1. Proteinuria can be classified based on quantity, origin, and whether it is isolated or associated with other conditions. Common types include orthostatic proteinuria, transient proteinuria, and proteinuria related to diabetes or hypertension.
2. Clinical assessment of proteinuria involves taking a medical history focused on symptoms, risk factors, and family history. A physical exam evaluates for signs of systemic disease or complications. Laboratory tests quantify protein levels and identify the type and cause.
3. Treatment depends on the underlying cause but generally includes restricting salt and protein intake, treating infections, and using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or diuretics. Specific therapies target
This was a review of different guidelines on lupus nephritis from ACR, EULAR, and KDIGO. Goal is appreciate similarities and differences between the different guidelines.
This was a review of different guidelines on lupus nephritis from ACR, EULAR, and KDIGO. Goal is appreciate similarities and differences between the different guidelines.
Rapidly progressive glomerulonephritisajith joseph
Rapidly progressive glomerulonephritis (RPGN) is a syndrome of the kidney that is characterized by a rapid loss of renal function,[4][5] (usually a 50% decline in the glomerular filtration rate (GFR) within 3 months)[5] with glomerular crescent formation seen in at least 50%[5] or 75%[4] of glomeruli seen on kidney biopsies. If left untreated, it rapidly progresses into acute renal failure[6] and death within months. In 50% of cases, RPGN is associated with an underlying disease such as Goodpasture syndrome, systemic lupus erythematosus or granulomatosis with polyangiitis; the remaining cases are idiopathic. Regardless of the underlying cause, RPGN involves severe injury to the kidneys' glomeruli, with many of the glomeruli containing characteristic glomerular crescents (crescent-shaped scars)
- English version of this lecture is available at:
https://youtu.be/t7N2GSXhYwA
- Arabic version of this lecture is available at:
https://youtu.be/WzFZym9hDtQ
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Rapidly progressive glomerulonephritisajith joseph
Rapidly progressive glomerulonephritis (RPGN) is a syndrome of the kidney that is characterized by a rapid loss of renal function,[4][5] (usually a 50% decline in the glomerular filtration rate (GFR) within 3 months)[5] with glomerular crescent formation seen in at least 50%[5] or 75%[4] of glomeruli seen on kidney biopsies. If left untreated, it rapidly progresses into acute renal failure[6] and death within months. In 50% of cases, RPGN is associated with an underlying disease such as Goodpasture syndrome, systemic lupus erythematosus or granulomatosis with polyangiitis; the remaining cases are idiopathic. Regardless of the underlying cause, RPGN involves severe injury to the kidneys' glomeruli, with many of the glomeruli containing characteristic glomerular crescents (crescent-shaped scars)
- English version of this lecture is available at:
https://youtu.be/t7N2GSXhYwA
- Arabic version of this lecture is available at:
https://youtu.be/WzFZym9hDtQ
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Chronic Kidney Disease Management and caresachintutor
Chronic kidney disease (CKD) is defined as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 mt2, persisting for 3 months or more, irrespective of the cause.
Unraveling the Enigma of Proteinuria A Deep Dive into Its Connection with Kid...jsomal
The human body is an intricate web of interconnected systems, each playing a vital role in maintaining overall health. Among these, the kidneys stand out as unsung heroes, diligently filtering waste and excess fluids to ensure a delicate balance within. However, when the kidneys encounter challenges, it can manifest in various ways, with proteinuria being a significant red flag. In this comprehensive exploration, we will unravel the complexities of proteinuria and its intricate relationship with kidney disease.
What is Proteinuria?
Proteinuria, a term that may sound intimidating at first, is simply the presence of an abnormal amount of protein in the urine. The kidneys act as meticulous gatekeepers, allowing essential substances to stay in the bloodstream while efficiently filtering out waste products. When this selective process goes awry, proteins, particularly albumin, may leak into the urine. This phenomenon is not a standalone condition; rather, it serves as a crucial indicator of underlying kidney issues.
