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Flashcards in Haematuria Proteinuria Deck (31)

Haematuria and Proteinuria mean?

Leaking blood or protein in urine


What are the 3 main types of Renal Disease?

Generalised Parenchymal**:
-Haematuria, proteinuria, acute nephritis syn, chronic renal failure

Collecting Sys. Abnorm:
-infection, polyuria, CRF

Focal Lesions:
-Haematuria, backache (masses)


How are the kidneys like a sieve?

When not functioning, they can be blocked (decreased GFR) or Leaky (leaking blood or protein into urine)


Although the kidneys handle _____ filtrate/day including ____g/L of protein, there's only

Although the kidneys handle 150L filtrate/day including 60-80 g/L of protein, there's only <150 mg/24h of urinary protein


What are the barriers to urinary protein?

Glomeruli***= filters the protein

(also tubules have a role in reabsorbing snd degrading most of the filtered protein)


Blocked filter leads to

reduced GFR > acute kidney injury and/or chronic kidney disease


Why is controlling/lowering BP an important form of treatment for a leaky filter?

Because by increasing the pressure in the glomeruli you can leak more protein and even damage your sieve further! (worsening CKD)


What do we lose in Proteinuria

We mainly lose Albumin (others in small amounts)

-Measure via a 24hr urine (annoying)
-Measure ratios (albumin:creatinine or protein: creatinine)



Usually with diabetes, very bad!
Leak 30-300mg albumin/24hr
(* within normal range!)
Indicator of diabetes and other bad things

Other Causes-exercise, fever, HF


ACR ranges?

<2.5 mg/mmol : normal
2.5-25mg/mmol: MA
>25mg/mmol : Proteinuria


Nephrotic Syndrome

People leaking LOTS of protein, due to podocyte damage >3.5g/day
Low serum albumin
frothy urine
blood clots

Renal function can be normal OR impaired!


What is the mechanism for getting oedema with intense proteinuria?

-Increased Albumin excretion
-Liver can't keep up (to make more protein)
-Oncotic pressure reduces
-Fluid moves into interstitial space

**low oncotic P and high hydrostatic P, fluid pushed out


Flow diagram of Nephrotic Syndrome

Glomerular injury > protein leakage into bowmans capsule > plasma volume and CO decreases > stimulationg of RAA system > sodium and water retention > oedema


Hypercholesterolaemia due to Nephrotic syndrome?

Low plasma oncotic pressure stimulate liver to increase lipoproteins (to try keep up) > hypercholesterolaemia


Thromboembolism due to Nephrotic syndrome?

Not well understood, just know it increases risk. big leg clot. (decrease in Anti-thrombin III)
10% risk


Infection due to Nephrotic syndrome?

Due to a reduction of AB production and complement pathway.

Get more bacterial infections and chicken pox


malnutrition due to Nephrotic syndrome?

Due to protein leakage//protein malnutrition.


Renal function in nephrotic syndrome.

May be normal of eremely dimished.

Can have AKI or CKD

Look at nephrotic spectrum on page 51


What is Chronic Kidney Disease, what causes it and how do we treat it?

Due to Glomerular Disease or Diabetes.
-Blood or protein in urine (only protein in DN).
-Chronic Kidney Failure

Main treatment: controlling BP


Diabetic Nephropathy.

Hyperfiltration and microalbuminuria due to excess sugar in blood. if you cannot control glucose or BP, over time the more damage, the more GFR will start to decline, and more protein leaks.

After ~10years, you develop Diabetic Nephropathy. (Type 1)


Acute Kidney Injury

Can be pre-renal, renal or post-renal
Renal= intrinsic acute kidney injury
1) Acute Tubular Necrosis
2) Acute Glomerulonephritis


Acute Tubular Necrosis

From "pre-renal drugs and toxins" that have caused AKI.

Don't tend to have protein or blood in urine, but have a blocked filter > lower GFR


Acute Glomerulonephritis

Rapidly Progressive Glomerulinephritis
-Acute Renal failure
-Leaking glomeruli; blood and/or protein
-May have nephritic syndrome


What is nephritic Syndrome? (NOT nephrotic syndrome?)

Due to inflammatory response! (unlike nephrotic synd.)
Excessive WBC, RBC, AB in glomeruli > excess leakage of all of these in the urine. (haematuria and proteinuria)

Often patient is unwell, oliguric (little urine), hypertensive, fluid overloaded (can have pulmonary/peripheral oedema)

Can be AKI or CKD


Treatment of Proteinuria

Find cause (usually via kidney biopsy)
Control BP



Bleeding from somewhere in the urinary tract. (eg; glomerular, CS, focal lesion)

Micro (only see blood via microscope)
Macro (can see with naked eye, can have clots)


Glomerular haematuria

Generally microscopic and associated with proteinuria


Haematuria from the collecting duct

Generally macroscopic, with no/little proteinuria.

Can be via kidney stone: Associated with loin-groin pain, vomiting/nausea, anuria.
Diagnose via US.


Haematuria due to focal lesions

Can be macro or microscopic, often asymptomatic, backache with a mass


Renal Cell carcinoma

90% renal cancer
M:F 2:1
Peak 6th decade

Increased risk with smoking or genetics

Macroscopic: mottled red, yellow and brown, part cystic, may invade renal vein


Clinical picture of Renal cell carcinoma

Late symptoms, haematuria, flank pain, palpable mass, ectopic hormone production,

Local spread uncommon
Mainly blood-bourne metastases
Regional Lymph nodes

Survival : ~40% 5yr