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Proteinuria, A medical student prespective
 

Proteinuria, A medical student prespective

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A medical student rotating via Nephrology takes us via using a concept map as her understanding of proteinuria improved from her first encounter.

A medical student rotating via Nephrology takes us via using a concept map as her understanding of proteinuria improved from her first encounter.

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    Proteinuria, A medical student prespective Proteinuria, A medical student prespective Presentation Transcript

    • Proteinuria A medical Student perspective
      • Rahmat A. Balogun
      • North Shore LIJ
    • A concept map of proteinuria in my head before I read more about it
    • Barriers to Proteinuria
      • Size Barrier (podocytes restrict molecules >1.5nm)
      • Charge Barrier (negative charged BM and endothelial cells)
      • Proximal Tubule reabsorption
    • Determination of Proteinuria
      • Detection
        • Dipstick (0 to 3/4+) detects albumin
        • False +/-, pH dependent, concentration dependent
      • Quantitative
        • Microalbuminuria
        • Protein-Creatinine ratio (equal to 24hr collection)
      • Qualitative (electrophoresis)
    • Normal Urine Protein (<150mg/day)
      • Tamm-Horsfall Protein (glycoproteins)
      • Blood Group related
      • Albumin
      • Immunoglobulin
      • Mucopolysaccharides
      • Hormones, Enzymes, Other (very small amount)
    • Proteinuria Functional Tubular Glomerular Overflow Most common cause in clinical practice
    • Functional
      • Typically < 1g/24hrs
      • Benign form of proteinuria
    • Proteinuria Benign Orthostatic Transient Functional Standing Exertion Fever Tall, thin, <30 y/o
    • Glomerular
      • Most common cause in clinical practice
      • 85-99% albumin accompanied by other LMW proteins
      • May be only a few 100mg/24hrs
      • Only glomerular proteinuria can account for >1.5g protein/24hrs
      • Theories
        • Charge
        • Podocyte detachment
        • Increased Glomerular hydrostatic pressure
    • Proteinuria Primary Secondary Proliferative Non-Proliferative Proliferative Non-Proliferative Glomerular
    • Proteinuria IgA Proliferative Non-Proliferative Mesangial Proliferative Membranoproliferative Membranous Immunotactoid Fibrillary MCD FSGS Primary Glomerular
    • Proteinuria HSP Proliferative Non-Proliferative HepC Post infectious Light Chain Amyloid Secondary FSGS Anti-GBM Lupus Vasculitis Bacterial Endocarditis Cryoglobulin Diabetic HTN Secondary Glomerular
    • Tubular
      • Often accompanies Glomerular proteinuria
      • Often masked by Glomerular proteinuria (mixed proteinuria)
      • May occur in isolation (Fanconi Syndrome)
      • Almost never >1.5g/24hrs
    • Proteinuria Isolated Fanconi's Syndrome Mixed Tubular Acquired Inherited Proximal tubule dysfunction AIN ATN Other Toxins RTA Multiple Myeloma
    • Overflow
      • Increased production and excretion of LMW proteins, usually reabsorbed in Proximal Tubule.
      • Usually < Nephrotic Range
    • Proteinuria Light Chains Immunoglobulin Kappa IgG Lambda Overflow Amyloid IgM
    • A better understanding of the concepts now