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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.

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Proteinuria, A medical student prespective

  1. 1. Proteinuria A medical Student perspective <ul><li>Rahmat A. Balogun </li></ul><ul><li>North Shore LIJ </li></ul>
  2. 2. A concept map of proteinuria in my head before I read more about it
  3. 3. Barriers to Proteinuria <ul><li>Size Barrier (podocytes restrict molecules >1.5nm) </li></ul><ul><li>Charge Barrier (negative charged BM and endothelial cells) </li></ul><ul><li>Proximal Tubule reabsorption </li></ul>
  4. 4. Determination of Proteinuria <ul><li>Detection </li></ul><ul><ul><li>Dipstick (0 to 3/4+) detects albumin </li></ul></ul><ul><ul><li>False +/-, pH dependent, concentration dependent </li></ul></ul><ul><li>Quantitative </li></ul><ul><ul><li>Microalbuminuria </li></ul></ul><ul><ul><li>Protein-Creatinine ratio (equal to 24hr collection) </li></ul></ul><ul><li>Qualitative (electrophoresis) </li></ul>
  5. 5. Normal Urine Protein (<150mg/day) <ul><li>Tamm-Horsfall Protein (glycoproteins) </li></ul><ul><li>Blood Group related </li></ul><ul><li>Albumin </li></ul><ul><li>Immunoglobulin </li></ul><ul><li>Mucopolysaccharides </li></ul><ul><li>Hormones, Enzymes, Other (very small amount) </li></ul>
  6. 6. Proteinuria Functional Tubular Glomerular Overflow Most common cause in clinical practice
  7. 7. Functional <ul><li>Typically < 1g/24hrs </li></ul><ul><li>Benign form of proteinuria </li></ul>
  8. 8. Proteinuria Benign Orthostatic Transient Functional Standing Exertion Fever Tall, thin, <30 y/o
  9. 9. Glomerular <ul><li>Most common cause in clinical practice </li></ul><ul><li>85-99% albumin accompanied by other LMW proteins </li></ul><ul><li>May be only a few 100mg/24hrs </li></ul><ul><li>Only glomerular proteinuria can account for >1.5g protein/24hrs </li></ul><ul><li>Theories </li></ul><ul><ul><li>Charge </li></ul></ul><ul><ul><li>Podocyte detachment </li></ul></ul><ul><ul><li>Increased Glomerular hydrostatic pressure </li></ul></ul>
  10. 10. Proteinuria Primary Secondary Proliferative Non-Proliferative Proliferative Non-Proliferative Glomerular
  11. 11. Proteinuria IgA Proliferative Non-Proliferative Mesangial Proliferative Membranoproliferative Membranous Immunotactoid Fibrillary MCD FSGS Primary Glomerular
  12. 12. Proteinuria HSP Proliferative Non-Proliferative HepC Post infectious Light Chain Amyloid Secondary FSGS Anti-GBM Lupus Vasculitis Bacterial Endocarditis Cryoglobulin Diabetic HTN Secondary Glomerular
  13. 13. Tubular <ul><li>Often accompanies Glomerular proteinuria </li></ul><ul><li>Often masked by Glomerular proteinuria (mixed proteinuria) </li></ul><ul><li>May occur in isolation (Fanconi Syndrome) </li></ul><ul><li>Almost never >1.5g/24hrs </li></ul>
  14. 14. Proteinuria Isolated Fanconi's Syndrome Mixed Tubular Acquired Inherited Proximal tubule dysfunction AIN ATN Other Toxins RTA Multiple Myeloma
  15. 15. Overflow <ul><li>Increased production and excretion of LMW proteins, usually reabsorbed in Proximal Tubule. </li></ul><ul><li>Usually < Nephrotic Range </li></ul>
  16. 16. Proteinuria Light Chains Immunoglobulin Kappa IgG Lambda Overflow Amyloid IgM
  17. 17. A better understanding of the concepts now