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AUBF > 4.3 PROTEIN > Flashcards

4.3 PROTEIN Flashcards

1
Q

What is the most indicative routine chemical test for renal disease?

A

Protein determination in urine.

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2
Q

What is the normal amount of protein excreted in urine daily?

A

Less than 10 mg/dL or 100 mg/24 hours.

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3
Q

What is the major serum protein found in normal urine?

A

Albumin.

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4
Q

At what concentration does clinical proteinuria begin?

A

30 mg/dL (300 mg/L) or greater.

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5
Q

What are the three major categories of proteinuria based on origin?

A

Prerenal, Renal, and Postrenal.

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6
Q

What causes prerenal proteinuria?

A

Increased low-molecular-weight plasma proteins due to conditions like infections and inflammation.

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7
Q

What is a primary example of prerenal proteinuria involving multiple myeloma?

A

Bence Jones protein.

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8
Q

What causes renal proteinuria?

A

Glomerular membrane damage or tubular dysfunction.

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9
Q

How does glomerular damage cause proteinuria?

A

It impairs selective filtration, allowing serum proteins, red blood cells, and white blood cells to pass through the glomerulus.

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10
Q

What benign conditions can cause transient renal proteinuria?

A

Strenuous exercise, fever, dehydration, and exposure to cold.

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11
Q

What condition can be predicted by the detection of microalbuminuria?

A

Diabetic nephropathy.

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12
Q

What is the albumin range for microalbuminuria?

A

20 to 200 mg/L.

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13
Q

A benign proteinuria occurring after being in a vertical position, disappearing when lying down.

A

orthostatic proteinuria

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14
Q

How can orthostatic proteinuria be diagnosed?

A

Negative protein test in the first morning specimen and positive test after standing for several hours.

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15
Q

What conditions cause tubular proteinuria?

A

Disorders like Fanconi syndrome, exposure to toxins, heavy metals, or viral infections.

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16
Q

What is postrenal proteinuria caused by?

A

Infections, inflammations, or contamination with blood, prostatic fluid, or sperm from the lower urinary tract.

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17
Q

What are the components of normal urine protein?

A

Low-molecular-weight serum proteins,
albumin,
tubular microglobulins,
uromodulin (Tamm-Horsfall protein), and
genitourinary proteins.

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18
Q

A glycoprotein produced by the renal tubular epithelial cells in the ascending loop of Henle.

A

uromodulin

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19
Q

What is uromodulin, and where is it produced?

A

A glycoprotein produced by the renal tubular epithelial cells in the ascending loop of Henle.

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20
Q

is a low-molecular-weight immunoglobulin light chain found in urine due to multiple myeloma, which overwhelms the renal reabsorptive capacity.

A

Bence Jones protein

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21
Q

What are major causes of glomerular proteinuria?

A

Amyloid deposits, immune complexes (e.g., in lupus, glomerulonephritis), toxic substances, and increased glomerular pressure.

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22
Q

What is the characteristic feature of Bence Jones protein in a heat-based screening test?

A

Bence Jones protein coagulates between 40°C and 60°C and dissolves at 100°C.

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23
Q

How is interference from other proteins removed in the Bence Jones protein test?

A

By filtering the specimen at 100°C, then observing for turbidity as it cools to between 40°C and 60°C.

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24
Q

How was microalbuminuria detected before modern reagent strip methods?

A

By collecting a 24-hour urine specimen and using quantitative procedures to measure albumin levels, reported in mg/24 hours or as the albumin excretion rate (AER).

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25
Q

What were the thresholds for microalbuminuria in the older testing methods?

A

Microalbuminuria was significant when 30 to 300 mg of albumin was excreted in 24 hours, or the AER was 20 to 200 µg/min.

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26
Q

Clinical Significance of Urine Protein

Prerenal

A

Intravascular hemolysis
Muscle injury
Acute-phase reactants
Multiple myeloma

27
Q

Clinical Significance of Urine Protein

Renal

A

Glomerular disorders
Immune complex
Amyloidosis
Toxic agents
Diabetic nephropathy
Strenuous exercise
Dehydration
Hypertension
Preeclampsia
Orthostatic or postural proteinuria

28
Q

Clinical Significance of Urine Protein

Tubular Disorders

A

Fanconi syndrome
Toxic agents/heavy metals
Severe viral infections

29
Q

Clinical Significance of Urine Protein

Postrenal

A

Lower urinary tract infections/ inflammation
Injury/trauma disorders
Menstrual contamination
Prostatic fluid/spermatozoa
Vaginal secretions

30
Q

What is the most indicative routine chemical test of renal disease?

