Clinical Syndromes Overview

Question 1

Is there much protein in normal urine? What’s the normal range?

Answer 1

No, not much.

Normal range: 60-100mg/d (which I think means per “day”)

Question 2

What’s the most abundant protein in normal urine?

Answer 2

Tam-Horsfall protein.

Question 3

Two types of benign proteinuria?

Answer 3

Orthostatic (only occurs when standing)

Intermittent (excercise, fever, acute illness)

Question 4

What’s the difference between microalbuminemia and macroalbuminemia?

Answer 4

Simply the quantity of albumin in the urine (the terms are confusing).
“Nephrotic-range” proteinuria means there’s even more.

Question 5

3 “anatomic”ish categories of proteinuria?

Answer 5

Glomerular proteinuria (too much gets filtered).
Tubular proteinuria (not enough gets reabsorbed).
Overproduction proteinuria.

Question 6

Albuminuria and low GFR are both predictors of bad outcomes.

Answer 6

We’re not surprised.

Question 7

5 tests for analyzing protein in the urine?

Answer 7

24 hour urine collection (best, but hardest).
Urine dipstick (easiest, but most limited).
Spot collection.
Precipitation of urine proteins
Electrophoresis.

Question 8

2 major limitations of testing for proteinuria with a dipstick?

Answer 8

It really only sees albumin.

It only assesses concentration. (so albumin will look high if urine volume is low, and vice versa)

Question 9

How is proteinuria assessed with a spot urine? Clinical utility of this?

Answer 9

Protein:creatinine ratio is measured.
This is good for following the same patient over time, but not good for an absolute measure of protein because creatinine excretion will vary between people.

Question 10

In urine protein electrophoresis, what’s the biggest protein found, and what’s the smallest?

Answer 10

Biggest: Albumin.
Smallest: Gammaglobulin aka. immunoglobulin.

Question 11

Quick way to check for high levels of proteins (including non-albumin) in the urine?

Answer 11

Sulfosalicylic acid (SSA) test -> precipitates proteins if present.

Question 12

How can you tell if the redness or brownness of urine is due to RBCs vs. hemoglobin vs. myoglobin vs. drugs/AIP/beets

Answer 12

Spin the urine: if supernatant clear, it was RBCs.

If the supernatant still is red/brown, test for heme.

Question 13

What are acanthocytes? If present in urine, what process do they strongly suggest?

Answer 13

Dysmorphic RBCs with blebbing (sometimes “mickey mouse ears”) - not to be confused with schistocytes.
These strongly suggest glomerular inflammation.

Question 14

What would blood in urine from a kidney stone look like?

Answer 14

Normal RBCs, no casts.

Question 15

When do you see epthelial / squamous cells in the urine?

Answer 15

Ischemic or nephrotoxic injury to tubules, bladder, or other parts of collecting system.

Question 16

3 things typically present in acute glomerulonephritis?

4 other things that are often present?

Answer 16

Hematuria.
RBC casts.
Proteinuria.
(Edema, HTN, reduced GFR, and systemic symptoms are also often present)

Question 17

RBC casts are “almost pathognomonic” of what?

Answer 17

Acute glomerulonephritis.

Question 18

3 classifications of nephrITIC disorders?

Answer 18

Immune complex deposition.
Anti-glomerular basement membrane Abs.
Pauci-immune (vasculitis).

Question 19

Best way to see immune complex deposition?

Answer 19

Immunofluorescence on biopsy sammple.

Can also use EM.

Question 20

What does crescentic glomerulonephritis suggest?

Answer 20

Rapidly progressive glomerulonephritis (RPGN).

Question 21

What forms the crescent in crescentic GN?

Answer 21

Proliferating epithelial cells

Question 22

What do people with nephrotic syndrome always have?

Answer 22

Heavy proteinuria.

edema, hypoalbuminemia, and hyperlipidemia are often present

Question 23

4 classifications of nephrotic lesions?

covered in more detail in the non-inflammatory kidney disease lecture

Answer 23

Normal - “minimal change disease”.
Membranous.
Focal segmental glomerulosclerosis.
Other - diabetes, amyloid, light chain deposition,etc.

Question 24

What’s the current definition of acute kidney injury (AKI)?

Answer 24

An abrupt decline in GFR.

-with this, you see increases in plasma Cr and BUN.

Question 25

3 location-based categories of AKI?

Answer 25

Pre-renal (reduced renal perfusion).
Renal (GN, vasculitis, interstitium, tubules)
Post-renal (obstruction)

Question 26

What’s a typical urine finding in acute tubular necrosis (ATN)?

Answer 26

Muddy brown casts

Question 27

What are stages of chronic kidney disease (CKD) based on?

Answer 27

GFR

Question 28

What are 80% of cases of CKD caused by?

Answer 28

Diabetes mellitus.
HTN.
(most of the rest is from GN and polycystic kidney disease)

Question 29

What do most people with CKD die of?

Answer 29

Cardiovascular disease.. most die before reaching ESRD and needing transplant/dialysis.

Question 30

Best treatment for CKD?

Answer 30

Aggressive blood pressure control.