the importance of proteinuria W1

Question 1

spelling?!!?!!!!

Answer 1

proteinuria (not urea)

Question 2

what important proteins do the kidneys make

Answer 2

erythropoietin (epo)
active vitamin D
renin

Question 3

function of erythropoietin

Answer 3

hormone which stimulates the bone marrow to produce red blood cells

Question 4

what is proteinuria a cardinal sign of?

Answer 4

kidney disease

Question 5

when should testing for proteinuria be carried out?

Answer 5

any routine medical consultation
oedema
part of care of patients with hypertension, diabetes mellitus etc
if a systemic disease is possible

Question 6

oedema features

Answer 6

ascites (oedema in abdomen)
pleural effusions

Question 7

what does colour coding on test strips show you when testing for proteinuria?

Answer 7

trace
1+
2+
3+
4+

Question 8

what does 2+ proteins in urine imply

Answer 8

implies intrinsic renal disease and very unlikely to be explained by asymptomatic infection

Question 9

why is the albumin/creatinine ratio used?

Answer 9

accurately correct for eg volume, concentration

Question 10

albumin?

Answer 10

protein which doesn’t usually appear in the urine in significant quantities

Question 11

units for albumin/creatinine ratio? what can this be performed on?

Answer 11

mg/mmol
performed on small urine sample taken any time of the day

Question 12

what approximates the amount of albumin in 24 hours

Answer 12

ACR (albumin creatinine ratio) x10 approximates to mg of albumin in 24 hours

Question 13

ACR levels meaning?

Answer 13

<3.5 is normal
3.5-30 = microalbuminuria
>30 = (macro)albuminuria

Question 14

measurements of excretory renal function?

Answer 14

plasma/serum creatinine
estimated GFR (MDRD formula - sex, age, race, creatinine)
creatinine clearance (creatinine in blood compared to excreted but old fashioned)
isotope GFR (inject radioactive isotope, very formal)

Question 15

what do different creatinine measures mean for different people?

Answer 15

if its high in elderly, female, slim then more of an indicator of low GFR than if its high in muscular, young, male as creatinine is a breakdown product of muscle.

Question 16

what does the number of functioning nephrons decrease with? which ethnicities may have fewer nephrons?

Answer 16

number of functioning nephrons decreases with age
Black and Asian people may have fewer nephrons

Question 17

congenital nephrotic syndrome?

Answer 17

massive leakage of protein into urine.
ascites
can be kept alive with dialysis
may need kidneys removed (will need dialysis, transplant)

Question 18

what is congenital nephrotic syndrome due to

Answer 18

mutation in podocyte specific gene eg nephrin

Question 19

asymptomatic 50 yr old man with ++ protein and ++ blood - investigations?

Answer 19

BP
test for diabetes
quantify proteinuria
check kidney function
renal ultrasound
renal biopsy?

Question 20

what does the presence of blood and protein in the urine imply

Answer 20

glomerular disease - therefore urgent need to test excretory kidney function.
consider systemic diseases (eg vasculitis, lupus)

Question 21

what does albuminuria imply in diabetes and hypertension

Answer 21

in diabetes - earliest feature of diabetic nephropathy
in hypertension - suggests primary renal cause

Question 22

albuminuria and cardiovascular disease?

Answer 22

albuminuria is a potent independent cardiovascular risk factor in both diabetic and non-diabetic populations and aggressive management of cardiovascular risk is indicated.

Question 23

16 year old female with recent onset of severe body swelling - investigations?
treatment?

Answer 23

BP
test for diabetes/other systemic diseases
quantify proteinuria
check kidney function
renal ultrasound
renal biopsy

treatment - corticosteroids, other drugs

Question 24

nephrotic syndrome features?

Answer 24

oedema
heavy proteinuria
hypoalbuminaemia

Question 25

nephrotic syndrome - features not included in definition but still clinically important?

Answer 25

thrombotic risk propensity to infection often severe hyperlipidaemia

Question 26

what may/may not nephrotic syndrome be associated with

Answer 26

impairment of excretory kidney function

Question 27

symptoms of nephrotic syndrome

Answer 27

severe lethargy reduced exercise tolerance nausea loss of appetite

Question 28

causes of nephrotic kidney syndrome

Answer 28

glomerulonephritis diabetes infections (hep B/C, malaria, HIV) amyloid (deposition in glomeruli)

Question 29

20 year old woman with short history of rash and painful small joints in both hands and feet. +protein, +++blood what does this indicate?

Answer 29

increased blood over protein indicates inflammation in glomerulus - glomerular nephritis

Question 30

ANCA?

Answer 30

anti-neutrophil cytoplasm antibody

Question 31

what does haematuria indicate?

Answer 31

haematuria, whether visible (macroscopic) or non-visible (microscopic) can be a sign of a serious systemic disease for which diagnosis and treatment is very urgent, whether or not there is also albuminuria

Question 32

diseases where the glomerulus is damaged?

Answer 32

rare genetic/developmental disorders diabetes mellitus vascular disease/ischaemia/age vasculitis (isolated/systemic) inflammation of glomerulus itself (glomerulonephritis) deposition diseases (eg amyloid, myeloma)