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Proteinuria

Proteinuria

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Proteinuria

  1. 1. D O N E B Y : AB D U LWAH A B K N E YAZ I M B B S PROTEINURIA
  2. 2. CONTENT • Introduction • Classification • Nephrotic syndrome • Nephritic Syndrome
  3. 3. INTRODUCTION • Normally, less than 150 mg of protein in the urine per day. • More than 150 mg per day is called proteinuria.
  4. 4. CLASSIFICATION Proteinuria Transient proteinuria Orthostatic proteinuria Persistent proteinuria
  5. 5. TRANSIENT • Most common form of proteinuria. Transient proteinuria usually resolves without treatment. • Stresses such as fever, exercise, Pregnancy and UTI may cause transient proteinuria.
  6. 6. ORTHOSTATIC • 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 morning
  7. 7. ORTHOSTATIC • No further management typically disappears with age
  8. 8. PERSISTENT Persistent Overflow Tubular Glomerular
  9. 9. OVERFLOW • Overproduction of protein, leading to increase filtered load is to a level that exceeds the normal proximal reabsorptive capacity. • Multiple myeloma • Acute myelomonocytic leukemia • myoglobin (in rhabdomyolysis) • intravascular hemolysis (free hemoglobin) that is not bound to haptoglobin.
  10. 10. TUBULAR • Tubulointerstitial diseases or some primary glomerular diseases THAT Interfere with proximal tubular reabsorption. • Lead to increased excretion of smaller proteins
  11. 11. GLOMERULAR • Glomerular proteinuria is due to increased filtration of macromolecules (such as albumin) across the glomerular capillary wall.
  12. 12. GLOMERULAR • Nephrotic Syndrome • Nephritic syndrome
  13. 13. NEPHROTIC SYNDROME • Urine protein >3.5 g per day • Hypoalbuminemia • Hyperlipidemia and lipiduria • Edema
  14. 14. • Primary nephrotic syndrome, in the absence of an identifiable systemic disease • Secondary nephrotic syndrome, in the presence of an identifiable systemic disease.
  15. 15. CAUSES • 50%-75% nephrotic syndrome in the absence of an identifiable systemic disease membranous nephropathy • 35% Focal segmental glomerulosclerosis • 15% Membranoproliferative glomerulonephritis (e.g. Autoimmune diseases) • Systemic disease: DM, HTN, Drug/ toxin e.g. NSAID and penicillamine • Infection
  16. 16. DIAGNOSIS • History Edema, periorbital, anasarca foamy urine, DM, HTN Systemic manifestation and joint involvement • Examination Anasarca, Pulmonary edema
  17. 17. DIAGNOSIS • Urine analysis RBC cast(glomerulonephritis) WBC cast (pyelonephritis and interstitial nephritis) Fatty Cast (nephrotic syndrome) +ve albumin
  18. 18. DIAGNOSIS • Renal profile • Electrolyte (Hyponatremia) • lipid profile • Urine 24h collection for protein • total protein/creatinine (greater than 3 mg protein/mg creatinine)
  19. 19. TREATMENT • Controlling the underlying disease • ACE inhibitors • Diuretics • Vaccination (influenza and pneumococcus)
  20. 20. NEPHRITIC SYNDROME Nephrotic syndromeNephritic syndrome Abnormal glomerular permeability Inflammation of glomeruli(glomeruloneph ritis) Pathogenesis Membranous glomerulonephritis Post strept glomerulonephritis causes Proteinuria >3.5 g/24h Hypoalbunimia hyperlipidemia Hematuria, oliguria Mild Proteinuria lab Edema Hypercoagulable state Increase risk or infection HTN Edema Clinical finding
  21. 21. REFERENCE • 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.

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