Lecture 10: Haematuria Proteinuria

Question 1

Haematuria and Proteinuria mean?

Answer 1

Leaking blood or protein in urine

Question 2

What are the 3 main types of Renal Disease?

Answer 2

Generalised Parenchymal**:
-Haematuria, proteinuria, acute nephritis syn, chronic renal failure

Collecting Sys. Abnorm:
-infection, polyuria, CRF

Focal Lesions:
-Haematuria, backache (masses)

Question 3

How are the kidneys like a sieve?

Answer 3

When not functioning, they can be blocked (decreased GFR) or Leaky (leaking blood or protein into urine)

Question 4

Although the kidneys handle _____ filtrate/day including ____g/L of protein, there’s only

Answer 4

Although the kidneys handle 150L filtrate/day including 60-80 g/L of protein, there’s only <150 mg/24h of urinary protein

Question 5

What are the barriers to urinary protein?

Answer 5

Glomeruli***= filters the protein

also tubules have a role in reabsorbing snd degrading most of the filtered protein

Question 6

Blocked filter leads to

Answer 6

reduced GFR > acute kidney injury and/or chronic kidney disease

Question 7

Why is controlling/lowering BP an important form of treatment for a leaky filter?

Answer 7

Because by increasing the pressure in the glomeruli you can leak more protein and even damage your sieve further! (worsening CKD)

Question 8

What do we lose in Proteinuria

Answer 8

We mainly lose Albumin (others in small amounts)

• Measure via a 24hr urine (annoying)
• Measure ratios (albumin:creatinine or protein: creatinine)

Question 9

Microalbuminuria

Answer 9

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

Question 10

ACR ranges?

Answer 10

<2.5 mg/mmol : normal
2.5-25mg/mmol: MA
>25mg/mmol : Proteinuria

Question 11

Nephrotic Syndrome

Answer 11

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!

Question 12

What is the mechanism for getting oedema with intense proteinuria?

Answer 12

• 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

Question 13

Flow diagram of Nephrotic Syndrome

Answer 13

Glomerular injury > protein leakage into bowmans capsule > plasma volume and CO decreases > stimulationg of RAA system > sodium and water retention > oedema

Question 14

Hypercholesterolaemia due to Nephrotic syndrome?

Answer 14

Low plasma oncotic pressure stimulate liver to increase lipoproteins (to try keep up) > hypercholesterolaemia

Question 15

Thromboembolism due to Nephrotic syndrome?

Answer 15

Not well understood, just know it increases risk. big leg clot. (decrease in Anti-thrombin III)
10% risk

Question 16

Infection due to Nephrotic syndrome?

Answer 16

Due to a reduction of AB production and complement pathway.

Get more bacterial infections and chicken pox

Question 17

malnutrition due to Nephrotic syndrome?

Answer 17

Due to protein leakage//protein malnutrition.

Question 18

Renal function in nephrotic syndrome.

Answer 18

May be normal of eremely dimished.

Can have AKI or CKD

Look at nephrotic spectrum on page 51

Question 19

What is Chronic Kidney Disease, what causes it and how do we treat it?

Answer 19

Due to Glomerular Disease or Diabetes.

• Blood or protein in urine (only protein in DN).
• Chronic Kidney Failure

Main treatment: controlling BP

Question 20

Diabetic Nephropathy.

Answer 20

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)

Question 21

Acute Kidney Injury

Answer 21

Can be pre-renal, renal or post-renal
Renal= intrinsic acute kidney injury
1) Acute Tubular Necrosis
2) Acute Glomerulonephritis

Question 22

Acute Tubular Necrosis

Answer 22

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

Question 23

Acute Glomerulonephritis

Answer 23

Rapidly Progressive Glomerulinephritis

• Acute Renal failure
• Leaking glomeruli; blood and/or protein
• May have nephritic syndrome

Question 24

What is nephritic Syndrome? (NOT nephrotic syndrome?)

Answer 24

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

Question 25

Treatment of Proteinuria

Answer 25

Find cause (usually via kidney biopsy)
Control BP

Question 26

Haematuria

Answer 26

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)

Question 27

Glomerular haematuria

Answer 27

Generally microscopic and associated with proteinuria

Question 28

Haematuria from the collecting duct

Answer 28

Generally macroscopic, with no/little proteinuria.

Can be via kidney stone: Associated with loin-groin pain, vomiting/nausea, anuria.
Diagnose via US.

Question 29

Haematuria due to focal lesions

Answer 29

Can be macro or microscopic, often asymptomatic, backache with a mass

Question 30

Renal Cell carcinoma

Answer 30

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

Question 31

Clinical picture of Renal cell carcinoma

Answer 31

Late symptoms, haematuria, flank pain, palpable mass, ectopic hormone production,

Spread
Local spread uncommon
Mainly blood-bourne metastases
Regional Lymph nodes

Survival : ~40% 5yr