The Role of Kidneys in Filtration
To appreciate proteinuria, one must understand the kidney’s primary function—filtration. The nephrons, the functional units of the kidneys, intricately filter blood, ensuring that essential components like red blood cells and proteins remain in circulation while waste products are excreted as urine. The glomerulus, a network of tiny blood vessels within the nephron, plays a pivotal role in this filtration process. Any disruption to this finely tuned system can lead to the escape of proteins into the urine, setting the stage for proteinuria.
Chronic kidney disease (CKD) consists of a spectrum of different pathophysiologic processes associated with abnormal kidney function, and a progressive decline in glomerular filtration rate (GFR).
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Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
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Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
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In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
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Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
1. Prepared by : Yahya Farwan.
University of Science and Technology Hospital, Sana’a ,Yemen, 2023
.
2. Objectives
2
1. To know the meaning of proteinuria and albuminuria
2. To identify the types of proteinuria
3. To identify the complications of proteinuria
4. To identify the clinical assessment of proteinuria
5. To identify the lines of treatment of proteinuria
I
3. Table of Contents
3
1.1 Definitions of Proteinuria ……………………………….. 1
1.2 Classifications of Proteinuria …………………………… 2
1.3 Complications of Proteinuria …………………………… 10
2.1 History Taking ………………………………………….. 12
2.2 Physical Examination .……………………..…………… 21
2.3 Investigations …………………………………….…..…. 25
3.1 Approach Considerations ……………………………….. 32
3.2 Non-Specific Treatment ……………………….……...… 33
3.3 Specific Treatment ………………………………...……. 34
1. Overview
.
2 Clinical Assessment of Proteinuria
4. Summary ……………….....………........................…. 34
.
3 Treatment of Proteinuria
II
.
5 Resources……………….....………....................……... 35
4. 4
List of abbreviations
• AER Mean albumin excretion rate
• CKD Chronic kidney disease
• PCT Proximal convoluted tubules
• LL Lower limb
• MD Diabetes mellitus
• HTN Hypertension
• GN Glomerulonephritis
• Cr Creatinine
• ANA Anti-nuclear antibody
• RBS Random blood sugar
• KUB Kidney-ureter-bladder X-ray
• ASO Anti-streptolysin O
• ACEIs Angiotensin-converting-enzyme inhibitors
• ARBs Angiotensin receptor blockers
• CCBs Calcium channel blockers
• CHF Congestive heart failure
III
• SBP Spontaneous bacterial peritonitis
• PO By mouth
• RAS Renal artery stenosis
• ATN Acute tubular necrosis
• CT Computed tomography
• MRA Magnetic resonance angiography
• ELIS Enzyme-linked immunoabsorbent assay
• MMF Mycophenolate mofetil
6. 1.1 Definitions of Proteinuria
Normal urinary protein excretion is < 150 mg/24 hours and consists mostly of secreted proteins
such as Tamm-Horsfall proteins.
Proteinuria is the the urinary excretion of >150 mg /24 hours.
The normal mean albumin excretion rate (AER) is 5-10 mg/day.
Nephrotic-range proteinuria is defined as proteinuria greater than 3.5 g / 24 hours.
Persistent proteinuria proteinuria for more than 3 months.
Proteinuria can be accompanied by other clinical abnormalities :
Elevated BUN and S.creatinine, ABNL urine sediment.
1
• AER between 30 to 300 mg/day is called microalbuminuria.
• Levels greater than 300 mg/day are called macroalbuminuria.
8. 8
1.2 Classifications of Proteinuria
1. According to quantity:
A. Microalbuminuria
B. Macroalbuminria
2. According to origin:
A. Prerenal
B. Renal:
• Glomerular proteinuria
• Tubular proteinuria
• Mixed
C. Post-renal proteinuria
3. Isolated (benign proteinuria)
A. Orthostatic proteinuria
B. Transient proteinuria
2
9. A. Microalbuminemia:
• Urine albumin excretion of 30–300 mg/day.
• Early sign of diabetic and hypertensive nephropathy.
B. Macroalbuminemia:
• Urine albumin excretion > 300 mg/day.
• Standard urine dipstick tests can be used for detection.
According to quantity:
1.
