Proteinuria

Question 1

what is proteinuria a sign of

Answer 1

kidney disease

Question 2

when should you test for proteinuria

Answer 2

in routine medical consultations - good screening tool
recent onset of oedema (including periorbital and sacral)
unexplained ascites or pleural effusions
as part of care of patients with diabetes or hypertension
if a systemic disease is possible

Question 3

what are two signs of protein in urine to the naked eye

Answer 3

bubbles form when shaken - ‘detergent effect’
protein collects as white substance when urine is boiled

Question 4

what are the steps for testing for proteinuria

Answer 4

1. urine dipstick
2. quantify the actual quantity using the albumin/creatinine ratio
3. test renal function
4. never ignore proteinuria

Question 5

what level of proteinuria implies intrinsic renal disease and what needs to be done below this level

Answer 5

2+, at this level the proteinuria is very unlikely to be explained by asymptomatic infection
1+ or less needs further investigation

Question 6

is it appropriate to respond to proteinuria by sending a mid stream urine sample to exclude infection

Answer 6

no

Question 7

how many urine samples are required to calculate the albumin creatinine ratio

Answer 7

one
taken any time of day

Question 8

how do you calculate the approximate albumin creatinine ratio for 24h

Answer 8

ACR of one sample multiplied by 10

Question 9

an ACR of 100 shows what

Answer 9

may be a sign of very significant renal disease

Question 10

what is a normal ACR

Answer 10

<3.5

Question 11

an ACR of 3.5-30 is classified as what

Answer 11

microalbuminuria

Question 12

an ACR >30 is classified as what

Answer 12

(macro)albuminuria

Question 13

what is the MDRD formula

Answer 13

a formula used to calculate eGFR which takes into account sex, age, race and creatinine

Question 14

what is radioisotope GFR and when is it used

Answer 14

inject labelled chemical and see how long it takes to be cleared
only done when in doubt about kidney function or in kidney donor assessment

Question 15

what racial groups may have less nephrons

Answer 15

black and asian

Question 16

what are the three layers of the nephron filter

Answer 16

podocytes
glomerular basement membrane
glomerular endothelium

Question 17

what is the cause of congenital nephrotic syndrome

Answer 17

mutation in podocyte-specific gene (e.g. nephrin)

Question 18

what does the presence of blood and protein in the urine imply and what should be done about this

Answer 18

glomerular disease (kidney filter is diseased)
urgent need to test excretory kidney function and consider systemic diseases (e.g. vasculitis and lupus)

Question 19

what is the earliest clinical sign of diabetic nephropathy

Answer 19

microalbuminuria

Question 20

what is the most likely cause of hypertension with albuminuria

Answer 20

primary renal cause

Question 21

why is it important to pick up microalbuminuria

Answer 21

it is useful for risk stratification and is a modifiable risk risk factor for CVD

Question 22

what does nephrotic syndrome comprise of

Answer 22

oedema
heavy proteinuria
hypoalbuminaemia

Question 23

what three things are you more at risk of with nephrotic syndrome

Answer 23

thrombosis
infection
hyperlipidaemia (often severe)

Question 24

is nephrotic syndrome associated with impairment of excretory kidney function

Answer 24

can be but isn’t always

Question 25

main symptoms of nephrotic syndrome

Answer 25

severe lethargy
reduced exercise tolerance
nausea
loss of appetite

Question 26

causes of nephrotic syndrome

Answer 26

glomerulonephritits
diabetes
infections (hep B/C, malaria, HIV)
amyloid

Question 27

what is haematuria a sign of

Answer 27

serious systemic disease for which diagnosis and treatment is very urgent
shouldn’t be dismissed as due to urine infection