN
    • Secondary: Diabetic nephropathy, SLE,amyloidosis,
    • preeclampsia, infection (heptitis B,C,HIV,
    • post streptococcal GN, syphilis, malaria,
    • endo carditis), cancer (Lung, GI),
    • Renal transplant refection
    • Drug induced glomerulopathy: N-SAIDS, Heroin,
    • Lithium, heavy metals
    • Tubular causes (decrease reabsorption)
        • Hypertensive nepbrosclerosis
        • Uric acid nephropathy
        • Interstitial nephritis
        • Drug: NSAIDS, heavy metals
  • 7. Measurement of proteinuria
    • Dipstick proteinuria: crude semiquatitiation of protein
        • Trace: 5-20 mg/dl (<300 mg/d)
        • 1+: 30 mg/dl (300-800 mg/d)
        • 2+: 100 mg/dl (500-1500 mg/d)
        • 3+: 300 mg/dl (1000-3000 mg/d)
    • Protein to creatinine ratio:
    • reference value for age > 2 yrs: <0.2
    • age 6-24 month: <0.5
    • 24 hour collection quantification
  • 8. Proteinuria Dipstick> trace Exclude contamitation, UTI, prostatitis, orthostatic Repeat UA Negative Positive 24 hr urine protein Repeat Next 6M Positive Abnormal Sediment Isolated proteinuria Negative RC>5/HPF, cast Transient proteinuria Evaluated for systemic Nephritis disease: HT,DM, Hepatitis B,C

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