Proteinuria, A medical student prespective
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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