Lecture 7: Haematuria and Proteinuria Flashcards Preview

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1

Clinical Presentation and Clinical Problem associated with generalised Parenchymal kidney Disease

Clinical presentation:
Clinical Problem:

2

Clinical Presentation and Clinical Problem associated with generalised Collecting System Abnormality kidney Disease

Clinical presentation:
Clinical Problem:

3

Clinical Presentation and Clinical Problem associated with generalised Focal leson assoc. kidney Disease

Clinical presentation: Haematuria, backache
Clinical Problem:

4

Extremes of changed glomerular function

Blocked Leaky
Siv b/w
- may or may not ahve lead to a change in GFR

5

Blocked (glomerular) filter

Blocked filter = reduced GFR
- acute Kidney injury
- chronic kidney disease

6

Proteinuria

Kidney handle 150L filtrate/day
Normal humans <150mg/24hrs.
Barriers to urinary protein:
1. Glomeruli - filters protein
2. Tubules - reabsorbs and filters

7

Affect of damaged glomerulus + High Blood Pressure

1. Increased leaked protein --> Proteinuria
2. High Blood pressure --> Increased damage to glomerulus --> worsening of situation/leakiness

8

Leaky filter

Leaking of blood or protein through glomerulus
Kidney function may be normal
Creatinine goes through glomerular filter, but not proteins
Note: every glomerulus will leak a little bit of protein into our urine

9

Proteinuria

Mainly albumin
Other proteins in small amounts
Measurements:
1. 24 hour urine --> annoying
2. Albumin: creatinine
3. Protein : creatinine
Note: 2x ratios are good surrogates replacing 24hour urine collection

10

Microalbuminuria

(albumin:creatinine ratio)
30-300 albumin/24 hours
ACR: x < 2.5 - y - 25 < z (mg/mmol/24 hours)
x= normal y= MA z= proteinuria
Causes: Diabetes Mellitus, Fever, Exercise, HF, Poor Glycemic control

11

Diabetes Mellitus relatively increases risk of..

Heat disease
Eye disease
Kidney fialure

12

Nephrotic Sydrome

Signs of nephosis: Proteinuria, Hypoalbuminaemia, odema
>3.5 g/day urinary protein
- eat protein but pee out more than they can eat
Symptoms:
1. Frothy urine
2. Reduced metabolism (VLDL - LDL) --> Increased Tryglycerides
3. Blood clots --> Pulmonary embolism
4. Normal or impaired Renal function/GFR
5. Low plasma oncotic pressure --> Increased lipoprotein production by liver --> increased cholesterol production --> hypercholesterolemia --> increase risk of vascular disease

13

Mechanism for Oedma

Increased albumin excretion --> Food and liver cant keep up with making enough albumin --> Low levels of protein in blood --> Reduced vascular oncotic pressure --> Increased egression of fluid into interstitial space (in an attempt to balance colloid oncotic and hydrostatic pressure b/w BV and tissues

14

Reason for Nephrotic Syndrome Oedema

Decreased protein and increased water in vasculature --> Decreased vascular oncotic pressure and increased hydrostatic pressure --> trying to balance equilibrium by pushing water into Extracellular spaces (cannot move proteins through filter) --> odema

15

Starling's Equation

Flux = capillary permeability (intravascular hydrostatic pressure - interstitial hydrostatic pressure) - (intravascular oncotic pressure - interstitial oncotic pressure)
Capillary hydrostatic P: pushes fluid out of vessel if high
Capillary oncotic pressure : pulls fluid into vessel if high. Derived from plasma proteins

16

Glomerular injury --> Odema

Glomerular injury --> protein leakage into interstitial space (bowmans space) --> Decrease in Plasma volume and Cardiac output --> Arterial hypervoluemia --> stimulation of RAAS --> Sodium and H2O retention --> Expansion of sodium space --> Odema

17

Relationship b/w Lipids and cholesterol and Nephrotic syndrome

2. Reduced metabolism (VLDL - LDL) --> Increased Tryglycerides
5. Low plasma oncotic pressure --> Increased lipoprotein production by liver --> increased cholesterol production --> hypercholesterolemia --> increase risk of vascular disease

18

Thrombolism

Risk factor of Nephrotic Syndrome
Pathophysiology not well understood (Risk 10%)
Nephrotic syndrome --> increase risk of DVT and pulmonary emboli --> clot in leg/femoral artery --> swollen, red and painful --> risk of embolus --> travels to lungs --> right heart failure --> death

19

Infection

Reduced antibody production and decreased complement pathway
Increased bacterial infection and chicken pox in children

20

Protein malnutrition

Risk in nephrotic syndrome/ Microalbuminuria / proteinuria
Protein malnutrition --> wasted, lost weight and unwell

21

Diabetic Neuropathy

Increased lumps of matrix int he glomerulus = leakage of protein into the urine
Type I Hyperglycaemia --> high serum glucose --> increased GFR/hyperfiltration due to high hydrostatic pressure
- IF have good glycaemic and BP control can have normal GFR w/o protein leaking
BUT Low GFR --> leak protein into urine Preceding decline due to kidney damage/Nephrotic syndrome
** graph

22

CKD

Often due to glomerular disease
Other major cause is diabetes (would just have protein in blood)
Blood or protein in urine (only protein in DM)
CKFailure
Main treatment is controlling BP (ACE inhibitors)

23

AKI

Pre renal, renal, post renal
Rena; = intrinsic (specific to kidneys) AKI --> Acute Tubular necrosis (from prerenal/drugs) --> Acute glomerulonephritis --> may have proteinuria

24

Acute Tubular Necrosis

Due to:
1. Prerenal inadequate treatment
2. Drugs/toxins
No blood or protein in urine
Just decreased GFR (renal function) due to blocked filter

25

Acute Glomerulonephritis

= Rapidly progressive glomerulonephritis = Acute Renal Failre
Leaky glomeruli AND Blocked (fluid overload): Blood +/- protein
May have nephritic syndrome

26

Nephritic Syndrome

Occurs in Acute/Rapidly progressive glomerulonephritis/ Acute Renal failure
Leaky + Increased GFR
Fluid overload as only able to excrete a limited amount of fluid per day --> peripheral and pulmonary oedema
Symptoms/Signs:
1. Unwell
2. Oliguric
3. Hypertensive --> 4. Volume overload --> pulmonary/peripheral oedema
5. Signs of other Multi-System disease:
a) haemoptysis b) rash c) arthritis d) fever
6. MSU (blood/protein) --> Red Clast cells

27

Diagnosis of Nephritis syndrome/ Rapidly progressive/Acute Glomerulonephritis

1. Kidney Biopsy
2. Blood in urine (sometime protein)
--> Red Clast cells = Broken down RBC all clumped together

28

Nephrotic syndrome vs nephritic syndrome

NephrOtic syndrome: Oedema, Proteinuria, Hypoalbuminuria, Renal Function/GFR can be normal or impaired
Nephritic syndrome: ARI, Hypertension --> Fluid overload --> Pulmonary and peripheral oedema, RBC in urine --> Clast cells (damaged RBC cell clumps) in blood sample

29

Haematuria

Micro - in most people
Macro - clots if severe
Note: If blood in urine --> NEED TO EXCLUDE CANCER
- high chance is catch early

30

Origins of Haematuria

Bleeding from somewhere in urinary tract:
1. Glomerular (e.g. glomerulonephritis)
2. Collecting System (tumour/stone)
3. Focal lesion (ureters/stone/bladder/urethra)