10 - Haematuria and Proteinuria Flashcards
Problem with the generalised parenchyma of the kidney can lead to
haematuria, proteinuria, acute nephritis, nephrotic syndrome, CKD
Problem with collecting system…
infection
polyuria
renal colic
CKD
Focal lesions…
Haematuria
Backache
(need to exclude malignancy)
What 2 things essentially can go wrong with glomerular function?
Leaky (damaged) or blocked (kidney failure)
Can get mixture
What happens when you get a blocked glomerulus?
Reduced kidney function/gfr due to/resulting in AKI or CKD
Is there normally any protein in the urine
VERY little
Leaky filter?
Damaged glomerulus. Haematuria and or proteinuria. Kidney function may be normal.
Haematuria can be caused by a number of things i.e. disease, tumour, infection while proteinuria is more specific to a damaged glomerulus (glomerulonephritis)
What causes brown urine?
Muscle and RBC breakdown
Normal amount of protein in the urine
150mg/day
What protein is in proteinuria?
Mainly albumin and small amounts of other proteins.
How do you measure proteinuria?
- 24 hour urine test (not common/practical)
- albumin:creatinine
- protein: creatine via a spot urine test
(surrogate measures for protein in the urine)
Stages of proteinuria?
normal
micorproteinuria
proteinuria
neophrotic syndrome
Microalbuminuria?
- almost normal levels i.e. 30-300 mg albumin in 24 hours
- protein:creatinine ratio of less than 25
Causes of microalbuminuria?
Mainly diabetics
- protein in the urine in diabetics increases the risk of VASCULAR DISEASE, progression of the diabetes and retinopathy etc.
What is nephrotic syndrome?
- When there is a lot of protein in the urine (more than 3.5 GRAMS a day - more than 20x normal)
- means there will be a low SERUM albumin, low oncotic pressure in the blood, leading to odema
Symptoms of nephrotic syndrome?
- frothy urine
- hypercholesterolaemia
- blood clots
- renal function can be normal OR impaired
Is renal function normal or impaired in nephrotic syndrome?
Can be either normal or impaired renal function
Starlings law?
NFP = (hydrostatic cap p - interstitial hydrostatic p) - (oncotic bc p - interstitial oncotic p)
What else does glomerular injury in nephrotic syndrome stimulate?
RAAS - more salt and water accumulation worseing odema (i.e. peri-orbital)
How does nephrotic syndrome cause hypercholesterolaemia?
The reduced oncotic pressure stimulates the liver to make lipoproteins. Increases risk of vascular disease.
Do you get oedema in nephritic or nephrotic syndrome?
Both! Nephritic due to injury/rapidly progressive glomerulonehpritis and nephrotic due to reduction in oncotic pressure
