2. PROTEINURIA/ALBUMINURIA
ASPECTS OF DISCUSSION:
• 1) Definition
• 2) Types
• 3) Symptoms
• 4) People at risk for Proteinuria.
• 5) Tests for Proteinuria.
• 6) Precautionary measures and medications for proteinuria.
3. What is it?
• Proteins form the major building blocks for our bodies.
• The right amount of protein is important in our diets, for growth and
repair.
• Protein is present in the blood; healthy kidneys should only filter tiny
(trace) amounts into the urine as most protein molecules are too
large for the filters (glomeruli).
• It is not usual to lose protein in the urine. When this does happen it is
known as ‘Proteinuria
4. ALBUMINURIA
• Albuminuria is a condition wherein the protein albumin is abnormally
present in the urine.
• Albumin is a major plasma protein (normally circulating in the blood);
in healthy people. Only trace amounts of it are present in urine,
whereas larger amounts occur in the urine of patients with kidney
disease.
5. • Albumin is the main protein in the blood.
• Its function is to maintain osmotic pressure and transport some
nutrient.
• It is a chronic kidney disease (CKD), which can result from diabetes,
high blood pressure and diseases that causes inflammation in the
kidneys.
• Kidney disease is sometimes called renal disease.
• If CKD progresses, it can lead to end-stage renal disease (ESRD), when
the kidneys fails completely.
6. Normal urinary protein excretion
• In normal adult, normal urinary protein excretion should be < 150
mg/day.
• Normal rate of albumin excretion is < 20 mg/day (15 mcg/min),
increases with age and higher body weight.
7. Types of proteinuria
• A) Glomerular proteinuria
• B) Tubular proteinuria
• C) Overflow proteinuria
Glomerular proteinuria
• Increased filtration of macromolecules (such as albumin) across the
glomerular capillary wall.
8. Tubular proteinuria
• Tubular proteinuria: is proteinuria (excessive protein in the urine)
caused by renal tubular dysfunction.
• Proteins of low molecular weight are normally filtered at the
glomerulus of the kidney and are then normally reabsorbed by the
tubular cells, so that less than 150 mg per day should appear in the
urine.
• Low-molecular-weight proteins' appearing in larger quantities than
this is tubular proteinuria, which points to failure of reabsorption by
damaged tubular cells.
9. Overflow proteinuria:
• Overflow proteinuria: that is due to hemoglobin, myoglobin, or
immunoglobulin loss into the urine due to excessive amounts in the
bloodstream, such as in multiple myeloma; ( It is a cancer that forms
in a type of white blood cell).
10. SYMPTOMS
• In most cases, proteinuria has no symptoms and is detected during a
routine screening in people with high blood pressure or diabetes. If
protein loss is severe, swelling or edema can occur. Edema can be
present in the:
• Face and around the eyes
• Arms, hands, legs, ankles and feet
• Abdomen
11. Other symptoms can include:
• Foamy urine
• Weight gain caused by fluid retention
• Diminished appetite (loss of hunger)
• Hypertension
13. People at risk for proteinuria
• Mainly three types of people are at great risk to suffer through
Proteinuria:
1)Diabetic
2)Hypertensive
3)Obese
14. Diabetic People
• Diabetic people are one of the major suffers of proteinuria.
In both diabetes type 1,2 the albumin presence in urine is the first sign
of deteriorating kidney functions.
• Kidney functions decline with increase in the albumin concentration
in the urine.
15. Hypertensive People
• Hypertensive people are also at risk to have proteinuria.
• Since in hypertension:
i)blood flow is high & protein is big,
ii)exert great pressure on glomerulus,
iii)as a result the filter of kidney is damaged,
iv)which cause leakage of protein from blood to urine.
16. Obese People
• In obese people accumulation of fats on the walls of vessels occurs.
Which results in increased blood flow, and may lead to proteinuria.
• Some other peoples having family history of diabetes and renal
Diseases are also at risk.
17. Tests for Proteinuria
• Earlier researchers though that for protein measurements a
24 hours urine sample collection was required.
• But in recent years researchers have found that a single sample is
enough for the protein measurement of the patients.
• For this purpose URINE ALBUMIN TO CREATININE RATIO TEST is
carried out.
18. URINE ALBUMIN TO CREATININE
RATIO
• In newer technique the amount of albumin is compared with
creatinine. Creatinine is the waste product of muscles breakdown.
This test is called urine albumin to creatinine ratio.
If the sample contains more than 30mg albumin per gram of creatinine
the patient is said to have Persistent Proteinuria.
There is an additional test for proteinuria which is
called Estimated glomerulus filtration rate (eGFR).
19. ESTIMATED GLOMERULUS FILTRATION
RATE (eGFR)
Amount of creatinine in blood shows a persons kidney is removing
wastes efficiently.
Chronic Kidney Disease (CKD) is present when eGFR is less than
60ml/minute.
Which is an indicator for person suffering through proteinuria.
20. PRECAUTIONARY MEASURES &
MEDICATION
• Persons with diabetes and hypertension should control their blood
sugar and pressure. This is the only precautionary measure.
• The medication for proteinuria includes:
1)ACE Inhibitor (angiotensin converting enzyme inhibitor).
2)ARB’s (angiotensin receptor blockers).
• ACE Inhibitor & ARB’s reduce the intra glomerular pressure on kidney by
inhibiting angiotensin II-medicated efferent arteriolar vasoconstriction.
• These drugs also have a proteinuria reducing effect which is independent
of their antihypertensive effect.
