2.1 Haematuria And Proteinuria

Question 1

What causes dark brown or black urine?

Answer 1

Blood
Bile pigment
Methaemoglobinaemia

Question 2

What foods or drugs can cause red or pink urine?

Answer 2

Beetroot
Chloroquine
Blackberries

Question 3

Definition of haematuria?

Answer 3

> 5rbc/UK in uncentrifuged MSU

Question 4

Causes of bleeding from upper tract leading to haematuria?

Answer 4

Glomeruli
Glormerulonephritis, 
HUS
Alport’s
RVT
Ruptured cyst

Question 5

Causes of lower tract bleeding leading to haematuria?

Answer 5

UTI
Stone
Trauma
Chemical cystitis
Malingnancy

Menstrual
Fictitious

Question 6

What causes macroscopic haematuria?

Answer 6

UTI
Post-infectious GN
Hypercalcinuria/Stones
IgA nephropathy

Question 7

Causes of microscopic haematuria?

Answer 7

> 50% benign familial haematuria = thin basement membrane disease

• IgA, Lupus,
• Hypercalciuria
• alport’s

Question 8

Most common primary Glomerulonephritis?

Answer 8

Post-infectious

Membraneoproliferative

Question 9

Most common secondary glomerulonephritis?

Answer 9

Lupus
Henoch-Schloien Purpura
ANCA
Polyarteritis nodosa

Question 10

How to treat haematuria for most patients?

Answer 10

No treatment

Question 11

How to treat acute nephritis?

Answer 11

Fluid restriction
Salt restriction
Diuretics
Anti-hypertensives

Question 12

How to treat renal stones/hypercalciuria?

Answer 12

Low sodium diet

Increased fluids

Question 13

What confirms an upper tract haemauria cause?

Answer 13

Dysmorphic RBCs
RBC casts
Proteinuria

Question 14

What features are suggestive of acute GN?

Answer 14

Recent URTI

Or impetigo

Question 15

Most common glomerulonephritis? How does it work?

Answer 15

Post-strep
Immune complexes in Basement Membrane
Complement
Damage: haem/proteinurea
Oliguria
Oaedema/hypertension

Question 16

How long does micro haematuria last in post-strep GN?

Answer 16

Up to a year

Question 17

How to treat post-strep GN?

Answer 17

Treat the fluid overload and hypertension.

Diurectics, sodium restriction +/-hypertensive

Loop diuretic + Ca2+ blocker

Antibiotics to prevent strep spread

Question 18

What is a common complication of post-strep GN?

Answer 18

Hyperkalaemia

Question 19

When does gross haematuria resolve by in post-strep GN?

Answer 19

1-3 weeks

Question 20

When does proteinuria resolve by in post-strep GN?

Answer 20

6-8 weeks

Question 21

Proteinuria in urine of children common?

Answer 21

Yes, usu. benign

Question 22

What is the glomerular barrier? 3 layers

Answer 22

Fenestrated endothelium
Basement membrane
Podocytes + slit diaphragms

Question 23

How does the glomerular barrier prevent proteins from passing through?

Answer 23

Size selective
Electrostatic

Filtered
Reabsorbed in proximal tubule

Question 24

How to do get proteinuria? 2 main mechanisms

Answer 24

• Increased size/charge of basement membrane

- impaired reabsorption of filtered proteins

Question 25

How to measure for proteinuria?

Answer 25

Urine dipstick

Question 26

When is proteinuria abnormal on urine dipstick?

Answer 26

If more than +1

Question 27

Dipsticks and proteinuria false positives most common?

Answer 27

If pH >8 Left in urine too long Haematuria On penicillins

Question 28

How to investigate proteinuria?

Answer 28

Urinary protein:creatinine ratio

Question 29

How much protein is normally excreted in 24 hours?

Answer 29

<150mg

Question 30

What is the normal urine:creatinine ratio? And for infants?

Answer 30

<0.02g/mmol | Infants <2: 0.06g/mmol

Question 31

What are intermittent causes of proteinuria?

Answer 31

``` Fever Exercise Stress Orthostatic Cold exposure ```

Question 32

What are glomerular causes of proteinuria?

Answer 32

Primary GN Secondary GM HUS, DM, reflux

Question 33

3 causes of proteinuria?

Answer 33

Intermittent Glomerular Tubular

Question 34

What makes proteinuria more significant?

Answer 34

Associated haematuria Heavy losses: >1g/L Hypertension Family hx

Question 35

Diagnostic evaluation of asymptomatic children with proteinuria? 2 main things

Answer 35

1. Repeat urinalysis (early morning urine) | 2. Rule out orthostatic proteinuria

Question 36

When is proteinuria benign?

Answer 36

``` If orthostatic/transient, Asymptomatic No haematuria Normal GFR Normal blood pressure ```

Question 37

How to follow up patient with minor persistent abnormality?

Answer 37

Annual urinanalysis Annual blood pressure Annual, UECs

Question 38

What do you do in children’s with isolated microscopic haematuria or low grade proteinuria?

Answer 38

Repeat urine several times over >3/12 if they are well BEFORE referring Record BP Check early morning urine Send urine for dysmorphic red cells

Question 39

What is nephrotic syndrome?

Answer 39

Oedema Proteinuria Hypoalbuminaemia Hypercholesterolaemia

Question 40

nephrotic syndrome, treatment and response?

Answer 40

>80% respond to steroids

Question 41

How many will relapse in nephrotic syndrome?

Answer 41

70-80% relapse

Question 42

What is a systemic cause of secondary cause of nephrotic syndrome?

Answer 42

SLE | HSP

Question 43

What infections cause of secondary cause of nephrotic syndrome?

Answer 43

Hep B Hep C Malaria Schistosomiasis

Question 44

What drugs cause of secondary cause of nephrotic syndrome?

Answer 44

``` NSAIDS ACEi Heroin Pamidronate Penicillamine ```

Question 45

How to treat first presentation of Nephrotic Syndrome?

Answer 45

Pred 2mg/kg for 6/52 Then 1.5mg/kg alternate days for 6/52 STOP

Question 46

How to treat relapses in Nephrotic Syndrome?

Answer 46

Pred 2mg/kg until protein free for 3 consecutive days THEN 1.5mg/kg weaning over 6 weeks

Question 47

What infections are you more susceptible in Nephrotic Syndrome?

Answer 47

Pneumococcus and HiB | Because losing so much protein