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D O N E B Y : AB D U LWAH A B K N E YAZ I M B B S
• Nephrotic syndrome
• Nephritic Syndrome
• Normally, less than 150 mg of protein in the urine per
• More than 150 mg per day is called proteinuria.
• Most common form of proteinuria. Transient proteinuria
usually resolves without treatment.
• Stresses such as fever, exercise, Pregnancy and UTI
may cause transient proteinuria.
• loses protein in the urine while in an upright position but
not when lying down.
• Occurs in 2 to 5 % of adolescents but is unusual in
people over the age of 30 years.
• Orthostatic proteinuria is diagnosed by obtaining a split
urine collection. This requires collecting two urine
samples: usually during the day and another in the
• No further management typically disappears with age
• Overproduction of protein, leading to increase filtered load is
to a level that exceeds the normal proximal reabsorptive
• Multiple myeloma
• Acute myelomonocytic leukemia
• myoglobin (in rhabdomyolysis)
• intravascular hemolysis (free hemoglobin) that is not bound to
• Tubulointerstitial diseases or some primary glomerular
diseases THAT Interfere with proximal tubular
• Lead to increased excretion of smaller proteins
• Glomerular proteinuria is due to increased filtration of
macromolecules (such as albumin) across the
glomerular capillary wall.
• Nephrotic Syndrome
• Nephritic syndrome
• Urine protein >3.5 g per day
• Hyperlipidemia and lipiduria
• Primary nephrotic syndrome, in the absence of an
identifiable systemic disease
• Secondary nephrotic syndrome, in the presence of an
identifiable systemic disease.
• 50%-75% nephrotic syndrome in the absence of an
identifiable systemic disease membranous nephropathy
• 35% Focal segmental glomerulosclerosis
• 15% Membranoproliferative glomerulonephritis (e.g.
• Systemic disease: DM, HTN, Drug/ toxin e.g. NSAID and
Edema, periorbital, anasarca
Systemic manifestation and joint involvement
Anasarca, Pulmonary edema
• Urine analysis
WBC cast (pyelonephritis and interstitial nephritis)
Fatty Cast (nephrotic syndrome)
• Renal profile
• Electrolyte (Hyponatremia)
• lipid profile
• Urine 24h collection for protein
• total protein/creatinine (greater than 3
mg protein/mg creatinine)
• Controlling the underlying disease
• ACE inhibitors
• Vaccination (influenza and pneumococcus)
Nephrotic syndromeNephritic syndrome
Proteinuria >3.5 g/24h
Increase risk or infection
• Hinkes BG, Mucha B, Vlangos CN, et al. Nephrotic
syndrome in the first year of life: two thirds of cases are
caused by mutations in 4 genes (NPHS1, NPHS2, WT1,
and LAMB2). Pediatrics 2007; 119:e907.
• El Bakkali L, Rodrigues Pereira R, Kuik DJ, et al. Nephrotic
syndrome in The Netherlands: a population-based cohort
study and a
• McKinney PA, Feltbower RG, Brocklebank JT, Fitzpatrick
MM. Time trends and ethnic patterns of childhood nephrotic
syndrome in Yorkshire, UK. Pediatr Nephrol 2001; 16:1040.