This document discusses proteinuria in children. It begins by defining normal protein excretion levels in children and the kidney's role in filtering and reabsorbing proteins. It then covers causes of increased protein excretion including glomerular dysfunction and tubular reabsorption issues. Case studies are presented to demonstrate evaluating and differentiating between normal and abnormal proteinuria. Nephrotic syndrome is defined as massive proteinuria and causes such as minimal change disease are discussed. Complications include infections while treatment focuses on steroids, immunosuppressants, and managing symptoms.
Evaluation of proteinuria in children pptShane Watson
The document discusses the glomerular filtration barrier and the mechanisms of proteinuria. It defines normal levels of urinary protein excretion in children and describes different types of proteinuria including glomerular, tubular, and overflow proteinuria. Evaluation and workup of asymptomatic proteinuria is outlined including orthostatic testing, urine dipstick, and quantitative urine protein levels. Management depends on the type and severity of proteinuria.
- Proteinuria refers to abnormal levels of protein in the urine and can be caused by damage to the glomerular filtration barrier in the kidneys. The glomerular filtration barrier is normally highly selective and prevents protein leakage into the urine.
- Proteinuria is classified as transient, orthostatic, asymptomatic, symptomatic, isolated or associated with other symptoms. Measurement involves urine dipstick testing, 24-hour urine protein estimation, or urine protein-creatinine ratio.
- Evaluation of proteinuria includes assessing for signs and symptoms, measuring extent of proteinuria, and considering underlying causes like glomerular disease, tubular dysfunction, or overflow proteinuria from other medical conditions. Treatment is directed at the underlying cause
Proteinuria provides diagnostic and prognostic information about renal disease. It is associated with hypertension, obesity, and vascular disease, and can predict risks of chronic kidney disease progression, cardiovascular disease, and mortality. Monitoring proteinuria is important for assessing treatment response, as protein-lowering therapies may be renoprotective. A thorough history, physical exam, urinalysis, and further tests are needed to determine the type and cause of proteinuria and rule out underlying conditions in order to begin appropriate treatment.
This document provides information on proteinuria (abnormal amounts of protein in the urine) including its history, physiology, detection, quantification, causes, and diagnostic evaluation. It details the normal mechanisms by which the kidneys filter and reabsorb albumin and other proteins from the blood. Common causes of proteinuria include benign causes like exercise as well as pathological glomerular, tubular, and overflow proteinuria due to various kidney diseases and disorders. The diagnostic approach involves urinalysis, urine protein creatinine ratio, and ruling out transient causes through repeated testing.
- A 54-year-old male with a blood pressure of 110/70 mg and 24-hour urinary protein of 180 mg is being evaluated as a kidney donor for his sister. His 24-hour creatinine clearance is 85mL/min.
- Normal urinary protein excretion is defined as less than 150 mg per day. The patient's proteinuria is in the non-nephrotic range of less than 3.5 g per day.
- Various factors like transient causes, tubular disorders, and monoclonal gammopathies can cause different types of isolated or mixed proteinuria. Accurately measuring and characterizing proteinuria is important for evaluating kidney function and disease.
- Nephrotic syndrome is defined as protein excretion greater than 3.5 g/24 hours, hypoalbuminemia less than 3.0 g/dL, and peripheral edema.
- Common causes include minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy. Secondary causes can be due to diseases like diabetes, lupus, amyloidosis.
- Metabolic consequences of nephrotic syndrome include hyperlipidemia, risk of infection due to urinary protein losses, hypocalcemia, hypercoagulability, and hypovolemia with severe hypoalbuminemia.
This document summarizes different types of urinalysis specimens and their uses. It describes 1) random, morning, midstream, and timed urine collections, 2) catheterized and supra-pubic aspiration specimens, 3) pediatric collections, and 4) drug testing specimens. It also outlines macroscopic examination of urine color, clarity, and odor, as well as chemical analysis using urine dipsticks to detect substances like glucose, blood, protein, ketones, bilirubin, urobilinogen, nitrites, leukocyte esterase, pH, and specific gravity.
Proteinuria refers to excess protein in the urine. Normally less than 150 mg of protein is excreted in urine per day, mostly albumin and Tamm-Horsfall protein. Proteinuria can be caused by glomerular disease resulting in abnormal permeability of the glomerular basement membrane, overflow of small proteins in the blood, or tubular disease impairing reabsorption. Persistent proteinuria over 3.5 g per day usually indicates glomerular disease and is a predictor of progressive chronic kidney disease, with the rate of renal function decline proportional to the severity of proteinuria.
