2.1 Haematuria And Proteinuria Flashcards
What causes dark brown or black urine?
Blood
Bile pigment
Methaemoglobinaemia
What foods or drugs can cause red or pink urine?
Beetroot
Chloroquine
Blackberries
Definition of haematuria?
> 5rbc/UK in uncentrifuged MSU
Causes of bleeding from upper tract leading to haematuria?
Glomeruli Glormerulonephritis, HUS Alport’s RVT Ruptured cyst
Causes of lower tract bleeding leading to haematuria?
UTI Stone Trauma Chemical cystitis Malingnancy
Menstrual
Fictitious
What causes macroscopic haematuria?
UTI
Post-infectious GN
Hypercalcinuria/Stones
IgA nephropathy
Causes of microscopic haematuria?
> 50% benign familial haematuria = thin basement membrane disease
- IgA, Lupus,
- Hypercalciuria
- alport’s
Most common primary Glomerulonephritis?
Post-infectious
Membraneoproliferative
Most common secondary glomerulonephritis?
Lupus
Henoch-Schloien Purpura
ANCA
Polyarteritis nodosa
How to treat haematuria for most patients?
No treatment
How to treat acute nephritis?
Fluid restriction
Salt restriction
Diuretics
Anti-hypertensives
How to treat renal stones/hypercalciuria?
Low sodium diet
Increased fluids
What confirms an upper tract haemauria cause?
Dysmorphic RBCs
RBC casts
Proteinuria
What features are suggestive of acute GN?
Recent URTI
Or impetigo
Most common glomerulonephritis? How does it work?
Post-strep Immune complexes in Basement Membrane Complement Damage: haem/proteinurea Oliguria Oaedema/hypertension
How long does micro haematuria last in post-strep GN?
Up to a year
How to treat post-strep GN?
Treat the fluid overload and hypertension.
Diurectics, sodium restriction +/-hypertensive
Loop diuretic + Ca2+ blocker
Antibiotics to prevent strep spread
What is a common complication of post-strep GN?
Hyperkalaemia
When does gross haematuria resolve by in post-strep GN?
1-3 weeks
When does proteinuria resolve by in post-strep GN?
6-8 weeks
Proteinuria in urine of children common?
Yes, usu. benign
What is the glomerular barrier? 3 layers
Fenestrated endothelium
Basement membrane
Podocytes + slit diaphragms
How does the glomerular barrier prevent proteins from passing through?
Size selective
Electrostatic
Filtered
Reabsorbed in proximal tubule
How to do get proteinuria? 2 main mechanisms
- Increased size/charge of basement membrane
- impaired reabsorption of filtered proteins
How to measure for proteinuria?
Urine dipstick
When is proteinuria abnormal on urine dipstick?
If more than +1
Dipsticks and proteinuria false positives most common?
If pH >8
Left in urine too long
Haematuria
On penicillins
How to investigate proteinuria?
Urinary protein:creatinine ratio
How much protein is normally excreted in 24 hours?
<150mg
What is the normal urine:creatinine ratio? And for infants?
<0.02g/mmol
Infants <2: 0.06g/mmol
What are intermittent causes of proteinuria?
Fever Exercise Stress Orthostatic Cold exposure
What are glomerular causes of proteinuria?
Primary GN
Secondary GM
HUS, DM, reflux
3 causes of proteinuria?
Intermittent
Glomerular
Tubular
What makes proteinuria more significant?
Associated haematuria
Heavy losses: >1g/L
Hypertension
Family hx
Diagnostic evaluation of asymptomatic children with proteinuria? 2 main things
- Repeat urinalysis (early morning urine)
2. Rule out orthostatic proteinuria
When is proteinuria benign?
If orthostatic/transient, Asymptomatic No haematuria Normal GFR Normal blood pressure
How to follow up patient with minor persistent abnormality?
Annual urinanalysis
Annual blood pressure
Annual, UECs
What do you do in children’s with isolated microscopic haematuria or low grade proteinuria?
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
What is nephrotic syndrome?
Oedema
Proteinuria
Hypoalbuminaemia
Hypercholesterolaemia
nephrotic syndrome, treatment and response?
> 80% respond to steroids
How many will relapse in nephrotic syndrome?
70-80% relapse
What is a systemic cause of secondary cause of nephrotic syndrome?
SLE
HSP
What infections cause of secondary cause of nephrotic syndrome?
Hep B
Hep C
Malaria
Schistosomiasis
What drugs cause of secondary cause of nephrotic syndrome?
NSAIDS ACEi Heroin Pamidronate Penicillamine
How to treat first presentation of Nephrotic Syndrome?
Pred 2mg/kg for 6/52
Then
1.5mg/kg alternate days for 6/52
STOP
How to treat relapses in Nephrotic Syndrome?
Pred 2mg/kg until protein free for 3 consecutive days
THEN
1.5mg/kg weaning over 6 weeks
What infections are you more susceptible in Nephrotic Syndrome?
Pneumococcus and HiB
Because losing so much protein
