1 / 31

Proteinuria: Types, Measurement, and Management in Clinical Practice

This article provides an overview of proteinuria, including its types, measurement methods, and management strategies. It includes information on glomerular, tubular, and overflow proteinuria, as well as the importance of monitoring proteinuria in various patient populations. The article also discusses the prognosis of glomerular proteinuria based on the quantity of proteinuria.

coleent
Download Presentation

Proteinuria: Types, Measurement, and Management in Clinical Practice

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PROTEINURIA DR HEDAYATI

  2. INTRODUCTION

  3. URINARY PROTEIN > 150mg/day • More than 1 time • ↑ capillary permeability

  4. ISOLATED PROTEINURIA • PROTEINURIA WITHOUT HEMATURIA WITHOUT ↑ IN CREATININE

  5. ISOLATED PROTEINURIA • MAY BE ASYMPTOMATIC • HEAVY PROTEIONURIA , LIPIDURIA ,EDEMA , +/- ACTIVE URINE SEDIMENT

  6. SCREENING • NO COST- EFFECTIVE FOR GENERAL POPULATION, < 60y/o • HIGH RISK PATIENTS : DM HTN → ACEI or ARB SLOWING THE PROGRESSION OF PROTEINURIA

  7. TYPES OF PROTEINURIA • Glomerular proteinuria • Tubular proteinuria • overflow proteinuria

  8. Glomerular proteinuria • ↑ filteration of macromolecules Diabetic nephropathy ,glomerulopathy , exercise-induced, orthostatic proteinuria • Most : 1-2g/day

  9. Tubular proteinuria • Low molecular wt proteins • Interference with PCT reabsorption • No detection by dipstick

  10. overflow proteinuria • ↑ excretion of LMW • Almost always : MM • Others : AML ( Lysozyme ) Rhabdomyolysis ( Myoglobin) Hemolysis ( Hb) • Filtered load > reabsorption by PCT

  11. MIXED FORMS OF PROTEINURIA • MM • FSGS

  12. MEASUREMENT

  13. STANDARD URINE DIPSTICK • ALBUMIN • COLORIMETRIC REACTION • TETRABROMOPHENOL • GREEN SHADES • GLOMERULAR PROTEINURIA • HIGH SPECIFIC • NOT VERY SENSITIVE ( + ONLY : > 300-500 mg/d )

  14. STANDARD URINE DIPSTICK • INSENSITIVE METHOD TO DETECT INITIAL INCREASE IN PROTEIN EXCRETION • MICROALBUMINURIA (DIABETIC NEPHROPATHY ) • FALSE POSITIVE : CONTRAST ( 24 h ).

  15. STANDARD URINE DIPSTICK • GRADING : • NEGATIVE • 1 + : 15-30 mg /dL • 2 + : 30-100 mg/dL • 3 + : 100-300 mg/dL • 4 + : > 1000 mg/dL • ROUGH GUIDE : URINE VOLUME

  16. SULFOSALICYLIC ACID • ALL PROTEINS • AKI + BENIGN U/A +NEGATIVE DIPSTICK :MM • SULFOSALICYLIC ACID : + URINE DIPSTICK : - → NONALBUMIN PROTEINS MOST : LIGHT Ig

  17. SULFOSALICYLIC ACID • 1 part urine urine + 3 part SSA3% • TURBIDITY • GRADING: 0 TRACE : 1-10 mg/dL 1+ : 15-30 mg/dL 2+ : 40-100 mg/dL 3+ : 150-300 mg/dL 4+ : > 500 mg/Dl • FALSE POPSITIVE : CONTRAST (24h )

  18. LYSOZYME • AML • URINE DIPSTICK : + • SSA : + • NO OTHER SIGNS OF NEPHROTIC SYNDROME • DIRECT MEASUREMENT

  19. QUANTITATIVE MEASUREMENT • BENIGN FORMS : < 1-2 g/d • PROGNOSTIC IMPORTANCE • MONITOR THE RESPONSE TO THERAPY

  20. QUANTITATIVE MEASUREMENT • 24 HOUR URINE • RANDOM URINE : PROTEIN /Cr ratio (mg/ g) • ~ daily protein excretion (g/m2 ) • SERIAL MONITORING

  21. MICROALBUMINURIA • NL ALBUMIN EXCRETION : < 20mg/d • MICROALBUMINURIA : 30-300 mg/d • SPECIFIC DIPSTICKS • ALBUMIN/Cr RATIO

  22. APPROACH TO PROTEINURIA

  23. HISTORY • PHYSICAL EXAMINATION If systemic disease : MANAGEMENT OF PROTEINURIA : MANAGEMENT OF DISEASE

  24. URINE EXAMINATION • ALL PATIENTS • URINE SEDIMENT • REPEATED

  25. R/O TRANSIENT PROTEINURIA • COMMON • FEVER, EXERCISE (Ag – NEP) • NO FURTHER EVALUATION

  26. R/O ORTHOSTATIC PROTEINURIA • < 30y/o • ↑ proteinuria in UPRIGHT POSITION BUT NL in SUPINE • < 1g/d • Benign / No further evaluation

  27. R/O ORTHOSTATIC PROTEINURIA • First morning : - • 16 hour : 7 am- 11 pm NL activity . • Recumbent position : 2 hours before daytime collection finished • Overnight collection : 11 pm- 7 am

  28. R/O ORTHOSTATIC PROTEINURIA • Protein /Cr ratio: • First morning • Before bed • Must be normal excretion in SUPINE

  29. Persistent proteinuria • Underlyiong disease • BUN ,Cr • Quantitative measurement • Kidney sonography • Refer to nephrologist • Renal biopsy

  30. PROGNOSIS

  31. GLOMERULAR PROTEINURIA : QUANTITY OF PROTEINURIA NON-NEPHROTIC > NEPHROTIC • PERSISTENT MONITORING

More Related