10 - Haematuria and Proteinuria

Question 1

Problem with the generalised parenchyma of the kidney can lead to

Answer 1

haematuria, proteinuria, acute nephritis, nephrotic syndrome, CKD

Question 2

Problem with collecting system…

Answer 2

infection
polyuria
renal colic
CKD

Question 3

Focal lesions…

Answer 3

Haematuria
Backache
(need to exclude malignancy)

Question 4

What 2 things essentially can go wrong with glomerular function?

Answer 4

Leaky (damaged) or blocked (kidney failure)

Can get mixture

Question 5

What happens when you get a blocked glomerulus?

Answer 5

Reduced kidney function/gfr due to/resulting in AKI or CKD

Question 6

Is there normally any protein in the urine

Answer 6

VERY little

Question 7

Leaky filter?

Answer 7

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)

Question 8

What causes brown urine?

Answer 8

Muscle and RBC breakdown

Question 9

Normal amount of protein in the urine

Answer 9

150mg/day

Question 10

What protein is in proteinuria?

Answer 10

Mainly albumin and small amounts of other proteins.

Question 11

How do you measure proteinuria?

Answer 11

• 24 hour urine test (not common/practical)
• albumin:creatinine
• protein: creatine via a spot urine test
  (surrogate measures for protein in the urine)

Question 12

Stages of proteinuria?

Answer 12

normal
micorproteinuria
proteinuria
neophrotic syndrome

Question 13

Microalbuminuria?

Answer 13

• almost normal levels i.e. 30-300 mg albumin in 24 hours

- protein:creatinine ratio of less than 25

Question 14

Causes of microalbuminuria?

Answer 14

Mainly diabetics
- protein in the urine in diabetics increases the risk of VASCULAR DISEASE, progression of the diabetes and retinopathy etc.

Question 15

What is nephrotic syndrome?

Answer 15

• 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

Question 16

Symptoms of nephrotic syndrome?

Answer 16

• frothy urine
• hypercholesterolaemia
• blood clots
• renal function can be normal OR impaired

Question 17

Is renal function normal or impaired in nephrotic syndrome?

Answer 17

Can be either normal or impaired renal function

Question 18

Starlings law?

Answer 18

NFP = (hydrostatic cap p - interstitial hydrostatic p) - (oncotic bc p - interstitial oncotic p)

Question 19

What else does glomerular injury in nephrotic syndrome stimulate?

Answer 19

RAAS - more salt and water accumulation worseing odema (i.e. peri-orbital)

Question 20

How does nephrotic syndrome cause hypercholesterolaemia?

Answer 20

The reduced oncotic pressure stimulates the liver to make lipoproteins. Increases risk of vascular disease.

Question 21

Do you get oedema in nephritic or nephrotic syndrome?

Answer 21

Both! Nephritic due to injury/rapidly progressive glomerulonehpritis and nephrotic due to reduction in oncotic pressure