Proteinuria

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Proteinuria – early indicator of renal disease …

Proteinuria – early indicator of renal disease

Increases the risk of renal impairment, hypertension & cardiovascular disease.

Proteinuria of 1+ or more persisting on 2 subsequent dipstick tests at weekly intervals – requires further investigations.

Causes of transient proteinuria to be excluded

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  • 1. Proteinuria Dr. Sachin Verma MD, FICM, FCCS, ICFC Fellowship in Intensive Care Medicine Infection Control Fellows Course Consultant Internal Medicine and Critical Care Ivy Hospital Sector 71 MohaliWeb:- http://www.medicinedoctorinchandigarh.com Mob:- +91-7508677495
  • 2. Proteinuria – early indicator of renal disease Increases the risk of renal impairment, hypertension & cardiovascular disease. Proteinuria of 1+ or more persisting on 2 subsequent dipstick tests at weekly intervals – requires further investigations. Causes of transient proteinuria to be excluded.
  • 3. CAUSES Transient proteinuria  UTI  Fever  Heavy exercise  Pregnency  Orthostatic proteinuria - not found in early morning sample, uncommon over age of 30 yrs  Vaginal mucus
  • 4. Persistant proteinuria Primary renal disease  Glomerular – GN  Tubular Secondary renal disease  DM  CTD  Vasculitis  Amyloidosis  Myeloma  CCF  Hypertension
  • 5. Evaluation History  Symptoms of renal failure  CTD – arthralgia, mouth ulcers, rashes.  Past h/o DM, HTN, CCF, CTD  H/O drugs ass. with proteinuria – NSAIDs, captopril, penicillamine  Family h/o PCKD, reflux nephropathy, CTD.
  • 6. Examination Look for signs of Nephrotic syndrome Signs of multisystem dis – rashes, splinter haemorrhage, bruits. B.P Urine dipstick test to check for microscopic haematuria – if + go for urine microscopy. Rule out Diabetes and UTI
  • 7. Quantification of proteinuria 24 hr urinary collection Spot morning protein/creatinine ratio – simpler & as accurate. 24 hr urinary protein excretion (mg/24hrs) can be approximated as (mg/l protein) / ( mmol/l creatinine) × 10 or (mg/l creatinine ) × 100. More than 150 mg in 24 hr or protein to creatinine ratio of 15 mg/mmol or 150 mg/mg is abnormal Nephrotic range - >3.5 g/24 hr or a ratio > 3500 - check for serum albumin and cholesterol.
  • 8. Assessment of renal function Check serum creatinine, urea, electrolytes. Creatinine clearance gives more accurate picture of renal function than creatinine alone, can be calculated by Cockcroft- Gault formula. Best to estimate GFR by MDRD formula GFR or creatinine clearance > 90ml/min can be considered normal. Lower values may be normal in old age and in people with low muscle mass.
  • 9.  Significant proteinuria > 100 mg/mmol although values > 50 may be significant if other features of renal disease are present like  Impaired renal function  Coexistant microscopic haematuria  Hypertension  Features underlying systemic disease.
  • 10. Further investigations Renal tract USG Immunology  Serum and urine protein electrophoresis  ANA  ANCA  Complements Hepatitis B & C serology
  • 11. Follow-up Review after six months and then annualy to reassess quantity of proteinuria, renal function and blood pressure. Any hypertension if present – to be treated aggressively with an ACE inhibitor or ARB.