1. low molecular weight proteins 2. Tamm- Horefall protein (made by renal tubules)

1. edema in body (hypoalbumin) 2. thrombotic complications 3. liver increases lipoproteins = hypolipidemia

Renal Approach To Proteinuria And Polyuria - Dr. Grin Flashcards by Radhika Patel

3 layers of glomerulous

Fenestrated Capillary Endothelium : keep out cells (RBC, WBC)
Glomerular BM : keep out plasma proteins (albumin)
Podocytes : keep out plasma proteins

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tubules reabsorb what proteins

low molecular weight ones that got through the glomerular BM and Podocytes

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tubules reabsorb what proteins

low molecular weight ones that got through the glomerular BM and Podocytes

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proteinuria is what

low molecular weight proteins

2. Tamm- Horefall protein (made by renal tubules)

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normal daily protein excretion

Protein : < 150mg/day

2. Albumin : < 30 mg/day

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Glomerular proteinuria

Damaged glomerular filtration barrier = albumin in urine

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Overflow proteinuria

low molecular weight proteins filtered to overload the reabsorption in tubules
= LMW proteins in urine

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Overflow proteinuria happens when

light chains in urine from multiple myeloma

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Tubulointerstitial proteinuria

tubular damage –> X reabsorption of LMW proteins

= LMG in urine

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Tubulointerstitial happens when

ATN (acute tubular necrosis)

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urinalysis

cheap easy

= detect albumin (low sensitivity)

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Spot urine albumin / Cr ratio

detect small amounts of albumin = important for early DM nephropathy
(detects albumin, higher sensitivity)

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Spot urine protein / CR ratio

detects albumin, light chains, B2-macroglobulin)

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24 hour Urine protein

GOLD STANDARD for proteinuria

= inconvenient

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how to detect light chain nephropathy

from MM

= protein / CR ratio test

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what causes Glomerular proteinuria

nephrotic syndrome

2. nephritic syndrome

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Nephrotic Syndrome

podocytes are damaged from inflammation
= albuminuria
= loss of Antithrombin 3

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nephrotic syndrome

edema in body (hypoalbumin)
thrombotic complications
liver increases lipoproteins = hypolipidemia

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edema in nephrotic syndrome

hypoalbuminemia = low oncotic P

2. low BV low renal BF = renin is increased = worse edema

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SX of nephrotic syndrome

proteinuria (foamy urine)
edema
hyperlipidemia (xanthelasemia, fatty casts)
hypercoagulation

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nephritic syndrome sx

= HTN
= RBC casts
= AKI / oligouria
= Proteinuria

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conditions that can cause nephrotic syndrome

DM
FSGS = focal seg glomerulosclerosis (HIV or chronic reflux)
Membranous (HEP b,c, syphilis, SLE, solid tumors)
Amyloid

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conditions that can cause nephritic syndrome

immune complex (post strep, SLE, IgA)
Anti-GBM (goodpasture)
ANCA associated (wagners, microscopic polyangitis, eosinophilic granulomatosis with polyangiitis)

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minimal change disorder

most common cause of nephrotic syndrome in children (idiopathic or post infection)

focal segmental glomerulonephritis can be caused by

HIV, heroin use, chronic reflux 1

DX nephrotic syndrome is done with what

1. serum Cr = GFR 2. urinalysis micoscopy (not dipstick, to see casts and cells) 3. urine albumin/cr, protien / cr 4. HIV, Hep B/C, SPEP - amyloid, lipids, A1C testing

Membranous nephrotic syndrome is causes by `

(HEP b,c, syphilis, SLE, solid tumors)

TX nephrotic syndrome

1. immunosuppressants 2. loop diuretic + Na restriction (edema) 3. control BP + ACE/ ARBs (proteinuria) 4. statin (hyperlipidemia)

ACE/ ARBs should be used when

protective agains renal failure in nephrotic syndrome | = should not be used if renal failure has progressed to hyperkalemia

nephritic syndrome is what

immune response damaging capillary endothelium = RBC and WBCs leak into Glomerulus = RBC casts = Pyuria (from WBC)

nephritic syndrome sx

1. inflammation --> oliguria* (low GFR) --> AKI* 2. Azotemia 3. pyuria (WBC) = increase renin = rapid HTN* 4. Hematuria **

when is AKI from nephritic syndrome usually seen

in ANCA conditions | and Goodpasture's

immune complex problems in nephritic syndrome

1. low complement : - Post infection (strep) + - SLE nephritis 2. normal complement : - IgA nephropathy

SLE can cause what (kidneys)

rapidly progressive glomeruolnephritis = EM (nephritic syndrome) can also cause membranous nephrotic syndrome

IgA nephropathy does what to kidney

hematuria (nephritic syndrome) DURING URI infection not after like in post strep nephritic syndrome

pulmonary renal syndromes and what can they do

ANCA Anti - GBM = can progress to rapidly progressive GN

3 things causing nephritic syndrome that are ANCA

1. Wegners 2. microscopic polyangiitis 3. eosinophilic granulomatosis with polyangiitis

nephritic syndrome DX how

1. serum Cr : GFR 2. urinalysis microscopy 3. urine albumin/cr, protein/ cr 4. ANCA, Anto-GBM, ANA, complement testing

active vs bland urine

nephritic syndrome : ACTIVE (RBC, WBC, RBC casts) only some protein nephrotic syndrome : BLAND : high proteins

nephritic syndrome TX when rapidly progressing GN

renal consult HIGH STEROIDS Plasma exchange

Polyuria is what

more then 3L urine in 24hrs

serum osmolality is regulated by what

thirst and ADH

ADH

released from hypothalamus and released from PP = bind to vasopressin receptor 2 = increase aquaporins to open = increase water back to blood (decrease osmolality)

4 causes of polyuria

1. osmotic diuresis 2. central diabetes insipidus 3. nephrogenic diabetes insipidus 4. primary polydipsia

central diabetes insipidus is what

low ADH = cant concentrate urine

nephrogenic diabetes insipidus

kidneys dont respond to ADH that binds

primary polydipsia

patient is drinking excessive water

osmotic diuresis

high solutes in blood | = glucosuria (high glucose in tubules)----> more water into tubules

Osmotic diuresis from glucosuria DX

Dipstick : high glucose + high urine osmolality > 300mOsm/L

Diabetes Insipidus sx

large diluted urine output tasteless = you drink more water a lot

Central Diabetes Insipidus causes that can cause it

trauma tumor congenital

Central Diabetes Insipidus what happens when they are thirsty overnight

no change in ADH levels

Central Diabetes Insipidus TX

1. drink more water | 2. Desmopressin to administer ADH

Nephrogenic Diabetes Insipidus can be caused by what

1. Lithium (medication for bipolar disorder)**** | 2. congenital abnormal vasopressin Rs or aquaporins

Diabetes Insipidus and NA level

hypernatremia usually however can be compensated with drinking water

Primary Polydipsia SX

urine osmolality is low | and this increases over night

Primary Polydipsia SX

urine osmolality is low | and this increases over night

Nephrogenic Diabetes Insipidus TX

1. drink more water | 2. Thiazide diuretics