F&e Maddy Proteinuria

Front 1

Proteinuria is defined as greater than __ mg of total protein in the urine in a 24 hour period

Back 1

150-200

Front 2

What are the three types of proteinuria?
Which type is the most significant?

Back 2

Tubular, overflow, and glomerular

Glomerular -

Front 3

Tubular proteinuria is when ______ tubule dysfunction leads to inability reabsorb low mol wt proteins, insulin, PTH.

Back 3

proximal

Front 4

______ proteinuria:
Low mol wt protein that is typically present in small quantities exceeds the reabsorptive capacity of the tubule due to high _____ levels

Back 4

Overflow
plasma

Front 5

Example of overflow proteinuria is ____-____ proteinuria where the light chains from _____ are found in the urine.

Back 5

Bence-Jones
Myeloma
Also myoglobin in muscle injury or hemoglobin with hemolysis

Front 6

Glomerular proteinuria:
Increased filtration of ___molecules (primarily _____) takes place due to glomerular dysfunction/membrane leak

Back 6

macromolecules
albumin

Front 7

Glomerular proteinuria has two subtypes: selective and non-selective. Whats the difference?

Back 7

Selective is when the normal negative membrane charge is altered so it no longer repels negatively charged mol (albumin, IgG) and they cross the membrane
Nonselective is just enlarged pore size so any protein can cross

Front 8

what is the most clinically signficant protein to test for in urine?
what is the best measurement test?

Back 8

albumin

spot total protein to creatinine ratio - estimates 24 hr protein excretion

Front 9

What can cause a benign glomerular proteinuria?

Back 9

Stress, fever, heavy exercise

Front 10

If you have a peds/teen come in with glomerular proteinuria, what test should you do?

Back 10

Suspect orthostatic proteinuria (2-5% adolescents)
Evaluate with 16 hours daytime and 8 hour nighttime (suppine) collections

Front 11

What is the main sign of nephritic proteinuria?
What is the main sign of nephrotic proteinuria?
Nephritic/Nephrotic?

Back 11

hematuria

severe proteinuria

RPGN-rapidly progressive glomerulonephritis

Front 12

Pathology terms:
Segmental?
Global?
Focal?
Diffuse?

Back 12

part of a single glomerulus
all of a single glomerulus
less than 50% of glomeruli in the sample/kidney
more than 50% of the glomeruli

Front 13

Nephritic glomerulonephritis:
Predominant finding is _____
_____ renal function and BP
Less than 1.5 gr/day protein

Back 13

hematuria
Normal

examples: IgA nephropathy, hereditary nephritis, thin basement membrane disease, Henoch-Schonlein purpura

Front 14

Diffuse Nephritic/Nephrotic:
Characterized by _____ and heavier _____
Often with hypertension, edema, and elevated ______
Onset is ______

Back 14

hematuria
proteinuria
creatinine
EXPLOSIVE - fast, bad

Examples: Acute glomerulonephritides such as post infect GN, lupus, Wegener's, Goodpasture's

Front 15

Nephrotic Diseases - Idiopathic:
Predominant feature is severe ______
Examples:
Minimal change disease
Focal sclerosis
membranous
membranoproliferative
mesangiolproliferative

Back 15

proteinuria

Front 16

______ diseases - secondary:
Each has _____ pathology
Amyloidosis
Lupus
Diabetic nephropathy
Drugs
Infections
Neoplasms

Back 16

Nephrotic
unique

Front 17

What condition can you get from permiscuity (heroin use, Hep B/C, or HIV) or Hodgkin/Non-hodgkin?

Back 17

Secondary nephrotic syndromes

Front 18

KNOW THIS SLIDE:
Definition of nephrotic syndrome:
Heavy _____ > 3g/day
Hypo_______ < 3g/dl
Edema - due to inability to excrete ____
Anasarca - what is it?

Back 18

Proteinuria
albuminemia
salt
intense edema throughout the body (periorbital, arms, abdomen, scrotum)

Front 19

Complications of Nephrotic Syndrome:
________ events due to what state?

