Approach to Proteinuria Flashcards
Normoalbuminuria
< __mg per day of proteinuria
< ____mh per day of albuminuria
Normoalbuminuria
< 150mg per day of proteinuria
< 30mg per day of albuminuria
nephrotic vs nephritic
the sub epithelium/protein barrier = nephrotic.
blood barrier= neprhitic = sub ENDOTHELIAL site
neprhitic syndrome triad
- active urine with DYSMORPHIC RED BLOOD CELLS AND RED CASTS. (may also have proteinuria)
- hypertension
- acute renal failure.
nephrotic syndrome triad
proteinuria (Way more than in nephritic) - >3.5 grams per day of protein, or >3 grams per day of albuminuria
- hypoalbuminemia
- edema
Micro-albuminuria
__-__ per day of proteinuria
__-__ mg per day of albuminuria
Micro-albuminuria
150-300mg per day of proteinuria
30-300 mg per day of albuminuria
Overt proteinuria (Proteinuria) \> \_\_\_mg per day of proteinuria or albuminuria
Overt proteinuria (Proteinuria) \> 300mg per day of proteinuria or albuminuria
Nephrotic Syndrome
>__ g per day of proteinuria
>__ g per day of albuminuria
Nephrotic Syndrome
> 3.5 g per day of proteinuria
> 3.0 g per day of albuminuria
Proteinuric renal disease exists on a spectrum: diseases may progress slowly this spectrum, such as in ___ ____
Dsieases can also present severely and with Nephrotic syndrome. These do not have to pass throguh all the stages of peoteinuria, and can arrest at any stage of proteinuria. Ex, __ ___ __
Proteinuric renal disease exists on a spectrum: diseases may progress slowly this spectrum, such as in DIABETIC NEPHROPATHY
Dsieases can also present severely and with Nephrotic syndrome. These do not have to pass throguh all the stages of peoteinuria, and can arrest at any stage of proteinuria. Ex, MINIMAL CHANGE DISEASE
OUTLINE THE spectrum of proteinuric glomerular disease
describe the different measures of proteinuria
note: 24 hour urine quantificaiton is gold standard, but its cumbersom. we usualyl do random quantification
random quantification urine protein:
T/F patients withp proteinuria are an indiication of decreased mortality
true. low gfr but no proteinuria = lower mortality than those with heavy proteinuria, even if they have normal gfr.
note the different stages
KDgo– came up with a heat map regaridng kidney disease mortality staging. stratified by the amount of albumin in the urine
classic complications of nephrotic syndrome proteinuria (6)
- edema; albumin rexerts oncotic pressure which keeps fluid in vessels. if theres less albumin, then fluid leaks out resulting in edema.
- progressive renal failure
- hyperlipidemia/hypertriglyceridemia
- coagulopathy
- immune cimpromise- because you’re peeing out all your immunoglobulins
- malnutrition
newer found complications seen in patients with nephrotic syndrome
- increased risk of CV disease
- increased risk of death
general treatment of proteinuria:
- Treat the __ __
- to treat the actual Proteinuria:
Moderate protein diet – ___g/kg/day
__or __ meds
general treatment of proteinuria:
- Treat the underlying cause
- to treat the actual Proteinuria:
Moderate protein diet – 1g/kg/day
ACE-I or ARB
These medications reduce proteinuria
Both renal and non-renal outcomes improved
treatment of edema from the proteinuria
- low sodium diet
- compression stockings
- diuretics; furosemide
treatment of the hyperlipidemia complications of proteinuria
- diet
- statins
treatment of immunocompromise complications of proteinuria
vaccinatino
treatment of coagulopathy complications of proteinuria
THIS IS PARTICULARLY AN ISSUE WITH ALBUMIN <20
- high index of suscipicion for clots
- need DVT PROPHYLAXIS
approach to proteinuria
proteinuria can be branched into three broad causes: __ issues like __ or waldenstroms conditions, ___ issues involving albumin, or __ issues.
Glomerular issues can be classified as __ or __ events. __ events can be branched into __ (bland urinee) or __ synromes (active urine).
proteinuria can be branched into three broad causes: overflow issues like myloma or waldenstroms conditions, glomerular issues involving albumin, or tubular issues.
Glomerular issues can be classified as persistent or transient events. Persistnet events can be branched into nephrotic (bland urinee) or nephritic synromes (active urine).
T/F transient proteinuria usually is characterized by >1gram of protein excretion per day
false. rarely exceeds 1 gram per day. cannot have any other associated renal problems (CKD or hematuria)
- can be cuaused be fever, CHF, orthostatic, exercise issues.
- transient proteinuria is not as big of a problem as an an ongoing issue.
if someone has albuminemia-proteinuria, it is a ___ issue
a glomerular issue.
main causes of transient proteinuiria
- fever
- CHF
- orthostatic
- exercise
primary and secondary causes of nephrotic syndrome
primary: minimal change disease, membranous GN, FSGS
secondary: diabetes or amyloidosis.
main cause of minimal change disesase (primary nephrotic syndrome disease)
NSAIDS.
main cause of membranous nephropathy (type of primary nephrotic syndrome)
- would see spikes on biopsy
- malignancy, autoimmune (lupus or sjogranes), infection, drugs.
- if it is determined that a malginancy or AI disease cuased it, it is considered a seocndary membranous nephropathy. but if there is no other cause, it’s considered idiopathic mn.
main cause of FSGS (type of primary nephrotic syndrome)
collapsing variant associates with HIV
What do you see on lab in someone has igA nephropathy
gross hematuria
Screening for nephrotic syndrome
- fasting glucose and HbA1C (can see if diabetes plays a role in proteinuria)
- SPEP, 24 hour UPEP
- ANA, C3 and C4 (r/o autoimmune causes that can cause membraneous nephropathy)
- HepBS, HepCAb
- biopsy; once the biopsy is back, you then order investigations to rule out secondary causes of taht specfici GN)
5 indications for biopsy
- progressive proteinuria over 1 gram/day, nephrotic syndrome triad
- progressive renal disease in the presence of proteinuria.
- serology suggestive of a glomerular disease or systemic auto-immune disease
- co-existent hematuria
- diabetic patient with proteinuria with progression that is atypical for diabetic nephropathy
if a kid presents with nephrotic syndrome, what is the first disease on your ddx
minimal change disease.
at what point in diabetes type I natural history will you see overt diabetic nephropathy
at 15 years
