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2 - CPR (renal) > Proteinuria and Polyuria > Flashcards

Proteinuria and Polyuria Flashcards

1
Q

What are the 3 layers of the Glomerular Filtration Barrier?

A
  1. Fenestrated Capillary Endothelium
  2. Glomerular Basement Membrane
  3. Podocytes
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2
Q

The Fenestrated Capillary Endothelium layer of the Glomerular Filtration Barrier keeps what out of the urine?

A

Cells

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3
Q

The Glomerular Basement Membrane and the Podocytes layer of the Glomerular Filtration Barrier keep what out of the urine?

A

Large plasma proteins like Albumin

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4
Q

What things get through the Glomerular Filtration Barrier?

A

Low molecular weight proteins
Solutes
Small molecules

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5
Q

What amount of protein and albumin in the urine is normal?

A

Protein < 150 mg/day

Albumin < 30 mg/day

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6
Q

What is the main cause of Proteinuria?

A

Damaged Glomerular Filtration Barrier

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7
Q

Which 2 tests to measure proteinuria can only detect Albumin in the urine?

A
  • Urinalysis

- Spot urine Albumin/Creatinine ratio

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8
Q

What can the Spot Urine Albumin/Creatinine Ratio recognize?

A

Diabetic Nephropathy

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9
Q

What test to measure proteinuria can detect light chain proteinuria due to multiple myeloma?

A

Spot urine Protein/Creatinine Ratio

– detects all proteins

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10
Q

What test to measure proteinuria is the gold standard but inconvenient?

A

24 hour urine protein

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11
Q

What is Nephrotic Syndrome?

A

Damaged Glomerular Filtration Barrier

=> proteins pass into renal tubule

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12
Q

What are the 5 main attributes of Nephrotic Syndrome?

A
  1. Proteinuria > 3.5 g/day
  2. Edema
  3. Hypoalbuminemia
  4. Hypercoagulability
  5. Hyperlipidemia
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13
Q

What are the 5 main attributes of Nephrotic Syndrome?

A
  1. Proteinuria > 3.5 g/day
  2. Edema
  3. Hypoalbuminemia
  4. Hypercoagulability
  5. Hyperlipidemia
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14
Q

What causes Edema with Nephrotic Syndrome?

A

Either:

  • Decreased oncotic pressure due to hypoalbuminemia OR
  • Decreased renal blood flow which causes RAAS (+) with na+ and water retention
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15
Q

What causes the Hypercoagulability with Nephrotic Syndrome?

A

Losing Antithrombin III in the urine which is an anticoagulant
=> increased thromboembolic events

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16
Q

The urine sediment with Nephrotic Syndrome is ___

A

Bland

– few cells

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17
Q

How will the urine look with Nephrotic Syndrome?

A

Foamy

- Proteinuria > 3.5 g/day

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18
Q

How will the Hyperlipidemia present with Nephrotic syndrome?

A

Fatty casts and Xanthelasmas

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19
Q

What are 5 potential causes of Nephrotic Syndrome?

A
  1. Diabetes
  2. Minimal Change Disorder
  3. Focal Segmental Glomerulosclerosis
  4. Membranous Nephropathy
  5. Amyloidosis
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20
Q

Diabetes is a main cause of Nephrotic Syndrome. Minimal Change Disorder can also be a cause. Who is that common in?

A

Children

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21
Q

What cause of Nephrotic Syndrome is associated with HIV, heroin use and chronic reflux?

A

Focal Segmental Glomerulosclerosis

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22
Q

What cause of Nephrotic Syndrome is associated with hepatitis B/C, syphilis, SLE…?

A

Membranous Nephropathy

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23
Q

What is Nephritic Syndrome?

A

Inflammation affecting the capillary endothelium

=> cells and proteins pass into renal tubule

24
Q

What are the 4 attributes of Nephritic Syndrome?

A

Proteinuria < 3.5 g/day
Hematuria
New onset HTN
AKI/Oliguria

25
Q

What are the 4 attributes of Nephritic Syndrome?

A

Proteinuria < 3.5 g/day
Hematuria
New onset HTN
AKI/Oliguria

26
Q

What is an emergent indication of Nephritic syndrome that must be addressed immediately?

A

Rapidly Progressive Glomerulonephritis

– > can turn into renal failure

27
Q

What are 2 LOW complement immune complex causes of Nephritic Syndrome?

