Proteinuria – early indicator of renal disease
Increases the risk of renal impairment, hypertension & cardiovascular disease.
Proteinuria of 1+ or more persisting on 2 subsequent dipstick tests at weekly intervals – requires further investigations.
Causes of transient proteinuria to be excluded
(Rocky) Jaipur Call Girl - 9521753030 Escorts Service 50% Off with Cash ON De...
Proteinuria
1. Proteinuria
Dr. Sachin Verma MD, FICM, FCCS, ICFC
Fellowship in Intensive Care Medicine
Infection Control Fellows Course
Consultant Internal Medicine and Critical Care
Ivy Hospital Sector 71 Mohali
Web:- http://www.medicinedoctorinchandigarh.com
Mob:- +91-7508677495
2. Proteinuria – early indicator of renal disease
Increases the risk of renal impairment,
hypertension & cardiovascular disease.
Proteinuria of 1+ or more persisting on 2
subsequent dipstick tests at weekly intervals –
requires further investigations.
Causes of transient proteinuria to be excluded.
3. CAUSES
Transient proteinuria
UTI
Fever
Heavy exercise
Pregnency
Orthostatic proteinuria - not found in early morning
sample, uncommon over age of 30 yrs
Vaginal mucus
5. Evaluation
History
Symptoms of renal failure
CTD – arthralgia, mouth ulcers, rashes.
Past h/o DM, HTN, CCF, CTD
H/O drugs ass. with proteinuria – NSAIDs,
captopril, penicillamine
Family h/o PCKD, reflux nephropathy, CTD.
6. Examination
Look for signs of Nephrotic syndrome
Signs of multisystem dis – rashes, splinter
haemorrhage, bruits.
B.P
Urine dipstick test to check for microscopic
haematuria – if + go for urine microscopy.
Rule out Diabetes and UTI
7. Quantification of proteinuria
24 hr urinary collection
Spot morning protein/creatinine ratio – simpler & as
accurate.
24 hr urinary protein excretion (mg/24hrs) can be
approximated as (mg/l protein) / ( mmol/l creatinine)
× 10 or (mg/l creatinine ) × 100.
More than 150 mg in 24 hr or protein to creatinine
ratio of 15 mg/mmol or 150 mg/mg is abnormal
Nephrotic range - >3.5 g/24 hr or a ratio > 3500 -
check for serum albumin and cholesterol.
8. Assessment of renal function
Check serum creatinine, urea, electrolytes.
Creatinine clearance gives more accurate
picture of renal function than creatinine alone,
can be calculated by Cockcroft- Gault formula.
Best to estimate GFR by MDRD formula
GFR or creatinine clearance > 90ml/min can
be considered normal. Lower values may be
normal in old age and in people with low
muscle mass.
9. Significant proteinuria > 100 mg/mmol
although values > 50 may be significant if
other features of renal disease are present like
Impaired renal function
Coexistant microscopic haematuria
Hypertension
Features underlying systemic disease.
10. Further investigations
Renal tract USG
Immunology
Serum and urine protein electrophoresis
ANA
ANCA
Complements
Hepatitis B & C serology
11. Follow-up
Review after six months and then annualy to
reassess quantity of proteinuria, renal function
and blood pressure.
Any hypertension if present – to be treated
aggressively with an ACE inhibitor or ARB.