A

Protein determination

31
Q

How much protein is normally excreted in urine per 24 hours?

A

Less than 100 mg

32
Q

What is the primary protein found in normal urine?

A

Albumin

33
Q

Why is albumin content in normal urine low?

A

Most albumin is not filtered by the glomerulus or is reabsorbed by the tubules.

34
Q

Which protein forms the matrix of urinary casts?

A

Uromodulin (formerly Tamm-Horsfall protein).

35
Q

Where is uromodulin produced?

A

In the ascending loop of Henle by renal tubular epithelial cells

36
Q

At what protein concentration in urine is clinical proteinuria indicated?

A

30 mg/dL or greater.

37
Q

What are the three major categories of proteinuria?

A

Prerenal, renal, and postrenal

38
Q

What causes prerenal proteinuria?

A

Conditions affecting the plasma before it reaches the kidney

39
Q

Is prerenal proteinuria indicative of renal disease?

A

No

40
Q

Name a key protein associated with multiple myeloma and prerenal proteinuria.

A

Bence Jones protein

41
Q

At what temperature does Bence Jones protein coagulate?

A

Between 40°C and 60°C.

42
Q

What happens to Bence Jones protein at 100°C?

A

It dissolves.

43
Q

What can cause glomerular proteinuria?

A

Damage to the glomerular membrane

44
Q

Name a benign cause of transient renal proteinuria.

A

Strenuous exercise, dehydration, or exposure to cold.

45
Q

What condition in pregnancy might proteinuria indicate?

A

Preeclampsia

46
Q

What is microalbuminuria?

A

Albumin levels in urine of 20–200 mg/L.

47
Q

What does microalbuminuria predict in diabetics?

A

The onset of diabetic nephropathy.

48
Q

Proteinuria that occurs after standing and disappears when lying down.

A

orthostatic proteinuria

49
Q

How is orthostatic proteinuria tested?

A

By comparing a first-morning specimen with a specimen collected after standing for hours.

50
Q

By comparing a first-morning specimen with a specimen collected after standing for hours.

A

Infections, inflammation, injury, or contamination (e.g., menstrual fluid, prostatic fluid)

51
Q

What principle do reagent strips for protein testing use?

A

Protein error of indicators

52
Q

What proteins are reagent strips most sensitive to?

A

Albumin

53
Q

What colors indicate protein presence on reagent strips?

A

Yellow to green to blue, depending on concentration

54
Q

What are reagent strip results reported as?

A

Negative, trace, 1+, 2+, 3+, 4+, or semiquantitative values (e.g., 30 mg/dL).

55
Q

What can cause false-positive reagent strip results?

A

Highly buffered alkaline urine, contamination, or visibly bloody urine.

56
Q

Name a test used to detect microalbuminuria

A

Micral-Test or ImmunoDip

57
Q

What ratio is calculated in microalbuminuria testing?

A

Albumin-to-creatinine (A:C) ratio.

58
Q

What does the ImmunoDip reagent strip measure?

A

Urine albumin using an immunochromographic technique

59
Q

What dye is used in albumin reagent strips?

A

Bis(3’,3”-diiodo-4’,4”-dihydroxy-5’,5”-dinitrophenyl)-3,4,5,6-tetrabromo sulphonphthalein (DIDNTB).

60
Q

What test is used to confirm protein presence in urine?

A

Sulfosalicylic acid (SSA) precipitation test.

61
Q

How is the SSA test performed?

A

By adding SSA reagent to centrifuged urine and observing turbidity.

62
Q

What protein level does a 4+ SSA result indicate?

A

Greater than 400 mg/dL.

63
Q

What is a key technical tip for interpreting trace protein results?

A

Consider the urine’s specific gravity; trace protein in dilute urine is more significant than in concentrated urine.

64
Q

What can interfere with reagent strip readings for albumin?

A

Abnormally colored urine or visible blood.

AUBF (22 decks)

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