DONE BY :ABD ULWAHAB K NEYAZ I MBBS

PROTEINURIA

CONTENT

• Introduction

• Classification

• Nephrotic syndrome

• Nephritic Syndrome

INTRODUCTION

• Normally, less than 150 mg of protein in the urine per day.

• More than 150 mg per day is called proteinuria.

CLASSIFICATION

Proteinuria

Transient proteinur

ia Orthostatic

proteinuriaPersistent

proteinuria

TRANSIENT

• Most common form of proteinuria. Transient proteinuria usually resolves without treatment.

• Stresses such as fever, exercise, Pregnancy and UTI may cause transient proteinuria.

ORTHOSTATIC

• loses protein in the urine while in an upright position but not when lying down.

• Occurs in 2 to 5 % of adolescents but is unusual in people over the age of 30 years.

• Orthostatic proteinuria is diagnosed by obtaining a split urine collection. This requires collecting two urine samples: usually during the day and another in the morning

ORTHOSTATIC

• No further management typically disappears with age

PERSISTENT

Persistent

Overflow

Tubular

Glomerular

OVERFLOW

• Overproduction of protein, leading to increase filtered load is to a level that exceeds the normal proximal reabsorptive capacity.

• Multiple myeloma

• Acute myelomonocytic leukemia

• myoglobin (in rhabdomyolysis)

• intravascular hemolysis (free hemoglobin) that is not bound to haptoglobin.

TUBULAR

• Tubulointerstitial diseases or some primary glomerular diseases THAT Interfere with proximal tubular reabsorption.

• Lead to increased excretion of smaller proteins

GLOMERULAR

•  Glomerular proteinuria is due to increased filtration of macromolecules (such as albumin) across the glomerular capillary wall.

GLOMERULAR

• Nephrotic Syndrome

• Nephritic syndrome

NEPHROTIC SYNDROME

• Urine protein >3.5 g per day

• Hypoalbuminemia

• Hyperlipidemia and lipiduria

• Edema 

• Primary nephrotic syndrome, in the absence of an identifiable systemic disease

• Secondary nephrotic syndrome, in the presence of an identifiable systemic disease.

CAUSES• 50%-75% nephrotic syndrome in the absence of an

identifiable systemic disease membranous nephropathy

• 35% Focal segmental glomerulosclerosis

• 15% Membranoproliferative glomerulonephritis (e.g. Autoimmune diseases)

• Systemic disease: DM, HTN, Drug/ toxin e.g. NSAID and penicillamine

• Infection

DIAGNOSIS

• History Edema, periorbital, anasarca foamy urine, DM, HTN Systemic manifestation and joint involvement

• Examination Anasarca, Pulmonary edema

DIAGNOSIS

• Urine analysis

RBC cast(glomerulonephritis)WBC cast (pyelonephritis and interstitial nephritis)Fatty Cast (nephrotic syndrome)+ve albumin

DIAGNOSIS

• Renal profile

• Electrolyte (Hyponatremia)

• lipid profile

• Urine 24h collection for protein

• total protein/creatinine (greater than 3 mg protein/mg creatinine)

TREATMENT

• Controlling the underlying disease

• ACE inhibitors

• Diuretics

• Vaccination (influenza and pneumococcus)

NEPHRITIC SYNDROMENephrotic syndrome

Nephritic syndrome

Abnormal glomerular permeability

Inflammation of glomeruli(glomerulonephritis)

Pathogenesis

Membranous glomerulonephritis

Post strept glomerulonephritis

causes

Proteinuria >3.5 g/24hHypoalbunimia hyperlipidemia

Hematuria, oliguria Mild Proteinuria

lab

Edema Hypercoagulable stateIncrease risk or infection

HTN Edema

Clinical finding

REFERENCE• Hinkes BG, Mucha B, Vlangos CN, et al. Nephrotic syndrome

in the first year of life: two thirds of cases are caused by mutations in 4 genes (NPHS1, NPHS2, WT1, and LAMB2). Pediatrics 2007; 119:e907.

• El Bakkali L, Rodrigues Pereira R, Kuik DJ, et al. Nephrotic syndrome in The Netherlands: a population-based cohort study and a

• McKinney PA, Feltbower RG, Brocklebank JT, Fitzpatrick MM. Time trends and ethnic patterns of childhood nephrotic syndrome in Yorkshire, UK. Pediatr Nephrol 2001; 16:1040.