Proteinurea & Hematuria Flashcards
What proteins does urine dipstick detect?
Albuminurea
Name diseases with proteinurea that are less likely to be detected by dipstick?
- Tubular proteinuria
- bence jones
- gamma globulins
What does the depth of color in dipstick indicate in proteinurea
Increase protein excretion
What does trace, +1, +2, +3, +4 indicate in dipstick tests: of protein
- trace: between 15-30
- 1: between 30-100
- 2: between 100-300
- 3: between 300 -1000
- 4: >1000
Name false positive results from proteinurea in dipstick
- gross hematuria
- concentrated urine
- alkaline urine
- antiseptic and radiocontrats
Name false negative results from proteinurea in dipstick
Non-albumin proteins - diluted urine
In which group of population is transient proteinurea more common
School aged and adolecent
What are the causes that may cause transient proteinurea
Exercise, fever, dehydration, cold weather, stress, seizures, heart failure
What are the findings of proteinurea in dipstick?
They don’t exceed +2
What is orthostatic proteinurea?
Proteinurea when standing up in an asymptomatic school aged-adolecent child
How to treat orthostatic postural proteinurea?
No need, it’s benign codnition just folllow up
How to establish diagnosis for orthostatic proteinurea?
By early morning sample after being supine over the night (negative) - after standing up during the day (positive)
What are the dipstick finding in glomerular proteinurea?
From 1g to 30 grams in one day
When to suspect glomerular proteinurea?
- first morning protein\creatining >1
- proteinura w\ HTN, hematuria, edema, renal dysfunction
What is the treatment of choice for minimal changr disease?
Corticosteroid
What is the worst prognosis of primary nephrotic syndrome?
Focal segmental GN
Whats the % of response to steroid in primary NS?
- 90% in minimal
- 50% mesengial
- 20% in focal segmental
Whats the outcome after focal segmental ns
ESRD
What are the lab findings in blood for nephrotic syndrome?
- low albumin
- high cholesterol
- normal BUN\creatinine (high if Intravascular depletion or dehydration)
- normal C3 (in MCNs)
What are the lab findings in urine for nephrotic syndrome?
- high specific gravity
- proteinuria (>40mg\hr) - (creatinine ratio >2.0)
- oligiureia
- hematuria (micro & asymp)
What are the indications for renal biopsy for nephrotic syndrome?
- gross hematuria
- HTN
- renal insufficiency
- Hypocomplementemia
- age <1 yr - >10yr
- steroid resistance (after initial steroid)- steroid dependent (before 2nd line)
What are the clinical manifestations of minimal change disease?
- generalized edema
- normal\low BP
- thrombosis
- bacterial infection (sbp)
- hyperlipedemia complication (rare in child)
What is the most common form of nephrotic syndrome in childhood?
Idiopathic nephrotic syndrome (primary)
What is the common (age\gender) to develop minimal change nephrotic syndrome?
2-6 years
Males
What may trigger Mcns
- infections (minor)
- reaction to insect bites\bee stings
- poison ivy
what is the recommended diet for child w\nephrotic syndrome
Low fat and salt - high protein
What should be ruled out before starting steroid therapy?
Tb infection
Treatment of nephrotic syndrome:
- diuretic “mod-severe edema”
- salt restricted albumin “severe edema”
- steroid (definitive)
What are the presentations of severe edema?
Anasarca - genital - pulmonary edema
What is the definition of remission after steroid therapy in Ns
Negative urine protein for 3 consecutive days
What is the definition of relapse after steroid therapy in Ns
- 2+ or more protein in Ua >3d
- hypoalbuminemia
- edema
When to consider patient steroid resistant?
Fail to have remission after 6-8w of steroid therapy
tx of Steroid resistant:
- renal biopsy
- 2nd line tx (cyclosporine + tacrolimus)
What to suspect in case of steroid resistance in Ns?
Other cause (not mcns)
What are the mimickers of hematuria?
Dyes - hemoglbinurea - myoglobinurea - mensturation - factious
What medication can mimic hematuria
Rifampicin
How to confirm hematuria?
urine Dipstick + microscopy
Define hematuria in urine microscopy
> 5 RBC\HPF (centerfuged)
Or >6 (>10) RBC\0.9mm (uncenterfuged)
How much blood is enough to make urine look bloody?
1ml of blood in 1L of urine
Does color of blood in urine indicate severity?
No
What causes transient hematuria
Fever or sternous exercise
What to do if you diagnose patient with transient hematuria?
Repeat UA after 1 week
Define persistent hematuria:
3 of 3 consequetive urine specimen obtained 1 week apart
What is the most common etiology of hematuria?
Glomerular es
What is the next step when you find child with hematuria?
Check family members + check BP
Name common gomerular causes of hematuria
- post streptococcal (post infectious)
- henoch schonlein purpura
- IgA nephropathy
What are the tubulointerstital causes of hematuria
- acute tubular necrosis
- tubulointerstitial nephritis
- Autosomal dominant PCKD
What induces ATN?
Shock - drugs
What induces TIN
Drgu
What are the causes of hematuria in lower urinary tract
Stones, hypercalcuria, infection, foreign body
What are the vascular causes of hematuria?
Renal vein\artery thrombosis
seen in umbilical artery\vein catheterizaition in baby
What are the coagulopathy causes of hematuria
Hemophilia, thrombocytopenia, sickle cell
What is the most common cause of acute nephritis in children
Post infectious GN
What is the organism to commonly cause PIGN?
Group A beta-hemolytic strep
What is the typical presentation for post infectious gn
After skin or throat infection
What are the lab findings of PIGN?
- hematuria (variable micro to gross)
- proteinuria
- low C3 & CH50
- normal C4
- HTN
- elevated serum creatinine
- positive streptozyme\ASOT - throat or skin culture
What is the duration of infection before developing PIGN?
1-3 weeks (pharyngitis)
3-6 weeks (skin infection)
What is the picture of PIGN?
Nephritic mostly but can be nephrotic
What is the treatment of choice for PIGN
- lasix for HTN
- medical treatment of acute kidney injury
- penicillin
- follow up
Why use penicillin in PIGN?
To avoid spread of infection
What is the prognosis of PIGN?
90% will have complete resolution
But small subset will have late renal complication (HTN - proteinurea - renal insufficency)
How long does complement, proteinurea, and hematuria take to resolve after treatment of PIGN?
- complement (1\2m)
- proteinurea (6m)
- hematuria (1\2y)
What is the most common cause of recurrent gross hematuria?
IgA nephropathy
Differentiate between IgA and post-streptococcal infection?
Both are amongst the most common causes of hematuria
- PIGN: acute, acquired, skin and pharyngitis
- IgA:, primary, recurrent gross or presistant microhematuria, URTI and vaccination
What type of microscopy used to detect IgA nephropath
Immunoflurescene (IgA deposits)
What is the prognosis of IgAN
- most live normal
- 50% develop ESRD - renal failure
What indicates bad prognosis of IgAN
Proteinurea, HTN, BUN\Creat
What is the prognosis of alport syndrome?
Poor
All will progress to worsen status
What is the triad of alport syndrome?
- ocular abnormalities
- sensoryneural hearing loss
- glomerular disease
What is the part of the glomeruli that shows the disorder in alport syndrome?
Basement membrane disorder (Type 4(
What is the genetic mutation in alport syndrome?
Alpha 3,4, and 5 chains of type 4 collagen
X-linked (AR or AD)
What is considered always pathological
(Proteinurea or hematuria)?
Proteinurea