Evaluation of proteinuria in children pptShane Watson
The document discusses the glomerular filtration barrier and the mechanisms of proteinuria. It defines normal levels of urinary protein excretion in children and describes different types of proteinuria including glomerular, tubular, and overflow proteinuria. Evaluation and workup of asymptomatic proteinuria is outlined including orthostatic testing, urine dipstick, and quantitative urine protein levels. Management depends on the type and severity of proteinuria.
- Proteinuria refers to abnormal levels of protein in the urine and can be caused by damage to the glomerular filtration barrier in the kidneys. The glomerular filtration barrier is normally highly selective and prevents protein leakage into the urine.
- Proteinuria is classified as transient, orthostatic, asymptomatic, symptomatic, isolated or associated with other symptoms. Measurement involves urine dipstick testing, 24-hour urine protein estimation, or urine protein-creatinine ratio.
- Evaluation of proteinuria includes assessing for signs and symptoms, measuring extent of proteinuria, and considering underlying causes like glomerular disease, tubular dysfunction, or overflow proteinuria from other medical conditions. Treatment is directed at the underlying cause
Proteinuria provides diagnostic and prognostic information about renal disease. It is associated with hypertension, obesity, and vascular disease, and can predict risks of chronic kidney disease progression, cardiovascular disease, and mortality. Monitoring proteinuria is important for assessing treatment response, as protein-lowering therapies may be renoprotective. A thorough history, physical exam, urinalysis, and further tests are needed to determine the type and cause of proteinuria and rule out underlying conditions in order to begin appropriate treatment.
This document provides information on proteinuria (abnormal amounts of protein in the urine) including its history, physiology, detection, quantification, causes, and diagnostic evaluation. It details the normal mechanisms by which the kidneys filter and reabsorb albumin and other proteins from the blood. Common causes of proteinuria include benign causes like exercise as well as pathological glomerular, tubular, and overflow proteinuria due to various kidney diseases and disorders. The diagnostic approach involves urinalysis, urine protein creatinine ratio, and ruling out transient causes through repeated testing.
- A 54-year-old male with a blood pressure of 110/70 mg and 24-hour urinary protein of 180 mg is being evaluated as a kidney donor for his sister. His 24-hour creatinine clearance is 85mL/min.
- Normal urinary protein excretion is defined as less than 150 mg per day. The patient's proteinuria is in the non-nephrotic range of less than 3.5 g per day.
- Various factors like transient causes, tubular disorders, and monoclonal gammopathies can cause different types of isolated or mixed proteinuria. Accurately measuring and characterizing proteinuria is important for evaluating kidney function and disease.
- Nephrotic syndrome is defined as protein excretion greater than 3.5 g/24 hours, hypoalbuminemia less than 3.0 g/dL, and peripheral edema.
- Common causes include minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy. Secondary causes can be due to diseases like diabetes, lupus, amyloidosis.
- Metabolic consequences of nephrotic syndrome include hyperlipidemia, risk of infection due to urinary protein losses, hypocalcemia, hypercoagulability, and hypovolemia with severe hypoalbuminemia.
This document summarizes different types of urinalysis specimens and their uses. It describes 1) random, morning, midstream, and timed urine collections, 2) catheterized and supra-pubic aspiration specimens, 3) pediatric collections, and 4) drug testing specimens. It also outlines macroscopic examination of urine color, clarity, and odor, as well as chemical analysis using urine dipsticks to detect substances like glucose, blood, protein, ketones, bilirubin, urobilinogen, nitrites, leukocyte esterase, pH, and specific gravity.
Proteinuria refers to excess protein in the urine. Normally less than 150 mg of protein is excreted in urine per day, mostly albumin and Tamm-Horsfall protein. Proteinuria can be caused by glomerular disease resulting in abnormal permeability of the glomerular basement membrane, overflow of small proteins in the blood, or tubular disease impairing reabsorption. Persistent proteinuria over 3.5 g per day usually indicates glomerular disease and is a predictor of progressive chronic kidney disease, with the rate of renal function decline proportional to the severity of proteinuria.
