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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
What are the 4 attributes of Nephritic Syndrome?
Proteinuria < 3.5 g/day Hematuria New onset HTN AKI/Oliguria
26
What is an emergent indication of Nephritic syndrome that must be addressed immediately?
Rapidly Progressive Glomerulonephritis | -- > can turn into renal failure
27
What are 2 LOW complement immune complex causes of Nephritic Syndrome?
1. Post-infectious Glomerulonephritis | 2. SLE Nephritis
28
Post-infectious Glomerulonephritis can cause Nephritic Syndrome. What is its category, and what will the patient have a history of?
LOW complement immune complex | -- History of strep infection
29
SLE nephritis can cause Nephritic Syndrome. What is its category and what is a common symptom?
LOW complement immune complex | -- Rapidly Progressive Glomerulonephritis and a butterfly rash
30
What is 1 NORMAL complement immune complex cause of Nephritic Syndrome?
IgA Nephropathy
31
IgA Nephropathy is the most common cause of Nephritic Syndrome. What does it present with?
Hematuria the same time as an URI
32
SLE Nephritis can present as Nephritic Syndrome. It can also present as what type of Nephrotic Syndrome?
Membranous
33
What are the signs that Nephritic Syndrome is being caused by Anti-Glomerular Basement Membrane?
Hematuria Hemoptysis AKI and rapidly progressive GN
34
What are the signs that Nephritic Syndrome is being caused by Anti-GBM?
Hemoptysis Hematuria AKI with rapidly progressive GN
35
What are the 3 ANCA-associated causes of Nephritic Syndrome?
1. Granulomatosis with Polangiitis 2. Microscopic Polangiitis 3. Eosinophilic Granulomatosis with Polyangiitis
36
What are the signs of Granulomatosis with Polyangiitis that is causing Nephritic Syndrome?
Saddle nose, Chronic sinusitis Hemoptysis Hematuria and AKI
37
What are the signs of Microscopic Polyangiitis that is causing Nephritic Syndrome?
Hemoptysis | Hematuria with AKI
38
What are the signs of Eosinophilic Granulomatosis with Polyangiitis that is causing Nephritic Syndrome?
Asthma and Eosinophilia Palpable purpura Hematuria and AKI
39
The urine sediment with Nephritic Syndrome is ___
ACTIVE | -- lots of RBCs, RBC casts, WBCs, etc.
40
What is the urgent treatment for Rapidly Progressive Glomerulonephritis and what does it usually present along side?
Renal consult + steroids + plasma exchange | -- presents with pulmonary renal syndromes (nephritic syndromes)
41
What defines Polyuria?
> 3 L of urine produced in 24 hours
42
What are the 2 mechanisms that regulate serum osmolality?
Anti-diuretic Hormone release | Thirst
43
What senses the osmolality (conc. of dissolved particles)?
Hypothalamus
44
How does ADH decrease the osmolality?
(+) Vasopressin receptor 2 | Aquaporins move and allow water back into blood stream
45
What are 3 causes of Polyuria?
1. Osmotic Diuresis 2. Diabetes Insipidus 3. Primary Polydipsia
46
What is Osmotic Diuresis?
Excess solute in the urine draws water into the filtrate | => polyuria
47
What is an example of when polyuria occurs with osmotic diuresis and what is the level of the Uosm?
Glucosuria | -- Uosm > 300
48
Diabetes Insipidus involves tasteless urine. What are the 2 types?
Central | Nephrogenic
49
What is Central Diabetes Insipidus?
Hypothalamus or pituitary gland issues prevent release of ADH
50
With Central Diabetes Insipidus that is causing Polyuria, what is the Uosm level and does it increase with water deprivation?
Uosm < 300 | -- does NOT increase
51
What is Nephrogenic Diabetes Insipidus?
Issue with kidney (vasopressin/AQPs) that does not respond to ADH
52
What medication can cause Nephrogenic Diabetes Insipidus?
Lithium
53
With Nephrogenic Diabetes Insipidus, what is the Uosm and does it increase with water deprivation?
Uosm < 300 | -- does NOT increase
54
How can you differentiate between central and nephrogenic diabetes insipidus that is causing polyuria?
Central Uosm will INCREASE with synthetic ADH administered (desmopressin)
55
What causes primary polydipsia?
Patient is just drinking too much water | -- usually pysch issues
56
What is the Uosm level with Primary Polydipsia and will it increase with water deprivation?
Uosm < 300 and YES it will increase

2 - CPR (renal) (27 decks)

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