Approach to Proteinuria and Hematuria Flashcards
Normal protein flow thru renal arteries
121,000g/day
Normal protein flow thru GLOMERULUS
1-2g/day
Normal protein excretion in urine
<150mg/day and (-) on dipstick
Usual first sign of renal complication
Microalbuminuria
Only protein detected on dipstick
Albumin
% of Tamm-Horsfall protein in Urine
60-80%
% Albumin in urine
20-40
550mg of protein in urine is considered
Moderate
Mild: <500 mg
Moderate: 500mg-2g
Severe: >2g
Most common cause of proteinuria
DM
Etiology of Protenuria is classified into
Overflow
Tubular
Glomerular
TorF: Tubulointerstitial disease would cause high molecular weight proteinuria
False. LOW bsta tubular kag overfLOW ky LOW
Disease that would cause high mol wt proteinuria
GN
Orthostatic proteinuria
Type of proteinuria which resolves with resolution of underlying dse
Transient proteinuria
Secondary causes of Tubulointerstitial disease
Uric acid nephropathy
Heavy Metal and drug toxicity
Sickle Cell Dse
Proteinuria while upright or after prolonged standing but normal when supine
Orthostatic proteinuria
Diagnostic methods for orthostatic proteinuria
Split urine collection
Spot protein creatinine ratio of 1st AM and mid afternoon void
T or F: More patients have secondary causes than primary glomerular disease
False: 75% primary
25% secondary
kidney disesase as a result
of the progression of symptoms diabetes mellitus
Diabetic Kidney disease
kidney disease as a direct
result of increased blood glucose
Diabetic nephropathy
How many yrs does microalbuminuria develop in Diabetic nephropathy/DKD
5 yrs, proteinuria 11-20 yrs
Why are young population prone to CKD
Due to fast food and salty diet (nan sigeha nyu ah)
What to look for in fundoscopy that would suggest DM
Retinopathy
Low C3 would suggest
Post strep
Normal C3 would suggest
Glomerulonephritis
Lab exam that you would request to detect chronicity and activity of renal lesions
Renal biopsy
T or F: atleast 1 kidney should be functional before doing biopsy
False: BOTH kidneys must be functioning
T or F: in adults pulse therapy is attempted before biopsy
False: it’s for pedia since pediatric Neo are more responsive. (adults:biopsy b4 treatment)
T or F: aurine dipstick analysis is most sensitive to albumin and least sensitive to low mol wt proteins
True
Turbidimetric assay based on protein precipitation;
Sulfosalicylic assay (SSA)
Type of protein measured by SSA
All proteins
Define Hematuria
> 3 RBC/hpf in centrifuged urine
Presence of clots may indicate
Ureteral or bladder origin
Origin of primary hematuria
Renal
Most common form of hematuria
Primary
Lab test that gives us an idea of what section of the urinary tract is involved in hematuria
Three-glass test
In the 3-glass tetst urine is collected during 3 stages, what are these
Urethral involvement
Bladder neck or triangle
Bladder or upper UT
If all urine samples in the 3-glass test have RBC which stage is this
Bladder or upper UT
(3glass tets) If the RBCs are only from near end of micturition which stage is this
Bladder neck or triangle
(3 glass test) if the RBCs are only from the START of micturition which stage
Urethral involevemtn
NO clots usually indicate which origin
Upper UT or glomerular origin
Test that distinguish btn glomerular from post-glomerular origin of hematuria
Phase contrast microscopy
Dysmorphic RBCs indicate which origin
Glomerular
Normal size and shape RBCs indicate which origin
Post glomerular
If the accompanying symptom is dysuria, micturition pause or straining this indicates
Bladder or urethral stone
If the hematuria is accompanied with symptoms like high spiking fever, chills, loin pain and positive kidney punch test this is a diagnosis of
Pyelonephritis
Hematuria plus urgency only
Cystitis
Hematuria plus edema and hypertension
GN
Hypertensive nephropathy
Hematuria plus chyluria
Filariasis
Painful gross hematuria without clots indicate
RCC
This test is best in evaluating hematuria
Renal biopsy
3wks pta px develop sore throat, positive ASO, (+) hematuria this is
Post strep GN
Eosinophiluria indicates
Allergic interstitial nephritis
