proteinuria 24 th june 2011 rachel lennon. the spectrum of glomerular disease minimal change...
TRANSCRIPT
The Spectrum of Glomerular Disease
Minimal change
Proteinuria
FSGS
IgA nephropathyMembranous
Diabetic nephropathy
MCGN
SLE
Post infectious nephritis
Anti-GBM disease
Small vessel vasculitis
Endothelial cells
Podocyte
GBM
1 million in each adult human kidney
Glomerular filtration barrier
Podocytes
Glomerular endothelial cells
GBM
180 litres of water and small solutes- almost no
proteins
Slit diaphragm
Mundel et al: Kidney International 2010 77 (7) p571-80
Definition
• Protein:creatinine ratio (PCR)– 20mg/mmol– 200mg/mmol nephrotic range
• Albumin: creatinine ratio (ACR)– 30mg/mmol
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
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
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
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
Summary
• Investigate persistent proteinuria– Orthostatic– Tubular disease– Nephropathy
• Use of anti-proteinuric agents to limit secondary injury