Proteinuria and Hematuria Flashcards
Proteinuria is defined as urinary excretion of greater than _______ mg protein/24hrs
150
Different classifications of proteinuria
glomerular - due to increased glomerular permiability (seen in nephrotic syndrome)
tubular - abnormal tubular structure so protein isn’t reabsorbed as well (seen in sickle cell, urinary tract obstruction, interstitial nephritis)
overflow - increased production of small proteins
What other conditions can cause proteinuria
UTI, fever, heavy exertion/stress, CHF, orthostatic proteinuria, pregnancy
Nephrotic syndrome features urine protein excretion rate of greater than _____g/24 hr
3.5
Key features of nephrotic syndrome
urine protein >3.5, hypoalbuminemia leading to edema, , HYPERLIPIDEMIA since liver cannot keep up with protein loss, hypercoagulable state (due to loss of certain anticoaglulants in urine), increased infection (due to loss of immunoglobulins in urine
What primary glomerular diseases can cause nephrotic syndrome
membranous nephropathy (MCC adults)
focal segmental glomerulosclerosis (FSGS)
membranoproliferative GN
minimal change dx (MCC children)
What systemic diseases can cause proteinuria
DM, collagen vascular disease, SLE, RA, HSP, polyarteritis nodosa, Wegener granulomatosis, amyloidosis, crycglobulinemia
What drugs/toxins can cause nephrotic syndrome
captopril, heroin, heavy metals, NSAIDs, penicillamine
T/F: Infection can cause nephrotic syndrome
TRUE
What malignancy can cause nephrotic syndrome
multiple myeloma
What methods can be used to diagnose proteinuria
Urine dipstick
Urinalysis
Test for microalbuminuria
regular renal function tests
What do RBC casts, WBC casts, and fatty casts on urine sediment suggests?
RBC - glomerulonephritis
WBC - pyelonephritis and interstitial nephritis
Fatty - nephrotic syndrome (lipiduria)
What to do if urinalysis suggestions presence of protein
24 hour urine collection to establish presence of significant proteinuria
Microalbuminuria can be an early sign of what?
diabetic nephropathy
Treatment for transient asymptomatic proteinuria
NONE BITCH GET YO HONEY BUTTA CHICKEN BISCUIT
Treatment for symptomatic proteinuria or persistent asymptomatic proteinuria
further testing!
treat underlying disease
edema - diueretics
hypo-immunoglobulinemia - vaccinate against pneumo and influenza
hyperlipidemia - cholesterol lowering agent, protein and sodium limited diet
Why are ACE inhibitors useful in treating diabetics with HTN?
decreases urinary albumin loss, essential.
Hematuria is defined as greater than ____erythrocytes/HPF on urinalysis
3
Gross/painless hematuria is a commonly a presenting sign of which 2 malginancies
bladder cancer and renal cell carcinoma
Microscopic hematuria is more commonly ____ in origin; gross hematuria is more commonly _____________ or _______ in origin
______ can cause either
glomerular
nonglomerular, urologic
infection
What can cause harmless hematuria
strenuous exercise (ex: marathon running), fever
Name some causes of hematuria
kidney stones trauma (blunt, foley placement, invasive procedures) BPH malginancy (renal cell or bladder cancer) infection (UTI, urethritis, pyelo) glomerular disease, IgA nephropathy bleeding disorders medications systemic disease polycystic kidney disease, simple cysts
What medications can cause hematuria
cyclophosphamide, anticoagulants, salicylates, sulfonamides
How to workup hematuria
urine dipstick, urinalysis (CRUCIAL), urine specimen, 24 hr urine, blood tests to check for coagulopathy, ….if no cause is identified by these try IVP, CT, or US to rule out stones, tumors, cysts, strictures, or AVMs, renal biopsy