Evaluation of proteinuria in children - by Dr.B.Sivakanthbsivakanth
1) Proteinuria, or excess protein in the urine, is a common finding in children that requires evaluation to determine the cause. Transient or orthostatic proteinuria are generally benign, while persistent proteinuria may indicate kidney disease.
2) Evaluation of a child with proteinuria includes a history, physical exam, urinalysis, and tests to assess kidney function. Distinguishing transient, orthostatic, and persistent proteinuria guides further testing and management.
3) For persistent proteinuria, additional tests are needed to identify potential causes like glomerular disease, tubular disorders, or infection and determine if nephrology referral is required. Ongoing monitoring is important to classify the
This document discusses renal function tests and their importance in assessing kidney function. It covers urine analysis including physical, chemical and microscopic examination. It also discusses various blood tests like serum creatinine, blood urea, uric acid and electrolytes to evaluate glomerular function. Tests of tubular function examined include urine concentration, vasopressin and water load tests. The significance of renal function tests in acute kidney injury is also highlighted. An addendum discusses cystatin C as a novel marker for non-invasive estimation of glomerular filtration rate and early renal impairment.
This document discusses renal function tests. It describes why renal function is tested, such as to assess kidney function and detect impairment. It outlines when renal function should be assessed, such as in older age, diabetes, or hypertension. The document then describes the different types of renal function tests, including urine analysis, blood tests like creatinine and urea, and glomerular function tests. Urine analysis involves examining color, volume, specific gravity, pH, and microscopic sediment. Blood tests evaluate substances that are normally excreted by the kidneys. Glomerular function tests directly measure the glomerular filtration rate.
The document discusses proteinuria and hematuria in children. It covers the definition, causes, evaluation, and treatment of both conditions. Proteinuria can be caused by glomerular, tubular, or overflow mechanisms and is evaluated through urine dipsticks, 24-hour urine collection, and urine protein to creatinine ratio. Hematuria can be gross or microscopic and is seen in conditions like UTI, nephrolithiasis, glomerulonephritis, IgA nephropathy, and Alport syndrome. Evaluation of hematuria involves urinalysis, urine culture, imaging, and considering familial causes. Specific renal diseases like post-streptococcal glomerulonephritis
Proteinuria refers to an excess of proteins, such as albumin, in the urine. It can be caused by damage to the glomeruli or renal tubules in the kidneys that prevents the normal reabsorption of proteins from the urine. People at highest risk include those with diabetes, hypertension, obesity, or a family history of kidney disease. Tests like the urine albumin-to-creatinine ratio can detect proteinuria. Treatment focuses on controlling blood pressure and blood sugar through medications like ACE inhibitors that protect the kidneys from further damage.
Proteinuria refers to an excess of proteins, such as albumin, in the urine. It can be caused by damage to the glomeruli or renal tubules in the kidneys that prevents reabsorption of proteins from the urine. People at highest risk include those with diabetes, hypertension, obesity, or a family history of kidney disease. Tests like urine albumin-to-creatinine ratio and estimated glomerular filtration rate are used to detect proteinuria. Treatment focuses on controlling blood pressure and blood sugar through medications like ACE inhibitors or ARBs to reduce protein loss in the urine.
Proteinuria, or excess protein in the urine, occurs when the kidneys fail to properly filter proteins from the bloodstream. There are three main types: glomerular, tubular, and overflow proteinuria. People with diabetes, high blood pressure, or who are obese are most at risk. A urine albumin-to-creatinine ratio test can detect proteinuria using a single urine sample. Medications like ACE inhibitors and ARBs can help reduce protein levels in the urine and protect kidney function. Uncontrolled, proteinuria can lead to edema and is an indicator of chronic kidney disease.
The document discusses urine formation and urine analysis. Key points:
- Urine is formed in the kidneys through glomerular filtration of blood and reabsorption/secretion in the renal tubules. This concentrates waste for excretion while retaining useful substances.
- Urine analysis provides information on health, kidney function, and other diseases. Physical properties like volume, color, and chemical components like proteins, glucose, and cells are evaluated.
- Proper urine sample collection and handling is important for accurate analysis. Tests are used to detect and quantify substances in urine to evaluate renal and systemic health.
A 6-year-old male child was admitted to the pediatric ward with hematuria and burning urination. Tests revealed protein in his urine and thickened bladder walls on ultrasound. This is consistent with chronic cystitis. The document goes on to define nephrotic syndrome, discuss its pathophysiology, incidence, etiology including genetic and secondary causes, clinical features, lab investigations, management including diet and steroids, complications, and nursing considerations like monitoring intake/output and administering medications.
