Oedema and proteinuria

Question 1

What is peripheral oedema?

Answer 1

The presence of palpable swelling resulting from increased interstitial fluid in the tissue from the extremities

Oedema is caused by an imbalance of the equilibrium between the hydrostatis forces that push fluid out into the interstitial tissue spaces and the oncotic gradient that draws fluids into the intravascular space

Question 2

What is anasarca?

Answer 2

Extreme generalised oedema

Often caused by decreased oncotic pressure

Question 3

What are the main causes of proteinuria?

Answer 3

• Amyloidosis
• Nephrotic syndrome
• CKD
• Endocarditis
• Glomerulonephritis
• Eclampsia
• Vigorous exercise
• Fever
• Orthostatic proteinuria (seen in children, not harmful)

Question 4

What are the causes of peripheral oedema?

Answer 4

1. Increased hydrostatic pressure: increased venous pressure/ congestion or total body fluid overload
2. Anything that reduces plasma colloid oncotic pressure: reduced serum protein levels due to kwashiorkor (underfill hypothesis)
3. Anything that increases vascular permeability to large proteins: cytokine, NO, prostaglandins e.g. in sepsis - patients have circulating cytokines that cause hyperpermeability and oedema
4. Anything that alters the drainage ability of the lymphatic system: maignancy, absence of lymphatic system, infection, surgery

Question 5

Discuss peripheral oedema and emergencies

Answer 5

• Acute onset, asymmetrical, tender leg oedema may be a DVT
• Phlegmasia dolens: venous congestion leading to a degree of oedema that results in compartment syndrome, arterial compromise and gangrene
• Heart failure may first present as oedema
• Pulmonary oedema
• New onset renal disease
• Myxoedema
• Compartment syndrome
• Sepsis

Question 6

How much protein has to be in the urine before it can be detected via dipstick?

Answer 6

300mg over 24hrs

Question 7

How much albumin to normal individuals excrete in the urine?

Answer 7

20ug/ min

or

30mg in 24hrs

Question 8

What is phlegmasia dolens?

Answer 8

‘Painful blue oedema’

Severe form of DVT where the deep and superficial veins of an extremity are blocked

Very high risk of pulmonary embolism

50% of cases are associated with malignancy

Question 9

What is amyloidosis?

Answer 9

The buildup of an abnormal protein, amyloid, in tissues and organs

Most people will have a buildup of amyloid in their kidneys

Question 10

Discuss protein : creatinine ratios

Answer 10

Preferred test for detection of small amounts of protein in the urine

Elevated levels may be seen temporarily with conditions such as infections, stress, pregnancy, diet, cold exposure, or heavy exercise. Persistent protein in the urine suggests possible kidney damage or some other condition that requires additional testing to determine the cause

Question 11

What are the consequences of amyloidosis?

Answer 11

Kidney failure: oedema, tiredness, weakness

Heart failure

Amyloid protein can build up anywhere e.g. nerves, liver, skin so a variety of symptoms can present