A
  1. Post-infectious Glomerulonephritis

2. SLE Nephritis

28
Q

Post-infectious Glomerulonephritis can cause Nephritic Syndrome. What is its category, and what will the patient have a history of?

A

LOW complement immune complex

– History of strep infection

29
Q

SLE nephritis can cause Nephritic Syndrome. What is its category and what is a common symptom?

A

LOW complement immune complex

– Rapidly Progressive Glomerulonephritis and a butterfly rash

30
Q

What is 1 NORMAL complement immune complex cause of Nephritic Syndrome?

A

IgA Nephropathy

31
Q

IgA Nephropathy is the most common cause of Nephritic Syndrome. What does it present with?

A

Hematuria the same time as an URI

32
Q

SLE Nephritis can present as Nephritic Syndrome. It can also present as what type of Nephrotic Syndrome?

A

Membranous

33
Q

What are the signs that Nephritic Syndrome is being caused by Anti-Glomerular Basement Membrane?

A

Hematuria
Hemoptysis
AKI and rapidly progressive GN

34
Q

What are the signs that Nephritic Syndrome is being caused by Anti-GBM?

A

Hemoptysis
Hematuria
AKI with rapidly progressive GN

35
Q

What are the 3 ANCA-associated causes of Nephritic Syndrome?

A
  1. Granulomatosis with Polangiitis
  2. Microscopic Polangiitis
  3. Eosinophilic Granulomatosis with Polyangiitis
36
Q

What are the signs of Granulomatosis with Polyangiitis that is causing Nephritic Syndrome?

A

Saddle nose, Chronic sinusitis
Hemoptysis
Hematuria and AKI

37
Q

What are the signs of Microscopic Polyangiitis that is causing Nephritic Syndrome?

A

Hemoptysis

Hematuria with AKI

38
Q

What are the signs of Eosinophilic Granulomatosis with Polyangiitis that is causing Nephritic Syndrome?

A

Asthma and Eosinophilia
Palpable purpura
Hematuria and AKI

39
Q

The urine sediment with Nephritic Syndrome is ___

A

ACTIVE

– lots of RBCs, RBC casts, WBCs, etc.

40
Q

What is the urgent treatment for Rapidly Progressive Glomerulonephritis and what does it usually present along side?

A

Renal consult + steroids + plasma exchange

– presents with pulmonary renal syndromes (nephritic syndromes)

41
Q

What defines Polyuria?

A

> 3 L of urine produced in 24 hours

42
Q

What are the 2 mechanisms that regulate serum osmolality?

A

Anti-diuretic Hormone release

Thirst

43
Q

What senses the osmolality (conc. of dissolved particles)?

A

Hypothalamus

44
Q

How does ADH decrease the osmolality?

A

(+) Vasopressin receptor 2

Aquaporins move and allow water back into blood stream

45
Q

What are 3 causes of Polyuria?

A
  1. Osmotic Diuresis
  2. Diabetes Insipidus
  3. Primary Polydipsia
46
Q

What is Osmotic Diuresis?

A

Excess solute in the urine draws water into the filtrate

=> polyuria

47
Q

What is an example of when polyuria occurs with osmotic diuresis and what is the level of the Uosm?

A

Glucosuria

– Uosm > 300

48
Q

Diabetes Insipidus involves tasteless urine. What are the 2 types?

A

Central

Nephrogenic

49
Q

What is Central Diabetes Insipidus?

A

Hypothalamus or pituitary gland issues prevent release of ADH

50
Q

With Central Diabetes Insipidus that is causing Polyuria, what is the Uosm level and does it increase with water deprivation?

A

Uosm < 300

– does NOT increase

51
Q

What is Nephrogenic Diabetes Insipidus?

A

Issue with kidney (vasopressin/AQPs) that does not respond to ADH

52
Q

What medication can cause Nephrogenic Diabetes Insipidus?

A

Lithium

53
Q

With Nephrogenic Diabetes Insipidus, what is the Uosm and does it increase with water deprivation?

A

Uosm < 300

– does NOT increase

54
Q

How can you differentiate between central and nephrogenic diabetes insipidus that is causing polyuria?

A

Central Uosm will INCREASE with synthetic ADH administered (desmopressin)

55
Q

What causes primary polydipsia?

A

Patient is just drinking too much water

– usually pysch issues

56
Q

What is the Uosm level with Primary Polydipsia and will it increase with water deprivation?

A

Uosm < 300 and YES it will increase

2 - CPR (renal) (27 decks)

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