Proteinuria and Hematuria

Question 1

Proteinuria is defined as urinary excretion of greater than _______ mg protein/24hrs

Answer 1

150

Question 2

Different classifications of proteinuria

Answer 2

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

Question 3

What other conditions can cause proteinuria

Answer 3

UTI, fever, heavy exertion/stress, CHF, orthostatic proteinuria, pregnancy

Question 4

Nephrotic syndrome features urine protein excretion rate of greater than _____g/24 hr

Answer 4

3.5

Question 5

Key features of nephrotic syndrome

Answer 5

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

Question 6

What primary glomerular diseases can cause nephrotic syndrome

Answer 6

membranous nephropathy (MCC adults)
focal segmental glomerulosclerosis (FSGS)
membranoproliferative GN
minimal change dx (MCC children)

Question 7

What systemic diseases can cause proteinuria

Answer 7

DM, collagen vascular disease, SLE, RA, HSP, polyarteritis nodosa, Wegener granulomatosis, amyloidosis, crycglobulinemia

Question 8

What drugs/toxins can cause nephrotic syndrome

Answer 8

captopril, heroin, heavy metals, NSAIDs, penicillamine

Question 9

T/F: Infection can cause nephrotic syndrome

Answer 9

TRUE

Question 10

What malignancy can cause nephrotic syndrome

Answer 10

multiple myeloma

Question 11

What methods can be used to diagnose proteinuria

Answer 11

Urine dipstick
Urinalysis
Test for microalbuminuria
regular renal function tests

Question 12

What do RBC casts, WBC casts, and fatty casts on urine sediment suggests?

Answer 12

RBC - glomerulonephritis
WBC - pyelonephritis and interstitial nephritis
Fatty - nephrotic syndrome (lipiduria)

Question 13

What to do if urinalysis suggestions presence of protein

Answer 13

24 hour urine collection to establish presence of significant proteinuria

Question 14

Microalbuminuria can be an early sign of what?

Answer 14

diabetic nephropathy

Question 15

Treatment for transient asymptomatic proteinuria

Answer 15

NONE BITCH GET YO HONEY BUTTA CHICKEN BISCUIT

Question 16

Treatment for symptomatic proteinuria or persistent asymptomatic proteinuria

Answer 16

further testing!
treat underlying disease
edema - diueretics
hypo-immunoglobulinemia - vaccinate against pneumo and influenza
hyperlipidemia - cholesterol lowering agent, protein and sodium limited diet

Question 17

Why are ACE inhibitors useful in treating diabetics with HTN?

Answer 17

decreases urinary albumin loss, essential.

Question 18

Hematuria is defined as greater than ____erythrocytes/HPF on urinalysis

Answer 18

3

Question 19

Gross/painless hematuria is a commonly a presenting sign of which 2 malginancies

Answer 19

bladder cancer and renal cell carcinoma

Question 20

Microscopic hematuria is more commonly ____ in origin; gross hematuria is more commonly _____________ or _______ in origin
______ can cause either

Answer 20

glomerular
nonglomerular, urologic
infection

Question 21

What can cause harmless hematuria

Answer 21

strenuous exercise (ex: marathon running), fever

Question 22

Name some causes of hematuria

Answer 22

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

Question 23

What medications can cause hematuria

Answer 23

cyclophosphamide, anticoagulants, salicylates, sulfonamides

Question 24

How to workup hematuria

Answer 24

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

Question 25

What to do if pyuria present on urinalysis

Answer 25

send urine culture

Question 26

If dipstick is positive for blood, but urinalysis doesn’t reveal hematuria (no RBCs) then what is most likely?

Answer 26

hemoglobunuria or myoglobunuria

Question 27

If suspicion for malignancy is high on urine specimen, what to do

Answer 27

perform cystoscopy to evaluate bladder regardless of cytology results