Back 19

Thromboemolic events due to hypercoaguable state - loss of anticoagulant proteins and increase in procoagulant proteins - deep vein and renal vein thrombosis and PE

Front 20

Complications of Nephrotic Syndrome:
Hyper______
Infection due to loss of ___ in the urine
Protein malnutrition
______ losses

Back 20

lipidemia - increased synthesis of LDL and VLDL and no change in HDL
IgG - susceptible to encapsulated organisms
hormonal

Front 21

Nephrotic syndrome tx -regardless of dx:
____ restriction
Regulated ____ intake
Diuretics (loop)
ACE inhibitors/ARBs
_____ ____ control
NSAIDs
Treat underlying disease

Back 21

salt (limit edema)
protein (decrease filtration pressure)
Blood pressure (125/75)
NSAIDs - but they lower renal function so excreted protein decreases

Front 22

Risk for and rate of progression correlates with clinical findings of
elevated _____
hypertension
amount of _______
age
which gender?

Back 22

creatinine
proteinuria
male

Front 23

Biopsy findings of ______ fibrosis and glomerular _____ portend poorer prognosis

Back 23

interstitial
sclerosis

Front 24

Nephrotic Syndrome Tx:
What is the main one?
Another one that has some nasty side effects?
Also calcineurin Inhibitors and Mycophenolate mofetil

Back 24

Prednisone - can cause impaired growth, obesity, acne, myopathy, diabetes, osteoporosis, poor healing, HTN, behavior changes, lipidemia
Cytoxan (alkylating chemo agent) - leukopenia, hemorrhagic cystitis, gonadal toxicity, hair loss, cancer, intense immunosuppression

Front 25

Which glomerular disease is most prevalent in children ages 1-10?
When people start getting myeloma?
Age 50-60?

Back 25

Minimal Change Glomerulopathy
age 55-65 - they get amyloidosis
Membranous glomerulopathy

Front 26

Which Nephropathy?
Nephrotic syndrome
Edema
No HTN, hematuria, or high creatinine
Most benign
Often atopic hx (exzema, asthma)
Lymphokine alters negative membrane charge

Back 26

Minimal Change Nephropathy

Front 27

What is the typical tx for Minimal Change Nephropathy?

Back 27

Prednisone 2mg/kg for 2 weeks, adults 6-8wks

Kids usually grow out of it

Front 28

Which Nephropathy?
Edema
Nephrotic syndrome
Sometimes not symptomatic, but presents as DVT/PE
Most common nephropathy in adults

Back 28

Membranous nephropathy

Front 29

Which condition?
Pathologically - depsoits on the epithelial side of the membrane, new membrane grows around and thickens

Back 29

Membranous nephropathy

Front 30

Which type of nephropathy can be caused from malaria, hep b/c, carcinomas, leukemia, lymphoma, lupus, sickle cel anemia

Back 30

Membranous - secondary

Front 31

Membranous Tx:
Those at medium-high risk treated with ____/____ combination
Cyclosporine controls ______ 3/4 of the time but when you stop it comes back

Back 31

prednisone/cytoxan

proteinuria

Front 32

Which nephropathy?
More so in African Americans
Systemic edema
HTN
elevated creatinine
Ominous progression - 3/4 develop ESRD within 10 yrs

Back 32

Focal Sclerosis

Front 33

How do you treat Focal Sclerosis?

Back 33

Longer course of higher dose of Prednisone (4-6mos) has 50% response rate

Front 34

Which nephropathy?
Nephritic - hematuria
Can have proteinuria
Most common cause of GN worldwide!
Asymptomatic disease often
Typically get hematuria within a day or two of an acute illness like URI

Back 34

IgA nephropathy

Front 35

IgA Nephropathy -
Deposits of IgA in the _______ with associated hypercellularity and matrix expansion
Abnormal galactosylation of hinge region leads to decreased ______ and increased _______
Secreted on mucosal surfaces in response to an _____

Back 35

mesagnium
clearance
deposition
antigen (association with URI or food allergy)

Front 36

Which nephropathy?
Renal lesion of IgA nephropathy, but associated with systemic vasculitis with IgA deposits in skin and gut as well
Pediatric with GI symptoms, ovasculitic rash (palpable purpura)

Back 36

Henoch-Schonlein Purpura

Front 37

Which nephropathy?
severe GN with crescents, diffuse proliferative appearance
Ill, emergent, HTN, edema, CHF, hemoptysis, seizures
Sx slow developing

Back 37

RPGN
Rapidly Progressive Glomerulonephritis