Lecture 10: Haematuria Proteinuria Flashcards
Haematuria and Proteinuria mean?
Leaking blood or protein in urine
What are the 3 main types of Renal Disease?
Generalised Parenchymal**:
-Haematuria, proteinuria, acute nephritis syn, chronic renal failure
Collecting Sys. Abnorm:
-infection, polyuria, CRF
Focal Lesions:
-Haematuria, backache (masses)
How are the kidneys like a sieve?
When not functioning, they can be blocked (decreased GFR) or Leaky (leaking blood or protein into urine)
Although the kidneys handle _____ filtrate/day including ____g/L of protein, there’s only
Although the kidneys handle 150L filtrate/day including 60-80 g/L of protein, there’s only <150 mg/24h of urinary protein
What are the barriers to urinary protein?
Glomeruli***= filters the protein
also tubules have a role in reabsorbing snd degrading most of the filtered protein
Blocked filter leads to
reduced GFR > acute kidney injury and/or chronic kidney disease
Why is controlling/lowering BP an important form of treatment for a leaky filter?
Because by increasing the pressure in the glomeruli you can leak more protein and even damage your sieve further! (worsening CKD)
What do we lose in Proteinuria
We mainly lose Albumin (others in small amounts)
- Measure via a 24hr urine (annoying)
- Measure ratios (albumin:creatinine or protein: creatinine)
Microalbuminuria
Usually with diabetes, very bad!
Leak 30-300mg albumin/24hr
(* within normal range!)
Indicator of diabetes and other bad things
Other Causes-exercise, fever, HF
ACR ranges?
<2.5 mg/mmol : normal
2.5-25mg/mmol: MA
>25mg/mmol : Proteinuria
Nephrotic Syndrome
People leaking LOTS of protein, due to podocyte damage >3.5g/day Low serum albumin oedema frothy urine hypercholesterolaemia blood clots
Renal function can be normal OR impaired!
What is the mechanism for getting oedema with intense proteinuria?
- Increased Albumin excretion
- Liver can’t keep up (to make more protein)
- Oncotic pressure reduces
- Fluid moves into interstitial space
**low oncotic P and high hydrostatic P, fluid pushed out
Flow diagram of Nephrotic Syndrome
Glomerular injury > protein leakage into bowmans capsule > plasma volume and CO decreases > stimulationg of RAA system > sodium and water retention > oedema
Hypercholesterolaemia due to Nephrotic syndrome?
Low plasma oncotic pressure stimulate liver to increase lipoproteins (to try keep up) > hypercholesterolaemia
Thromboembolism due to Nephrotic syndrome?
Not well understood, just know it increases risk. big leg clot. (decrease in Anti-thrombin III)
10% risk
Infection due to Nephrotic syndrome?
Due to a reduction of AB production and complement pathway.
Get more bacterial infections and chicken pox
malnutrition due to Nephrotic syndrome?
Due to protein leakage//protein malnutrition.
Renal function in nephrotic syndrome.
May be normal of eremely dimished.
Can have AKI or CKD
Look at nephrotic spectrum on page 51
What is Chronic Kidney Disease, what causes it and how do we treat it?
Due to Glomerular Disease or Diabetes.
- Blood or protein in urine (only protein in DN).
- Chronic Kidney Failure
Main treatment: controlling BP
Diabetic Nephropathy.
Hyperfiltration and microalbuminuria due to excess sugar in blood. if you cannot control glucose or BP, over time the more damage, the more GFR will start to decline, and more protein leaks.
After ~10years, you develop Diabetic Nephropathy. (Type 1)
Acute Kidney Injury
Can be pre-renal, renal or post-renal
Renal= intrinsic acute kidney injury
1) Acute Tubular Necrosis
2) Acute Glomerulonephritis
Acute Tubular Necrosis
From “pre-renal drugs and toxins” that have caused AKI.
Don’t tend to have protein or blood in urine, but have a blocked filter > lower GFR
Acute Glomerulonephritis
Rapidly Progressive Glomerulinephritis
- Acute Renal failure
- Leaking glomeruli; blood and/or protein
- May have nephritic syndrome
What is nephritic Syndrome? (NOT nephrotic syndrome?)
Due to inflammatory response! (unlike nephrotic synd.)
Excessive WBC, RBC, AB in glomeruli > excess leakage of all of these in the urine. (haematuria and proteinuria)
Often patient is unwell, oliguric (little urine), hypertensive, fluid overloaded (can have pulmonary/peripheral oedema)
Can be AKI or CKD
Treatment of Proteinuria
Find cause (usually via kidney biopsy) Control BP
Haematuria
Bleeding from somewhere in the urinary tract. (eg; glomerular, CS, focal lesion)
Micro (only see blood via microscope)
Macro (can see with naked eye, can have clots)
Glomerular haematuria
Generally microscopic and associated with proteinuria
Haematuria from the collecting duct
Generally macroscopic, with no/little proteinuria.
Can be via kidney stone: Associated with loin-groin pain, vomiting/nausea, anuria.
Diagnose via US.
Haematuria due to focal lesions
Can be macro or microscopic, often asymptomatic, backache with a mass
Renal Cell carcinoma
90% renal cancer
M:F 2:1
Peak 6th decade
Increased risk with smoking or genetics
Macroscopic: mottled red, yellow and brown, part cystic, may invade renal vein
Clinical picture of Renal cell carcinoma
Late symptoms, haematuria, flank pain, palpable mass, ectopic hormone production,
Spread
Local spread uncommon
Mainly blood-bourne metastases
Regional Lymph nodes
Survival : ~40% 5yr