This document provides information on evaluating and approaching a case of nephrotic syndrome. It defines key terms like proteinuria and nephrotic syndrome. It describes the normal physiology of protein filtration and reabsorption in the kidneys. It also classifies and discusses different types of proteinuria including tubular proteinuria, glomerular proteinuria, and microalbuminuria. The document outlines the initial workup and further investigations for a patient with proteinuria. It concludes by covering the causes, pathophysiology, and specific investigations for nephrotic syndrome.
This document provides information about nephrotic syndrome including its definition, causes, signs and symptoms, investigations, management, and complications. Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It can be caused by primary/idiopathic conditions like minimal change disease or secondary causes such as SLE, diabetes, or drugs. Management involves dietary modifications, diuretics, steroid therapy, and immunosuppressive drugs depending on disease severity and response to treatment. Complications include thrombosis, peritonitis, and hypovolemia which require prompt intervention.
Acute kidney injury (AKI) is a common condition characterized by a sudden decline in kidney function. It affects 5-7% of hospital admissions and 30% of intensive care unit admissions. The top causes of AKI in India are diarrheal diseases, sepsis, malaria, drug toxicity, and hospital-acquired injuries. Treatment focuses on optimizing fluid status and hemodynamics, removing nephrotoxins if possible, and initiating renal replacement therapy as needed based on the underlying cause and severity of AKI.
This document provides guidance on evaluating and approaching a patient presenting with proteinuria. It discusses normal and abnormal levels of protein in the urine and different types of proteinuria including glomerular, tubular, and overflow. For evaluation, it recommends determining the amount and type of protein, and assessing other relevant clinical and lab findings. Extensive workup is suggested for proteinuria accompanied by renal impairment, nonspecific symptoms, or in elderly patients to identify underlying causes like glomerular disease, tubular disorders, paraproteinemias, or malignancy that may require a renal biopsy for diagnosis.
Neonatal jaundice, also known as neonatal hyperbilirubinemia, refers to the yellow discoloration of skin and eyes in newborn babies due to high levels of bilirubin. It is common and usually harmless, but in rare cases can lead to kernicterus if bilirubin levels get too high. There are two main types - physiological jaundice which occurs after 24 hours of life and is harmless, and pathological jaundice which occurs earlier and requires treatment. Causes include breast milk jaundice, Rh incompatibility, infections, and liver or blood disorders. Treatment depends on bilirubin levels but may include phototherapy, fluid supplementation, or in severe cases
Proteins filtered by the glomerulus are usually reabsorbed almost completely such that no significantly detectable amounts are found in urine. But in some pathological conditions, proteins appear in urine either as microalbuminuria or frank proteinuria. This presentation discusses the different types of proteinuria and some conditions that can lead to them.
This case study describes a 31-year-old male with a history of Alport syndrome and kidney transplant who presented with acute renal failure secondary to transplant rejection. Key points include: the patient's medical history of ESRD due to Alport syndrome requiring dialysis and kidney transplant; presentation with elevated creatinine and signs of antibody-mediated transplant rejection; treatment involving immunosuppression medication and potential need for dialysis; and nutrition interventions focusing on meeting protein and calorie needs through a renal diet.
1. Proteinuria is defined as urinary protein excretion greater than 100 mg/m2 per day or a urine protein-to-creatinine ratio greater than 0.2. It can be evaluated using urine dipsticks, sulfosalicylic acid tests, or 24-hour urine collections.
2. Transient proteinuria resolves on its own and requires no further evaluation. Orthostatic proteinuria involves increased protein in upright urine samples that normalizes when supine.
3. Persistent or "fixed" proteinuria detected on multiple tests may indicate underlying renal pathology and requires further evaluation to determine if it is glomerular, tubular, or overflow proteinuria.
Icterus neonatorum presentation for studentsNehaNupur8
Introduction
Definition
Metabolism and excretion of bilirubin
Causes
Symptoms
Types
Physiological jaundice
Pathological jaundice
Breast milk jaundice
Neo natal jaundice is a yellow discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin level.
Neo natal jaundice becomes apparent at serum bilirubin concentration of 5-7mg / dL.
