2. PROTEINURIA/ALBUMINURIA
ASPECTS OF DISCUSSION:
1) Definition
2) Types
3) Symptoms
4) People at risk for Proteinuria.
5) Tests for Proteinuria.
6) Precautionary measures and medications for proteinuria.
3. PROTEINUIA (Protein in urine )
What is it?
proteins form the major building blocks for our bodies.
The right amount of protein is important in our diets, for growth and repair.
Protein is present in the blood; healthy kidneys should only filter tiny (trace) amounts into the
urine as most protein molecules are too large for the filters (glomeruli).
It is not usual to lose protein in the urine. When this does happen it is known as ‘Proteinuria’.
4. ALBUMINURIA
Albuminuria is a condition wherein the protein albumin is abnormally
present in the urine.
Albumin is a major plasma protein (normally circulating in the blood); in
healthy people.
only trace amounts of it are present in urine, whereas larger amounts occur
in the urine of patients with kidney disease.
5. ALBUMINURIA
Albumin is the main protein in the blood.
Its function is to maintain osmotic pressure and transport some nutrient.
It is a chronic kidney disease (CKD), which can result from diabetes, high
blood pressure and diseases that causes inflammation in the kidneys.
Kidney disease is sometimes called renal disease.
If CKD progresses, it can lead to end-stage renal disease (ESRD), when the
kidneys fails completely.
6. Normal urinary protein excretion
In normal adult, normal urinary protein
excretion should be < 150 mg/day.
Normal rate of albumin excretion is < 20
mg/day (15 mcg/min), increases with age and
higher body weight.
9. Tubular proteinuria
Tubular proteinuria: is proteinuria (excessive protein in
the urine) caused by renal tubular dysfunction. Proteins
of low molecular weight are normally filtered at the
glomerulus of the kidney and are then normally
reabsorbed by the tubular cells, so that less than 150
mg per day should appear in the urine.
Low-molecular-weight proteins' appearing in larger
quantities than this is tubular proteinuria, which points
to failure of reabsorption by damaged tubular cells.
10. Low-molecular weight
proteins
Symbols Molecular weights
Amount in normal
serum (plasma)
(mg /100ml)
Lysozymes 14,000 0.5-1.5
Basic protein B1 B1 11,000 –
Basic protein B2 B2 8,800 <1
0.6 S γ2-Globulin – 5,100 <1
2 S γ2-Globulin – 14,000 0.1
Post γ-globulin Pγ 13,260
11. Overflow proteinuria:
Overflow proteinuria: that due to hemoglobin,
myoglobin, or immunoglobulin loss into the urine
due to excessive amounts in the bloodstream, such
as in multiple myeloma; ( It is a cancer that forms in
a type of white blood cell)
12. SYMPTOMS
In most cases, proteinuria has no symptoms and is
detected during a routine screening in people with
high blood pressure or diabetes. If protein loss is
severe, swelling or edema can occur. Edema can be
present in the:
Face and around the eyes
Arms, hands, legs, ankles and feet
Abdomen
13. Other symptoms can include:
Foamy urine
Weight gain caused by fluid retention
Diminished appetite (loss of hunger)
Hypertension
14.
15. Introduction
My name Muhammad Muzamil Arshad.
And I will further carry on with the presentation discussing
Some of the remaining aspects of PROTEINURIA.
16. People at risk for proteinuria
Mainly three types of people are at great risk to suffer through
Proteinuria.
Hypertensive
17. Diabetic People
Diabetic people are one of the major suffers of proteinuria.
In both diabetes type 1,2 the albumin presence in urine is
the first sign of deteriorating kidney functions
Kidney functions decline with increase in the albumin
Concentration in the urine.
19. Hypertensive People
Hypertensive people are also at risk to have proteinuria.
Since in hypertension.
Blood flow is
high &
proteins are
big.
Exert great
pressure on
glomerulus.
As a result
the filter of
kidney is
damaged.
Which causes
leakage of
protein from
blood to
urine.
20. Obese People
In obese people accumulation of fats on the walls of vessels occurs.
Which results in increased blood flow. And may lead to proteinuria.
Some other peoples having family history of diabetes and renal
Diseases are also at risk.
21. Tests for Proteinuria
Earlier researchers though that for protein measurements a
24 hours urine sample collection was required.
But in recent years researchers have found that a single sample is enough
for the protein measurement of the patients.
For this purpose URINE ALBUMIN TO CREATININE RATIO TEST is
Carried out.
22. URINE ALBUMIN TO CREATININE
RATIO
In newer technique the amount of albumin is compared with creatinine.
Creatinine is the waste product of muscles breakdown.
This test is called urine albumin to creatinine ratio.
If the sample contains more than 30mg albumin per gram of creatinine the
patient is said to have Persistent Proteinuria.
Beside ATCR there is an additional test for proteinuria which is
called Estimated glomerulus filtration rate (eGFR).
23.
24. ESTIMATED GLOMERULUS FILTRATION
RATE (eGFR)
Amount of creatinine in blood shows a persons kidney is removing
wastes efficiently.
Chronic Kidney Disease (CKD) is present when eGFR is less than
60ml/minute.
Which is an indicator for person suffering through proteinuria.
25. PRECAUTIONARY MEASURES &
MEDICATION
Persons with diabetes and hypertension should control their blood
sugar and pressure. This is the only precautionary measure.
The medication for proteinuria includes
o ACE Inhibitor (angiotensin converting enzyme inhibitor).
o ARB’s (angiotensin receptor blockers).
ACE Inhibitor & ARB’s reduce the intra glomerular pressure on kidney by
inhibiting angiotensin II-medicated efferent arteriolar vasoconstriction.
These drugs also have a proteinuria reducing effect which is independent
of their antihypertensive effect.
