Approach to Proteinuria and Hematuria

Question 1

Normal protein flow thru renal arteries

Answer 1

121,000g/day

Question 2

Normal protein flow thru GLOMERULUS

Answer 2

1-2g/day

Question 3

Normal protein excretion in urine

Answer 3

<150mg/day and (-) on dipstick

Question 4

Usual first sign of renal complication

Answer 4

Microalbuminuria

Question 5

Only protein detected on dipstick

Answer 5

Albumin

Question 6

% of Tamm-Horsfall protein in Urine

Answer 6

60-80%

Question 7

% Albumin in urine

Answer 7

20-40

Question 8

550mg of protein in urine is considered

Answer 8

Moderate
Mild: <500 mg
Moderate: 500mg-2g
Severe: >2g

Question 9

Most common cause of proteinuria

Answer 9

DM

Question 10

Etiology of Protenuria is classified into

Answer 10

Overflow
Tubular
Glomerular

Question 11

TorF: Tubulointerstitial disease would cause high molecular weight proteinuria

Answer 11

False. LOW bsta tubular kag overfLOW ky LOW

Question 12

Disease that would cause high mol wt proteinuria

Answer 12

GN

Orthostatic proteinuria

Question 13

Type of proteinuria which resolves with resolution of underlying dse

Answer 13

Transient proteinuria

Question 14

Secondary causes of Tubulointerstitial disease

Answer 14

Uric acid nephropathy
Heavy Metal and drug toxicity
Sickle Cell Dse

Question 15

Proteinuria while upright or after prolonged standing but normal when supine

Answer 15

Orthostatic proteinuria

Question 16

Diagnostic methods for orthostatic proteinuria

Answer 16

Split urine collection

Spot protein creatinine ratio of 1st AM and mid afternoon void

Question 17

T or F: More patients have secondary causes than primary glomerular disease

Answer 17

False: 75% primary

25% secondary

Question 18

kidney disesase as a result

of the progression of symptoms diabetes mellitus

Answer 18

Diabetic Kidney disease

Question 19

kidney disease as a direct

result of increased blood glucose

Answer 19

Diabetic nephropathy

Question 20

How many yrs does microalbuminuria develop in Diabetic nephropathy/DKD

Answer 20

5 yrs, proteinuria 11-20 yrs

Question 21

Why are young population prone to CKD

Answer 21

Due to fast food and salty diet (nan sigeha nyu ah)

Question 22

What to look for in fundoscopy that would suggest DM

Answer 22

Retinopathy

Question 23

Low C3 would suggest

Answer 23

Post strep

Question 24

Normal C3 would suggest

Answer 24

Glomerulonephritis

Question 25

Lab exam that you would request to detect chronicity and activity of renal lesions

Answer 25

Renal biopsy

Question 26

T or F: atleast 1 kidney should be functional before doing biopsy

Answer 26

False: BOTH kidneys must be functioning

Question 27

T or F: in adults pulse therapy is attempted before biopsy

Answer 27

False: it’s for pedia since pediatric Neo are more responsive. (adults:biopsy b4 treatment)

Question 28

T or F: aurine dipstick analysis is most sensitive to albumin and least sensitive to low mol wt proteins

Answer 28

True

Question 29

Turbidimetric assay based on protein precipitation;

Answer 29

Sulfosalicylic assay (SSA)

Question 30

Type of protein measured by SSA

Answer 30

All proteins

Question 31

Define Hematuria

Answer 31

>3 RBC/hpf in centrifuged urine

Question 32

Presence of clots may indicate

Answer 32

Ureteral or bladder origin

Question 33

Origin of primary hematuria

Answer 33

Renal

Question 34

Most common form of hematuria

Answer 34

Primary

Question 35

Lab test that gives us an idea of what section of the urinary tract is involved in hematuria

Answer 35

Three-glass test

Question 36

In the 3-glass tetst urine is collected during 3 stages, what are these

Answer 36

Urethral involvement Bladder neck or triangle Bladder or upper UT

Question 37

If all urine samples in the 3-glass test have RBC which stage is this

Answer 37

Bladder or upper UT

Question 38

(3glass tets) If the RBCs are only from near end of micturition which stage is this

Answer 38

Bladder neck or triangle

Question 39

(3 glass test) if the RBCs are only from the START of micturition which stage

Answer 39

Urethral involevemtn

Question 40

NO clots usually indicate which origin

Answer 40

Upper UT or glomerular origin

Question 41

Test that distinguish btn glomerular from post-glomerular origin of hematuria

Answer 41

Phase contrast microscopy

Question 42

Dysmorphic RBCs indicate which origin

Answer 42

Glomerular

Question 43

Normal size and shape RBCs indicate which origin

Answer 43

Post glomerular

Question 44

If the accompanying symptom is dysuria, micturition pause or straining this indicates

Answer 44

Bladder or urethral stone

Question 45

If the hematuria is accompanied with symptoms like high spiking fever, chills, loin pain and positive kidney punch test this is a diagnosis of

Answer 45

Pyelonephritis

Question 46

Hematuria plus urgency only

Answer 46

Cystitis

Question 47

Hematuria plus edema and hypertension

Answer 47

GN | Hypertensive nephropathy

Question 48

Hematuria plus chyluria

Answer 48

Filariasis

Question 49

Painful gross hematuria without clots indicate

Answer 49

RCC

Question 50

This test is best in evaluating hematuria

Answer 50

Renal biopsy

Question 51

3wks pta px develop sore throat, positive ASO, (+) hematuria this is

Answer 51

Post strep GN

Question 52

Eosinophiluria indicates

Answer 52

Allergic interstitial nephritis