Shoulder and trunk 8-10mg/dl
Lower body – 10-12mg/dl.
Entire body 12-15 mg /DL
Evaluation of proteinuria in children - by Dr.B.Sivakanthbsivakanth
1) Proteinuria, or excess protein in the urine, is a common finding in children that requires evaluation to determine the cause. Transient or orthostatic proteinuria are generally benign, while persistent proteinuria may indicate kidney disease.
2) Evaluation of a child with proteinuria includes a history, physical exam, urinalysis, and tests to assess kidney function. Distinguishing transient, orthostatic, and persistent proteinuria guides further testing and management.
3) For persistent proteinuria, additional tests are needed to identify potential causes like glomerular disease, tubular disorders, or infection and determine if nephrology referral is required. Ongoing monitoring is important to classify the
This document discusses renal function tests and their importance in assessing kidney function. It covers urine analysis including physical, chemical and microscopic examination. It also discusses various blood tests like serum creatinine, blood urea, uric acid and electrolytes to evaluate glomerular function. Tests of tubular function examined include urine concentration, vasopressin and water load tests. The significance of renal function tests in acute kidney injury is also highlighted. An addendum discusses cystatin C as a novel marker for non-invasive estimation of glomerular filtration rate and early renal impairment.
This document discusses renal function tests. It describes why renal function is tested, such as to assess kidney function and detect impairment. It outlines when renal function should be assessed, such as in older age, diabetes, or hypertension. The document then describes the different types of renal function tests, including urine analysis, blood tests like creatinine and urea, and glomerular function tests. Urine analysis involves examining color, volume, specific gravity, pH, and microscopic sediment. Blood tests evaluate substances that are normally excreted by the kidneys. Glomerular function tests directly measure the glomerular filtration rate.
The document discusses proteinuria and hematuria in children. It covers the definition, causes, evaluation, and treatment of both conditions. Proteinuria can be caused by glomerular, tubular, or overflow mechanisms and is evaluated through urine dipsticks, 24-hour urine collection, and urine protein to creatinine ratio. Hematuria can be gross or microscopic and is seen in conditions like UTI, nephrolithiasis, glomerulonephritis, IgA nephropathy, and Alport syndrome. Evaluation of hematuria involves urinalysis, urine culture, imaging, and considering familial causes. Specific renal diseases like post-streptococcal glomerulonephritis
Proteinuria refers to an excess of proteins, such as albumin, in the urine. It can be caused by damage to the glomeruli or renal tubules in the kidneys that prevents the normal reabsorption of proteins from the urine. People at highest risk include those with diabetes, hypertension, obesity, or a family history of kidney disease. Tests like the urine albumin-to-creatinine ratio can detect proteinuria. Treatment focuses on controlling blood pressure and blood sugar through medications like ACE inhibitors that protect the kidneys from further damage.
Proteinuria refers to an excess of proteins, such as albumin, in the urine. It can be caused by damage to the glomeruli or renal tubules in the kidneys that prevents reabsorption of proteins from the urine. People at highest risk include those with diabetes, hypertension, obesity, or a family history of kidney disease. Tests like urine albumin-to-creatinine ratio and estimated glomerular filtration rate are used to detect proteinuria. Treatment focuses on controlling blood pressure and blood sugar through medications like ACE inhibitors or ARBs to reduce protein loss in the urine.
Proteinuria, or excess protein in the urine, occurs when the kidneys fail to properly filter proteins from the bloodstream. There are three main types: glomerular, tubular, and overflow proteinuria. People with diabetes, high blood pressure, or who are obese are most at risk. A urine albumin-to-creatinine ratio test can detect proteinuria using a single urine sample. Medications like ACE inhibitors and ARBs can help reduce protein levels in the urine and protect kidney function. Uncontrolled, proteinuria can lead to edema and is an indicator of chronic kidney disease.
The document discusses urine formation and urine analysis. Key points:
- Urine is formed in the kidneys through glomerular filtration of blood and reabsorption/secretion in the renal tubules. This concentrates waste for excretion while retaining useful substances.
- Urine analysis provides information on health, kidney function, and other diseases. Physical properties like volume, color, and chemical components like proteins, glucose, and cells are evaluated.
- Proper urine sample collection and handling is important for accurate analysis. Tests are used to detect and quantify substances in urine to evaluate renal and systemic health.