3
1.2 Classifications of Proteinuria
10. • Increased production of low-molecular-weight proteins → Overwhelming the
reabsorption capacity of the PCT → Proteinuria
Causes:
• Multiple myeloma→ Bence Jones proteins
• Hemolysis → Hemoglobin.
• Rhabdomyolysis → Myoglobin .
A. Pre-renal proteinuria
4
1.2 Classifications of Proteinuria
According to origin:
2.
11. • Damage to the glomeruli → increased permeability of the glomerular
filtration barrier → urinary protein excretion
• Characteristic finding: appearance of large proteins in the urine, primarily albumin.
• Causes of glomerular proteinuria:
Primary glomerular disease:
1. Minimal change glomerular disease
2. Membranous nephropathy
3. Focal segmental glomerulosclerosis
4. Congenital nephrotic syndrome
Secondary glomerular disease:
1. Nephritic syndromes
2. DM and HTN
3. Systemic lupus erythematosus
4. Cryoglobulinaemic disease
5. Henoch–Schonlein syndrome
6. Drugs :NSAIDs, gold, penicillamine
.
1 Glomerular proteinuria
5
1.2 Classifications of Proteinuria
B. Renal proteinuria
12. • Damage to the PCT → failure to reabsorb small proteins in the tubules
→ urinary protein excretion, typically beta-2 microglobulin without large proteins.
• The amount of proteinuria is usually < 2 g/day.
• Causes:
▪ Tubulointerstitial nephritis
▪ Nephrolithiasis
▪ Analgesics
▪ Immunosuppressive agents
▪ Acute renal failure.
Found in diseases that affect both the glomeruli and the tubules (e.g., CKD)
.
2 Tubular proteinuria
.
3 Mixed proteinuria
6
1.2 Classifications of Proteinuria
13. • Physiological proteinuria
Proteins that are being produced in the tubules (Tamm-Horsfall protein)
• Pathological proteinuria
Abnormalities affecting urinary tract from the renal pelvis to the urethra:
▪ Stones
▪ Inflammatory: Ureteritis, Prostatitis, Cystitis, Urethritis.
▪ Neoplastic
▪ Traumatic
C. Post-renal proteinuria
7
1.2 Classifications of Proteinuria
15. ▪ Defined as isolated proteinuria < 1 g/day
▪ Very common; mostly affects younger individuals
▪ No treatment necessary; excellent prognosis
Benign proteinuria :
3.
1. Orthostatic proteinuria (postural proteinuria) :
• Increased protein excretion only in the upright position for long time.
• More common in tall, thin adolescents or adults less than 30 years old.
• Dx: The patient has no proteinuria in early morning samples but has low-grade proteinuria
at the end of the day.
2. Transient proteinuria :
• Most common cause of isolated proteinuria in children
• Causes: heavy exertion, Acute illness, Fever, Seizures.
9
1.2 Classifications of Proteinuria
17. 1. Pulmonary edema due to fluid overload
2. Acute kidney injury due to intravascular depletion and progressive kidney disease
3. Increased risk of bacterial infection, including SBP
4. Increased risk of arterial and venous thrombosis, including renal vein thrombosis
5. Increased risk of cardiovascular disease
1.3 Complications of Proteinuria
10
19. Clinical Assessment
• Mild to moderate proteinuria may be asymptomatic.
• The majority of patients with proteinuria are asymptomatic, and proteinuria will be
detected in the course of routine laboratory testing conducted to evaluate
systemic disease.
• Considering the more common and benign causes of proteinuria first is important.
11
21. 2.1 History Taking
How old are
you and what
is your job ?
I’m 28 years old
and I’m
bodyguard,i came
for regular
screening.
Maybe orthostatic proteinuria
Proteinuria (less than 1g/day)
observed in tall, thin adolescent
or adults younger than 30 years
12
22. Hello dair,
What’s your
complaint ?
I have fever
rof hguoc dna
2 days
Transtent proteinuria can be
caused by Acute illness, fever,
seizures and physical exertion
13
2.1 History Taking
23. Do you have
fever, chills,
flank pain,
nausea,
vomiting
Yes Doctor,
Urinary tract infections
14
2.1 History Taking
24. Did you suffer from
URTI?
