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29 Cards in this Set
- Front
- Back
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One of the first indications that renal disease is present
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proteinuria
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This is second most important parameter (behind GFR) in clinical evaluation of renal function
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proteinuria
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Normal daily protein excretion
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less than 150 mg (usually 40-80 mg)
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Amount of normal daily protein excretion that is albumin
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10 mg
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Albumin levels over what amount indicate overt proteinuria or macroalbumineria
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albumin over 300 mg/day
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Point at which the standard urinary dipstick becomes positive for protein
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300 mg/day
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What is considered nephrotic range proteinuria?
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protein level over 3.5 mg/day (VERY HIGH)
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Types of proteinuria (4)
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glomerular, tubular (ATN and tubulointerstitial dz), overload (multiple myeloma, hemolysis), functional (benign/functional- exercise, orthostatis)
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Why is identification of microalbuminuria especially important in DM?
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it is highly correlated with subsequent development of overt diabetic nephropathy
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How often do you screen Diabetes patients for microalbuminuria?
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at least annually
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Microalbumineria is seen in patients with DM, as well as ______ and _______.
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HTN and chronic kidney dz
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Preferred method to measure level of microalbumineria
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to obtain the total albumin-to-creatinine ratio (first morning sample is best)
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What does an albumin to creatinine value above 30 mg/day suggest
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suggests albumin excretion above 30 mg/day and therefore microalbumineria
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What proteins are usually detected by a dipstick? Which are usually missed?
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detected- albumin and intact globulins; missed- positive charged light chains of immunoglobulins
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What is done to confirm protienuria first detected on a dipstick?
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f/u with a first morning urine void not done after exercise; repeat up to three times to confirm proteinuria
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What is the GOLD standard to quantify the level of protein excretion?
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24 hour urine collection
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Why is random sample urinary protein: creatinine ration testing used often more than 24 hr urine collection?
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less cumbersome for patient; no question as to whether urine collection was properly done
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What normal random sample urinary protein: creatinine ratio?
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less than 0.2
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MC clinical complications of proteinuria
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generalized edema, pulmonary edema, acute renal failure, increased risk of bacterial infection, increased risk of thrombosis, increased risk of CVD
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Treatment goal for lowering proteinuria
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less than 0.5 g/day
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With respect to CKD progression, which is most important---lowering proteinuria or lowering BP?
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lowering proteinuria
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Drug tx for proteinuria
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ACE or ARB (decrease intraglomerular pressure, decrease protein excretion, slow progression of renal disease)
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What correlation does weight loss have with proteinuria?
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weight loss of 5% may decrease proteinuria up to 20-30%
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When do you refer proteinuria to a nephrologist?
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if persistent glomerular dz or renal failure
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