A 6-year-old male child was admitted to the pediatric ward with hematuria and burning urination. Tests revealed protein in his urine and thickened bladder walls on ultrasound. This is consistent with chronic cystitis. The document goes on to define nephrotic syndrome, discuss its pathophysiology, incidence, etiology including genetic and secondary causes, clinical features, lab investigations, management including diet and steroids, complications, and nursing considerations like monitoring intake/output and administering medications.
This document provides information on evaluating and approaching a case of nephrotic syndrome. It defines key terms like proteinuria and nephrotic syndrome. It describes the normal physiology of protein filtration and reabsorption in the kidneys. It also classifies and discusses different types of proteinuria including tubular proteinuria, glomerular proteinuria, and microalbuminuria. The document outlines the initial workup and further investigations for a patient with proteinuria. It concludes by covering the causes, pathophysiology, and specific investigations for nephrotic syndrome.
This document provides information about nephrotic syndrome including its definition, causes, signs and symptoms, investigations, management, and complications. Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It can be caused by primary/idiopathic conditions like minimal change disease or secondary causes such as SLE, diabetes, or drugs. Management involves dietary modifications, diuretics, steroid therapy, and immunosuppressive drugs depending on disease severity and response to treatment. Complications include thrombosis, peritonitis, and hypovolemia which require prompt intervention.
Acute kidney injury (AKI) is a common condition characterized by a sudden decline in kidney function. It affects 5-7% of hospital admissions and 30% of intensive care unit admissions. The top causes of AKI in India are diarrheal diseases, sepsis, malaria, drug toxicity, and hospital-acquired injuries. Treatment focuses on optimizing fluid status and hemodynamics, removing nephrotoxins if possible, and initiating renal replacement therapy as needed based on the underlying cause and severity of AKI.
This document provides guidance on evaluating and approaching a patient presenting with proteinuria. It discusses normal and abnormal levels of protein in the urine and different types of proteinuria including glomerular, tubular, and overflow. For evaluation, it recommends determining the amount and type of protein, and assessing other relevant clinical and lab findings. Extensive workup is suggested for proteinuria accompanied by renal impairment, nonspecific symptoms, or in elderly patients to identify underlying causes like glomerular disease, tubular disorders, paraproteinemias, or malignancy that may require a renal biopsy for diagnosis.
Neonatal jaundice, also known as neonatal hyperbilirubinemia, refers to the yellow discoloration of skin and eyes in newborn babies due to high levels of bilirubin. It is common and usually harmless, but in rare cases can lead to kernicterus if bilirubin levels get too high. There are two main types - physiological jaundice which occurs after 24 hours of life and is harmless, and pathological jaundice which occurs earlier and requires treatment. Causes include breast milk jaundice, Rh incompatibility, infections, and liver or blood disorders. Treatment depends on bilirubin levels but may include phototherapy, fluid supplementation, or in severe cases
Proteins filtered by the glomerulus are usually reabsorbed almost completely such that no significantly detectable amounts are found in urine. But in some pathological conditions, proteins appear in urine either as microalbuminuria or frank proteinuria. This presentation discusses the different types of proteinuria and some conditions that can lead to them.
This case study describes a 31-year-old male with a history of Alport syndrome and kidney transplant who presented with acute renal failure secondary to transplant rejection. Key points include: the patient's medical history of ESRD due to Alport syndrome requiring dialysis and kidney transplant; presentation with elevated creatinine and signs of antibody-mediated transplant rejection; treatment involving immunosuppression medication and potential need for dialysis; and nutrition interventions focusing on meeting protein and calorie needs through a renal diet.
1. Proteinuria is defined as urinary protein excretion greater than 100 mg/m2 per day or a urine protein-to-creatinine ratio greater than 0.2. It can be evaluated using urine dipsticks, sulfosalicylic acid tests, or 24-hour urine collections.
2. Transient proteinuria resolves on its own and requires no further evaluation. Orthostatic proteinuria involves increased protein in upright urine samples that normalizes when supine.
3. Persistent or "fixed" proteinuria detected on multiple tests may indicate underlying renal pathology and requires further evaluation to determine if it is glomerular, tubular, or overflow proteinuria.
Icterus neonatorum presentation for studentsNehaNupur8
Introduction
Definition
Metabolism and excretion of bilirubin
Causes
Symptoms
Types
Physiological jaundice
Pathological jaundice
Breast milk jaundice
Neo natal jaundice is a yellow discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin level.
