Proteinuria, A medical student prespective
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Proteinuria A medical Student perspective Rahmat A. Balogun North Shore LIJ
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A medical student rotating via Nephrology takes us via using a concept map as her understanding of proteinuria improved from her first encounter.
Transcript of Proteinuria, A medical student prespective
ProteinuriaA medical Student perspectiveRahmat A. BalogunNorth Shore LIJ
A concept map of proteinuria in my head before I read more about it
Barriers to Proteinuria
✤ Size Barrier (podocytes restrict molecules >1.5nm)
✤ Charge Barrier (negative charged BM and endothelial cells)
✤ Proximal Tubule reabsorption
Determination of Proteinuria
✤ Detection
✤ Dipstick (0 to 3/4+) detects albumin
✤ False +/-, pH dependent, concentration dependent
✤ Quantitative
✤ Microalbuminuria
✤ Protein-Creatinine ratio (equal to 24hr collection)
✤ Qualitative (electrophoresis)
Normal Urine Protein (<150mg/day)
✤ Tamm-Horsfall Protein (glycoproteins)
✤ Blood Group related
✤ Albumin
✤ Immunoglobulin
✤ Mucopolysaccharides
✤ Hormones, Enzymes, Other (very small amount)
Proteinuria
Functional TubularGlomerula
rOverflow
Most common cause in clinical practice
Functional
✤ Typically < 1g/24hrs
✤ Benign form of proteinuria
Proteinuria
BenignOrthostati
cTransient
Functional
StandingExertionFever
Tall, thin, <30 y/o
Glomerular
✤ Most common cause in clinical practice
✤ 85-99% albumin accompanied by other LMW proteins
✤ May be only a few 100mg/24hrs
✤ Only glomerular proteinuria can account for >1.5g protein/24hrs
✤ Theories
✤ Charge
✤ Podocyte detachment
✤ Increased Glomerular hydrostatic pressure
Proteinuria
Primary Secondary
Proliferative Non-
Proliferative
Proliferative Non-
Proliferative
Glomerular
Proteinuria
IgA
Proliferative
Non-Proliferative
Mesangial Proliferati
veMembranoproliferati
ve
Membranous
Immunotactoid
FibrillaryMCDFSGS
Primary Glomerular
Proteinuria
HSP
Proliferative
Non-Proliferative
HepC
Post infectious
Light Chain
Amyloid
SecondaryFSGS
Anti-GBM
Lupus
Vasculitis
Bacterial Endocarditis
Cryoglobulin
DiabeticHTN
Secondary Glomerular
Tubular
✤ Often accompanies Glomerular proteinuria
✤ Often masked by Glomerular proteinuria (mixed proteinuria)
✤ May occur in isolation (Fanconi Syndrome)
✤ Almost never >1.5g/24hrs
Proteinuria
Isolated
Fanconi's Syndrome
Mixed
Tubular
AcquiredInherited
Proximal tubule dysfunction
AINATN
Other
ToxinsRTA
Multiple Myeloma
Overflow
✤ Increased production and excretion of LMW proteins, usually reabsorbed in Proximal Tubule.
✤ Usually < Nephrotic Range
Proteinuria
Light Chains
Immunoglobulin
Kappa
IgG
Lambda
Overflow
Amyloid
IgM
A better understanding of the concepts now