Yes Doctor, it
occurred
before one
week.
Post-infectious
glomerulonephritis
15
2.1 History Taking
25. Do you
complaining of
fever, night
sweats, weight
loss, or bone
pain?
mmm..
Yes, all of
them
Malignancies :
Multiple myeloma
Tumors of the kidney, lung,
colon, stomach or breast
16
2.1 History Taking
26. Did you have Hx of
hepatitis, tuberculosis,
malaria, syphilis,
HIV,or endocarditis?
Yes Doctor.
TB
17
Infections remote to the kidney
2.1 History Taking
27. Do you have HTN,
DM,Heart failure,chronic
inflammatory disease or
hypercholesterolemia?
Yes Doctor, I
have T1DM
for 17 years
and HTN for 5
years .
Nephropathy secondary to
systemic diseases .
18
2.1 History Taking
28. Do you taking any
medication, including
over-the-counter or
herbal remedies ?
Yes Doctor,
NSAIDs
kidney injury due to
medications:
Analgesics
Immunosuppressants
Gold and mercury
Penicillamine
19
2.1 History Taking
29. Do you have
family history
of kidney
disease or
malignancy?
Yes, Polycystic
kidney disease
Congenital nephrotic syndrome
Malignancy
PKD
20
2.1 History Taking
31. 2.2 Physical Examination
I will examine the
JVP
Pulse rate
Blood pressure
Heart sounds
Assess intravascular volume status
Ammm
😪
21
32. I’ll look for Edema
and then i will listen to your
Breath sounds (which may be
decreased due to pleural
effusions)
Assess extravascular volume status
Okay
22
2.2 Physical Examination
33. I well examine you for retinopathy
,rash, joint swelling or deformity
,stigmata of CLD
,lymphadenopathy, cardiac
murmurs.
Examine the patient for signs of systemic disease
Okay
23
2.2 Physical Examination
34. Lastly, I well examine you for
Venous thrombosis and
Peritonitis
Examine the patient for complications
Okay
24
2.2 Physical Examination
37. 25
Standard urine dipstick test:
• Primarily detects albumin > 300 mg/day.
• Protein detected by urine dipstick should always be quantified with either a 24-hour urine
collection or protein-creatinine or albumin-creatinine ratio on random urine samples.
• Results interpretation:
• Trace = 50 to 150 mg/day; 1+ = 150 to 500 mg/day; 2+ = 0.5 to 1.5 g/day;
3+ = 2 to 5 g/day; 4+ = >5 g/day
2.3 Investigations
38. ○ Initial test once proteinuria is detected by dipstick test → examination of urine sediment:
• RBC casts → GN
• WBC casts → pyelonephritis or interstitial nephritis
• Fatty casts → nephrotic syndrome (lipiduria)
• Granular stsac → acute tubular necrosis
○ If urine casts are positive → treat the cause and repeat urinalysis for proteinuria
○ If urinalysis confirms the presence of protein, a 24-hour urine collection (for albumin and Cr)
is appropriate to quantify the proteinuria.
26
2.3 Investigations
Urinalysis :
39. 24-hour urine albumin:
Normal range <30mg/day
Microalbuminuria 30-300mg/ 24 hours
Macroalbuminuria >300mg/24 hours
Nephrotic syndrome ≥ 3.5 g/24hours
27
2.3 Investigations
24-hour urine collection (for albumin and Cr)
Spot urine protein or albumin/creatinine ratio :
Normal <50mg/g or <0.2mg/mg
Proteinuria ≥ 150mg/g or ≥0.2 mg/mg
40. ▪ Corresponds to albumin excretion of 30 to 300 mg/day.
▪ This is below the range of sensitivity of standard dipsticks.
▪ Special tests can detect microgrm amount of albumin, including:
.
1 Radioimmunoassay the most sensitive and specific test for microalbuminuria.
.
2 Specific urine dipstick tests
3. Sulfosalicylic acid test
.
