Abnormal proteinuria Objectives Proteinuria

 www.phwiki.com

 

The Above Picture is Related Image of Another Journal

 

Abnormal proteinuria Objectives Proteinuria

DePaul University, US has reference to this Academic Journal, Proteinuria Anh Nguyen, MD, MPH Objectives Define normal range of proteinuria Define abnormal range of proteinuria Learn so that work-up in consideration of proteinuria Normal urinary protein excretion In normal adult, normal urinary protein excretion should be < 150 mg/day Normal rate of albumin excretion is < 20 mg/day (15 mcg/min), increases alongside age in addition to higher body weight  Evans, Suzy DePaul University www.phwiki.com

 

Related University That Contributed for this Journal are Acknowledged in the above Image

 

Abnormal proteinuria Previously, abnormal proteinuria was defined as excretion of protein > 150 mg/day However, early renal disease is reflected by lesser degrees of proteinuria Persistent albumin excretion between 30 in addition to 300 mg/day (20 so that 200 mcg/min): high albuminemia (formerly called microalbuminuria) Albumin excretion > 300 mg/day (200 mcg/min): overt proteinuria or very high albuminuria (formerly called macroalbuminuria) Nephrotic Syndrome Massive proteinuria?at least 3.5 g/day Hypoalbuminemia (albumin < 3.5 mg/dL) Generalized edema Hyperlipidemia, hyperlipiduria Dysmorphic in addition to red cell casts in urine Isolated proteinuria (benign) Defined as proteinuria without hematuria or reduction in glomerular filtration rate (GRF) In most cases, patient is asymptomatic Urine sediment is unremarkable: few than 3 erythrocytes/hpf in addition to no casts) Protein excretion is less than 3 g/day (non-nephrotic) Serologic markers of systemic disease are absent Types of proteinuria Glomerular proteinuria: increased filtration of macromolecules (such as albumin) across the glomerular capillary wall. Tubular proteinuria: excretion of low-molecular-weight proteins, such as beta2-microglobulin, immunoglobin light chains, retinol-binding protein in addition to polypeptides derived from breakdown of albumin Overflow proteinuria: increased excretion of low-molecular-weight proteins; almost always due so that immunoglobin light chains in multiple myeloma, lysozymes in AML, or myoglobin in rhabdomyolysis Post-renal proteinuria: inflammation in the urinary tract (UTI), excreted proteins are generally non-albumin (IgA or IgG) Approach so that the patient alongside proteinuria Careful medical history in addition to physical exam Examine urine sediments A patient alongside isolated proteinuria (normal urine sediment, normal kidney function), should rule out transient in addition to orthostatic proteinuria Case 1 20 year-old man alongside no significant PMH who came so that clinic in consideration of a physical in consideration of college football. No physical complaints. Vital signs, BP WNL. Physical exams WNL. UA: no casts, +2 protein

Bookworm Inc. Designing Catalogs in consideration of Targeted Marketing Company Background Sample Survey EER Diagram Microsoft Access: Relationships Customer Grouping Catalog Generation Query What can be done Sample Report Next step? THANK YOU

Work-ups in consideration of proteinuria UA in addition to microscopic examination in consideration of at least 3 separate occasions Spot Alb/Cr or Pro/Cr ratio UA on early morning sample before patient is involved in physical activities or Split urine collection: daytime (7 AM so that 11 PM) in addition to nighttime (11 PM so that 7 AM) Case 1 (cont.) Repeat UA in the morning before physical activites: negative Case 2 43 year-old woman alongside h/o HTN in addition to anemia since age 12 presents progressive shortness of breath, hematuria, abdominal pain, in addition to recurrent epistaxis. Constitutional symptoms: subjective fever alongside night sweat, 30 lb weight loss, extreme fatigue in addition to weakness, dry mouth in addition to dry eyes Pleuritic chest pain, shortness of breath alongside walking 5 steps Arthritis alongside morning stiffness Abdominal pain alongside loose stool, more recently becoming black Large lymph nodes in the neck Epitaxis in consideration of one week Fingers in addition to toes are cold alongside tingling in addition to had non-blanching petechiae Excessive hair loss every morning on pillows over the past 6 months Violaceous rash on from thighs so that ankles, neck in addition to chest

Case 2 43 year-old woman alongside h/o HTN in addition to anemia since age 12 presents progressive shortness of breath, hematuria, abdominal pain, in addition to recurrent epistaxis. Constitutional symptoms: subjective fever alongside night sweat, 30 lb weight loss, extreme fatigue in addition to weakness, dry mouth in addition to dry eyes Pleuritic chest pain, shortness of breath alongside walking 5 steps Arthritis alongside morning stiffness Abdominal pain alongside loose stool, more recently becoming black Large lymph nodes in the neck Epitaxis in consideration of one week Fingers in addition to toes are cold alongside tingling in addition to had non-blanching petechiae Excessive hair loss every morning on pillows over the past 6 months Violaceous rash on from thighs so that ankles, neck in addition to chest Case 2 Lab Studies: BMP: electrolytes WNL, BUN 10 Cr 0.8, Glu 97, Ca 7.8 CBC: WBC 3.3 Hgb 8.6 Hct 25.6 PLT 42 MCV 84.9 AST: 56 ALT: 13 Iron Panel: Iron plasma 32, TIBC 217, FeSat 50%, Ferritin 213 UA: 200 protein spot, RBC 182 24 hour urine protein: 5.7 g CRP 2.6 ESR 109 Work-ups in consideration of proteinuria 24-hour urine Pro/Cr Rule out secondary causes: HA1C, ANA, ANCA, anti-dsDNA, C3, C4, SPEP/UPEP, HBV, HCV, HIV, RPR, phospholipase A2 receptor Ab Renal biopsy

Case 2 (cont.) Work-ups in consideration of nephrotic-range proteinuria showed: ANA Positive 1:320 Anti-dsDNA 1:640 Decreased C3 of 13.8 Decreased C4 of 2.0 Renal biopsy: Lupus Nephritis Class IV (capillary proliferation, wire loop thickening in addition to sub-endothelial deposits) Take Home Messages In normal adult, normal urinary protein excretion should be < 150 mg/day Persistent albumin excretion between 30 in addition to 300 mg/day (20 so that 200 mcg/min): high albuminemia (formerly called microalbuminuria) Albumin excretion > 300 mg/day (200 mcg/min): overt proteinuria or very high albuminuria (formerly called macroalbuminuria) Nephrotic syndrome: massive proteinuria?at least 3.5 g/day, hypoalbuminemia (albumin < 3.5 mg/dL), generalized edema, hyperlipidemia, hyperlipiduria Take Home Messages (cont.) Work-ups in consideration of isolated proteinuria: repeat UA in the morning or split urine collection Work-ups in consideration of proteinuria alongside systemic disease symptoms: 24-hour urine Pro/Cr, rule out secondary causes, renal biopsy References Rennke HG, Denker BM. Renal Pathophysiology: The Essentials 2nd edition. Lippincott Williams & Wilkins, 2007. Sabatine MS. Pocket Medicine, 4th edition. Wolters Kluwer Health/Lippincott Williams & Wilkins, 2011. Rovin BH. The assessment of urinary protein excretion in addition to evaluation of isolated non-nephrotic proteinuria in adults. UpToDate

Evans, Suzy Meteorologist

Evans, Suzy is from United States and they belong to Meteorologist and work for News 13 at 12 PM – KOLD-TV in the AZ state United States got related to this Particular Article.

Journal Ratings by DePaul University

This Particular Journal got reviewed and rated by and short form of this particular Institution is US and gave this Journal an Excellent Rating.