Neo natal jaundice becomes apparent at serum bilirubin concentration of 5-7mg / dL.
Shoulder and trunk 8-10mg/dl
Lower body – 10-12mg/dl.
Entire body 12-15 mg /DL
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
2. Introduction
Normal urinary protein excretion is
approximately 150mg/day.
Normal rate of protein excretion in urine is
variable in younger children:
<4 mg/m2/hour or <100 mg/m2/day
Neonates is higher up to 300 mg/m2
(reduced reabsorption of filtered protein)
3.
4. Protein handling by the kidneys
in normal children
The low excretion rate of protein
occurs because:
1- the glomeruli restrict filtration of
large serum protein, and
2- the proximal tubules reabsorb
most of the LMW proteins
5. The glomerular capillary barrier is a
complex and selective filtration barrier
that is made of three layers:
-Endothelium with fenestration
-Glomerular basement membrane
-The epithelial cells and the complex
network of podocytes
6.
7. Despite the complex structural
attributes of each component, it
functions as a single filtration unit.
The glomerular filtrate reaching the
proximal tubule contains mostly filtered
LMW protein and minor amounts of
albumin…..
8. ….and approximately 40-50% of this
protein consists of Tamm-Horsfall
protein, a glycoprotein secreted by the
ascending limb of the loop of Henle.
9. Composition of protein normally found in the
urine:
T-H 40%
Albumin 40%
IgG 10%
Light chains 5%
IgA 3%
10. CASE 1
At a well child visit a 23 month old has a
measured urinary protein of 30 mg/dl
(+1 on dipstick) and a urine creatinine of
180 mg/dl. Is this child passing more
protein in the urine than normal?
11. Case 1: Answer
No, this boy is not passing abnormal amounts
of protein.
U prot/Cr ration is less than 0.5 (mg
protein/mg creatinine).
Repeat evaluation in a few week to a month.
12. Protein handling by the kidneys in
children with renal disorders
Occurrence of proteinuria in a single urine
is relatively common.
The prevalence is generally between 5% to
15% of normal children in a random urine
specimen.
Less than 1% of children with random
protein will have persistent proteinuria on 4
successive specimens
13. Proteinuria is a marker of renal disease.
The dilemma for the PCP is to
differentiate the child with transient or
any other benign forms of proteinuria
from children with renal disease.
14. Abnormal protein excretion
Urinary protein excretion in excess
of 100 mg/m2/day or 4mg/m2/hr
Nephrotic range proteinuria is
defined as >1000 mg/m2/day or
40mg/m2/hr
15. Three main mechanism:
Glomerular (increase filtration)
Tubular (decrease reabsorption)
Overflow (marked overproduction
of a particular protein)
16. How do we measure urinary protein?
Quantitative methods
Urine dipstick
negative
trace between 15-30mg/dl
1+ 30-100 mg/dl
2+ 100-300mg/dl
3+ 300-1000mg/dl
4+ >1000mg/dl
17.
18. Qualitative assessment
May be necessary to differentiate
glomerular from tubular protein
(Urine protein electrophoresis)
19. Case 2
A child aged 5 years visit your office. She has
a fever of 103o F. A viral upper respiratory
infection is diagnosed. On urine dipstick she
has 1-2+ proteinuria.
What follow up does this child require for her
proteinuria?
20. Case 2: Answer
Repeat urinalysis after acute illness has
resolved
When asking patient to present for urinalysis,
instruct them not to exercise prior to giving
sample.
21. Approach to the child with proteinuria:
-Transient or Intermittent
Associated with fever, stress,
dehydration or exercise.
-Orthostatic
Elevated protein excretion when
subject is upright and normal when
recumbent or…..
23. Case 3
A 13 year-old adolescent was found to
have proteinuria on a routine sports
physical examination. His blood pressure
was normal and he had no edema. His
weight was 40 Kg. How would you set
about and initial evaluation of his
proteinuria?
24. Case 3: Answer
Ask patient to bring in first morning
sample to the office.
Patient should urinate immediately after
getting out of bed.
If proteinuria is confirmed on first
morning sample, then quantify with 24 hour
urine collection.
