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44 Cards in this Set
- Front
- Back
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How do you define proteinuria?
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urinary excretion of >150 mg protein/days
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What are the 4 classes of proteinuria?
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Glomerular, tubular, overflow, other
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What's the pathophys of glomerular proteinuria?
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Increased glomerular permeability to proteins
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Glomerular vs tubular proteinuria-- what's more severe?
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Glomerular is more severe
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Pathophys of tubular proteinuria
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Small proteins normally filtered @ glomerulus then reabsorbed by tubules appear in urine bc tubules aren't working
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Causes of tubular proteinuria
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Sickle cell dz, urinary tract obstruction, interstitial nephritis
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What is overflow proteinuria?
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Increased production of small proteins overwhelms tubules (such as Bence Jones protein in multiple myeloma)
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What else can cause proteinuria, besides glomerular, tubular and overflow?
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UTI, fever/heavy exertion/stress, CHF, pregnancy, orthostatic proteinuria
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What are the 5 features of nephrotic syndrome?
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"Proteinuria >3.5 g/d
Hypoalbuminemia (liver can't keep up with proteinuria) Edema (from hypoalbuminemia) Hyperlipidemia/lipiduria (bc liver is trying to keep up with protein loss, this is a byproduct) Hypercoagulable state (losing anticoagulants in urine)" |
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What 2 things are you more prone to in nephrotic syndrome?
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Thromboembolic events (loss of anticoagulants in urine) and infection (loss of Igs in urine)
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What's the underlying cause of nephrotic syndrome?
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abnormal glomerular permeability
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What are the causes of nephrotic syndrome?
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"METABOLIC/SYST- DM, collagen vascular dz, SLE, RA, HSP, PAN, WG; Amyloidosis, cryoglublinemia
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2. The MCC in children?"
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"1. Membranous nephropathy, FSGS, membranoproliferative GN
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What drugs/toxins lead to nephrotic syndrome?
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Captopril, heroin, heavy meatls, NSAIDs, penicillamine
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What are the diagnostic steps to take when proteinuria is suspected?
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"1. URINE DIPSTICK, if detect proteinuria --> URINALYSIS; if protein confirmed --> 24-HR URINE COLLECTION for albumin and Cr to establish severity
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2. persistent?"
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"1. no further workup
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How do you treat SYMPTOMATIC proteinuria?
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"--> further testing always required
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What is hematuria?
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>3 erythrocytes/HPF on urinalysis
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Gross painless hematuria --> think of what?
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Bladder or kidney cancer until proven otherwise
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Causes of hematuria
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"Nontraumatic: 25% infection, 20% stones
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What diagnostic steps should be taken if suspecting hematuria?
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"1. Urine dipstick (>90% sensitive)
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Treatment of hematuria
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Treat underlying cause, maintain urine volume
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How do you define proteinuria?
|
urinary excretion of >150 mg protein/days
|
|
|
What are the 4 classes of proteinuria?
|
Glomerular, tubular, overflow, other
|
|
|
What's the pathophys of glomerular proteinuria?
|
Increased glomerular permeability to proteins
|
|
|
Glomerular vs tubular proteinuria-- what's more severe?
|
Glomerular is more severe
|
|
|
Pathophys of tubular proteinuria
|
Small proteins normally filtered @ glomerulus then reabsorbed by tubules appear in urine bc tubules aren't working
|
|
|
Causes of tubular proteinuria
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Sickle cell dz, urinary tract obstruction, interstitial nephritis
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|
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What is overflow proteinuria?
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Increased production of small proteins overwhelms tubules (such as Bence Jones protein in multiple myeloma)
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What else can cause proteinuria, besides glomerular, tubular and overflow?
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UTI, fever/heavy exertion/stress, CHF, pregnancy, orthostatic proteinuria
|
|
|
What are the 5 features of nephrotic syndrome?
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"Proteinuria >3.5 g/d
Hypoalbuminemia (liver can't keep up with proteinuria) Edema (from hypoalbuminemia) Hyperlipidemia/lipiduria (bc liver is trying to keep up with protein loss, this is a byproduct) Hypercoagulable state (losing anticoagulants in urine)" |
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What 2 things are you more prone to in nephrotic syndrome?
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Thromboembolic events (loss of anticoagulants in urine) and infection (loss of Igs in urine)
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|
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What's the underlying cause of nephrotic syndrome?
|
abnormal glomerular permeability
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|
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What are the causes of nephrotic syndrome?
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"METABOLIC/SYST- DM, collagen vascular dz, SLE, RA, HSP, PAN, WG; Amyloidosis, cryoglublinemia
INHERITED/CONG- Primary glomerular dz (50-75%) NEOPLASTIC- multiple myeloma, malignant HTN, transplant rejection DRUGS/TOXINS" |
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"1. What are the top 3 causes of primary glomerular dz in adults?
2. The MCC in children?" |
"1. Membranous nephropathy, FSGS, membranoproliferative GN
2. Minimal change dz" |
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What drugs/toxins lead to nephrotic syndrome?
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Captopril, heroin, heavy meatls, NSAIDs, penicillamine
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What are the diagnostic steps to take when proteinuria is suspected?
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"1. URINE DIPSTICK, if detect proteinuria --> URINALYSIS; if protein confirmed --> 24-HR URINE COLLECTION for albumin and Cr to establish severity
2. If dipstick negative, test for microalbuminemia that may not be detected on urine dipstick. If + --> radioimmunoassay. 3. Otherwise, check: Cr, Serum BUN/Cr, albumin, Renal u/s, IVP, ANA levels/hep panel/antistrep/complement/cryo, electrophoresis for myeloma, renal biopsy" |
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"How do you treat ASYMPTOMATIC proteinuria if...
1. transient? 2. persistent?" |
"1. no further workup
2. further workup: check BP, urine sediment; treat underlying condition/associated problems" |
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How do you treat SYMPTOMATIC proteinuria?
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"--> further testing always required
-Treat underlying dz -ACE inhibitors (decrease albumin loss) -diuretics if edema -limit protein intake -treat hypercholesteroemia (diet or drugs) -vaccinate against flu/pneumococcus 2/2 increased risk" |
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What is hematuria?
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>3 erythrocytes/HPF on urinalysis
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Gross painless hematuria --> think of what?
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Bladder or kidney cancer until proven otherwise
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Causes of hematuria
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"Nontraumatic: 25% infection, 20% stones
False +: menstrual blood Vascular- bleeding disorders: hemophilia, thrombocytopenia; sickle cell dz Infectious- UTI, urethritis, pyelonephritis, cystitis, prostatitis Trauma/Iatrogenic- foley catheter placement, blunt trauma, invasive procedures, strenuous exercise/fever, analgesic nephropathy Autoimmune/inflammatory- SLE, rheumatic fever, HSP, WG, HUS, Goodpasture's, PAN Metabolic/systemic- kidney stones, glomerular dz, IgA nephropathy, PKD, BPH Inherited/congenital- simple cysts Neoplastic- bladder/kidney ca Drug/toxic- cyclophosphamide, anticoagulants, salicylates, sulfonamides" |
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What diagnostic steps should be taken if suspecting hematuria?
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"1. Urine dipstick (>90% sensitive)
2. UA 3. Urine specimen (cancer); 4. Blood tests (coags, CBC, BUN/Cr) If pyuria on UA --> UCx If suspect cancer --> cystoscopy always If proteinuria --> 24-hr urine (Cr, protein) If suspect glomerular dz --> renal bx If no causes from 1-4 --> IVP, CT, U/S |
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Treatment of hematuria
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Treat underlying cause, maintain urine volume
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