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Proteinuria

Proteinuria. 24 th June 2011 Rachel Lennon. The Spectrum of Glomerular Disease. SLE. Minimal change. IgA nephropathy. Membranous. Diabetic nephropathy. Anti-GBM disease. FSGS. Small vessel vasculitis. MCGN. Post infectious nephritis. Proteinuria. Endothelial cells. GBM. Podocyte.

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Proteinuria

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  1. Proteinuria 24th June 2011 Rachel Lennon

  2. The Spectrum of Glomerular Disease SLE Minimal change IgA nephropathy Membranous Diabetic nephropathy Anti-GBM disease FSGS Small vessel vasculitis MCGN Post infectious nephritis Proteinuria

  3. Endothelial cells GBM Podocyte 1 million in each adult human kidney

  4. Glomerular filtration barrier Glomerular endothelial cells 180 litres of water and small solutes- almost no proteins GBM Slit diaphragm Podocytes

  5. Mundel et al: Kidney International 2010 77 (7) p571-80

  6. Definition • Protein:creatinine ratio (PCR) • 20mg/mmol • 200mg/mmol nephrotic range • Albumin: creatinine ratio (ACR) • 30mg/mmol

  7. Case-1 • 13 year old boy • No PMH/FH renal disease • BP and renal function normal • Incidental finding • Urinalysis: 2+protein • Mild proteinuria (PCR 20-50) • 3 early morning urines: PCR • Orthostatic proteinuria

  8. Case-2 • 5 year old boy • BP and renal function normal • Urinalysis 2+ protein, 2+ blood • PCR 40-50 • ACR 20 • Calcium:creatinine: 1.5mmol/mmol • USS: Nephrocalcinosis • NAG/RBP:creatinine • Dent’s disease: CLC5/OCRL-1 mutations

  9. Case-3 • 8 year girl • PMH: Bilateral VUR and recurrent UTI • FH: VUR • DMSA: Bilateral renal scarring • BP normal, eGFR 65ml/min/1.73m2 • Urinalysis 2+ protein PCR 30-50 • Enalapril 5mg od • Renal function before and at 2 weeks • Reflux nephropathy

  10. Case-4 • 8 year old girl • HSP • Urinalysis: Protein 3+, blood 2+ • PCR 100-150: Persistent at 4 weeks • BP 95th centile • Normal renal function • Renal biopsy: Crescentic GN, IgA deposition • Steroids/Azathioprine/Enalapril • HSP nephritis

  11. Summary • Investigate persistent proteinuria • Orthostatic • Tubular disease • Nephropathy • Use of anti-proteinuric agents to limit secondary injury

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