25. Timing of urine testing
Dipstick
First morning urine (neg or trace)
Ambulatory urine (1-3+)
Timed ambulatory and recumbent urine collections
Ambulatory (14 hr) 325 mg protein
560 mg creatinine (0.6)
Recumbent (10 hr) 30 mg protein
480 mg creatinine (0.06)
26. Association between proteinuria
and progressive renal damage
Increasing levels of proteinuria provide
the best predictor of progressive renal
damage.
Persistent proteinuria should be viewed
as marker of renal disease, and also as a
cause of progressive renal injury.
27.
28. Association between proteinuria and
cardiovascular disease
Severe persistent proteinuria may also be a
long term risk factor for atherosclerosis in
children.
As the severity of proteinuria increases it is
associated with variety of metabolic
disturbances that contribute to cardiovascular
disease, e.g., hypercholesterolemia,
hypertriglyceridemia, and hypercoagulability.
29. Evaluating children with proteinuria
History and physical
Thorough history and physical
-change in urine volume or color
-edema
-increase BP
-recent strep infection
-family history for renal disease and
hearing loss (Alport syndrome)
30.
31.
32.
33. The Need for Renal Biopsy
The key indication for biopsy in any
renal disorder are the need to make
specific diagnosis for therapeutic
reasons or to provide a prognosis.
34. Nonspecific treatment options for
persistent proteinuria
Dietary recommendations.
It is recommended that children with
proteinuria receive the recommended daily
allowance of protein for age.
Blood pressure Control/Inhibition of
Angiotensin effects
Renal function is better preserved when lower
systolic blood pressures are achieved.
35.
36. Neprotic Syndrome
Nephrotic syndrome is characterized by
massive proteinuria, hypoalbuminemia,
edema, and hyperlipidemia; the most
common presenting symptom is edema.
37. Introduction
The annual incidence of Nephrotic
syndrome in healthy children is 2 to 3
new case per 100,000 children younger
than 18 years of age.
The peak age lf onset is at 2 to 3 years.
38. Definition
The diagnosis of NS is the presence of
urinary protein, with the albumin
disproportionately greater than globulin.
39. Clinical Diagnostic Criteria
1- Generalized edema
2- Hypoproteinemia <2 g/dL
(disproportionately low albumin in
relation to globulin)
40. 3-Urine protein to urine creatinine ratio
in excess of 2 (first A.M. void) or a
24- hour urine that exceeds
50mg/Kg body weight
4-Hypercholesterolemia (>200 mg/dL)
41.
42.
43. The mechanisms for edema include:
-Transudation of fluid from the
intravascular space into the intestitium
secondary to decreased albumin and
- Increased renal tubular
reabsorption of sodium and water
44.
45. The hyperlipidemia is secondary to:
-Increase in lipoprotein synthesis by
the liver and
-Decrease in lipid catabolism
resulting from reduced activity of the
enzyme lipoprotein lipase and lecithin
cholesterol acetyltransferase.
46. Case 4
An 8 year old boy presented with ankle swelling and
was found to have hypertension, hematuria and 4+
proteinuria. The remainder of the systematic
examination was normal.
A 24 hour urine collection contained 10 grams of
protein, and his serum albumin was 2.0 g/dl.
The creatinine clearance was normal for his age.
Streptococcal tests and serum complement 3 level
were normal. He received an 8 week course of
glucocorticoids without response.
What are the next appropriate diagnostic and
therapeutic steps?
47. Case 4: Answer
Steroid resistant nephrotic
syndrome
Renal biopsy performed
Diagnosis: Focal segmental
glomerulosclerosis (FSGS)
55. Complications
One true complication of NS is the
tendency to developed infections.
IgG antibody is lost in the urine, and
complement activation is impaired by
concomitant loss of factor B.
56. Marked intravascular depletion causes
diminished splachnic blood flow and
hypoxia, and a marked tendency to
thrombosis cause microinfarction,
lowering resistance of the bowel wall to
bacteria passage.
57. Peritonitis is a major contributor to
the 1% to 2% mortality in NS
The second major contributor is
Thromboembolism, however
anticoagulant therapy is not justified
during remission.
58. Growth is often impaired in NS
There may be losses of IGF-binding
protein, which could account for the
depressed serum concentration of IGF-
I and IGF-II.
59.
60. Prognosis
Mortality in minimal-change NS is
approximately 2%
Of the remaining 98%, most are steroid-
responsive
about 2/3 experience 1/3 possible
single relapse developing
protracted series of
relapses