4 ELISA
28
2.3 Investigations
Test for microalbuminuria
41. ■ BUN and Cr— for renal function
■ Serum albuminaimenimublaopyh detaicossa rof
■ ABG and electrolytes for associated metabolic acidosis
■ CBC—to detect anemia due to renal failure
■ Urine and plasma electrophoresis— to rule out tubulointerstitial diseases and multiple myeloma
■ Lipid profile —for associated dyslipidemia
■ Autoantibodies - If indicated, including ASO titers, ANA, anti-DNA, complement levels (C3 and C4).
■ Hepatitis B, hepatitis C, and HIV serologies - If indicated
29
2.3 Investigations
Other tests
42. ○ Renal ultrasound:
• Hydronephrosis suggests obstructive nephropathy.
• Small, smooth kidneys suggests chronic parenchymal renal disease.
• Renal asymmetry suggests RAS
• Renal enlargement can occur in ATN, renal vein thrombosis, and renal infiltration.
○ Plain abdominal film (KUB) if renal stones or nephrocalcinosis suspected.
○ Contrast CT angiography or Gadolinium- enhanced MRA for Atherosclerotic RAS
○ CXR –Infiltrates, CHF, pleural effusion .
○ Renal biopsy
30
Imaging Studies
2.3 Investigations
45. 3.1 approach considerations
● Nonspecific treatment –
Treatment that is applicable irrespective of
the underlying cause, assuming the patient has no contraindications to the therapy
● Specific treatment –
Treatment that depends on the underlying renal or
nonrenal cause and, in particular, whether or not the injury is immune mediated
● Referral to a nephrologist is indicated for any patient who develops proteinuria,
especially those with any adverse prognostic markers (eg, rise in albumin
excretion of > 1 g/day), or any worsening in kidney function.
32
46. ▪ Restriction of dietary salts and proteins .
▪ Cessation of smoking
▪ Vitamin D and calcium supplements.
▪ Pneumococcal vaccine
▪ Treatment of infection
3.2 Non-Specific Treatment
33
▪ Drugs:
▪ Diuretics :loop diuretic or a combination of diuretics such as a thiazide and loop diuretics .
▪ ACE inhibitors and ARBs
▪ CCB: if ACEIs or ARBs are contraindicated.
▪ Anticoagulants
▪ Treatment of dyslipidemiasnitats htiw
47. ● Minimal change disease : most respond to prednisone (adequate dose and duration),
but may relapse ,cyclophosphamide or cyclosporine may be used for frequent relapses
● Focal segmental glomerulosclerosis : high dose long-term steroids will lead to remission in about
1/3 of patients +_ MMF ,calcineurin inhibitors
● Membranoproliferative GN :steroid +-azathioprine, MMF
● Diabetic Nephropathy : strict control of blood sugar _+ARBS,ACE-I
● SLE Nephropathy:
Therapy : depend on class ,for all class use HCQ + prednisolone
for class 3, 4 , add cyclophosphamide or MMF (mycophenolate mofetil).
3.3 Specific Treatment
34
49. Summary
35
• Normal urinary protein excretion is < 150 mg/24 hours
• Proteinuria is the the urinary excretion of >150 mg /24 hours.
• Nephrotic-range proteinuria is defined as greater than 3.5 g / 24 hour
• Glomerular proteinuria mainly albumin while tubular proteinuria LMW proteins
• Prerenal and postrenal proteinuria occurs due to systemic diseases and urinary tract
abnormalities, respectively.
• Orthostatic and transient proteinuria are benign and have excellent prognosis
• Cardiovascular and pulmonary abnormalities, infections, VTE and AKI are main
complications of proteinuria
• The majority of patients with proteinuria are asymptomatic
• Considering the more common and benign causes of proteinuria first is important.
• Renal US is the most useful imaging study of kidney abnormalities
• Nonspecific treatment can be applied in all types of proteinuria
• ACEIs and ARBs can be used in patients with proteinuria regardless of the cause
• CCB can be used if there is contraindication of ACEIs or ARBs.
• Specific treatment of proteinuria according to the underlying cause.