Nephr|t|c and nephr|t|c syndrome

O normal urlne proLeln 130mg/day

O ncresead amounLs can lndlcaLe renal dlsease such as glomerulpnephrlLls
O lpsLlck LesLlng for albumln only
4 oesn'L deLecL paLhologlcal proLelns such as bence [ones
O ,lcroalbumlnurla ls an early slgn of dlabeLlc nephropaLhy
O need Lo look for slgns of renal dlsease ln paLlenLs
O @n odema on examlnaLlon
O ssessmenL
4 erum creaLlnlne and elecLrolyLes
4 hr urlne collecLlon and hr proLeln collecLlon
4 Drlne proLeln creaLlnlne raLlo
O osses of over 4Sg]day nephrot|c syndrome

O Nephrot|c syndrome

O 9roLelnurla

O ypoalbumlnaemla (30g)


O 9erlpheral odema
O ypercholesLerolaemla

O aemaLurla ls rare

O normal 89

O nvesLlgaLlons



O lso have D and renal blopsy
O auses

4 lomeular dlsease
,lnlmal change n commonesL ln chlldren and adulLs
,embranous nephropaLhy
9rollferaLlve n

4 dlopaLhlc 8090
4 nfecLlon assoclaLed
Lrp
ep b and c
I
,alarla
chlsLosomlasls
4 rugs
old
n
9enlclllamlne
4 uLolmmune

9
4 ,eLabollc
labeLes
enal amylold myeloma
4 ,allgnancy
a bronchus
a guL

@reaLemenL of mlnlmal change dlsease
Lerold responslve
O 9rednlsolone for 3 mnLhs ln chlldren longer ln adulLs
O yclophosphamlde for 8 weeks lf replase wlLh preds
O yclosporlne


Causes of ProteInurIa
2

TransIent proteInurIa
O 2otIonaI stress.
O ExercIse.
O ever.
O &rInary tract InfectIon.
O rthostatIc (postural) proteInurIa*.
O $eIzures.
O !ersIstent proteInurIa.
PrI2ary gIo2eruIar causes
O ocal segmental gIo2eruIonephrItIs.
O gA nephropathy (I.e. 8erger's dIsease).
O g| nephropathy.
O e2-ranoproIIferatIve gIo2eruIonephrItIs.
O |embranous nephropathy.
O InI2aI change dIsease.
$econdary gIo2eruIar causes
O AIport's syndro2e.
O A2yIoIdosIs.
O $arcoIdosIs.
O rugs (e.g. non-steroIdaI antI-InfIa22atory drugs (NSAs), penIcIIIa2Ine,
goId, angIotensIn-convertIng enzy2e (AC InhI-Itors).
O Anderson-Fa-ry dIsease.
O $IckIe ceII dIsease.
O |alIgnancIes (e.g. Iy2pho2a, solId tumours).
O nfectIons (e.g. ', syphIIIs, hepatItIs, poststreptococcal InfectIon).
Tu-uIar causes
O A2InoacIdurIa.
O rugs (e.g. NSAs, antIbIotIcs).
O FanconI's syndro2e.
O eavy metal IngestIon.
verfIow causes
O ae2ogIo-InurIa.
O uItIpIe 2yeIo2a.
O yogIo-InurIa.
ther I2portant causes (IIkeIy to have 2uItIpIe pathoIogIes
O Pre-ecIa2psIaeclampsIa.

Iseases outsIde the kIdney that can cause proteInurIa Include:
O Iabetes mellItus
O ConnectIve tIssue dIseases
O 'ascuIItIs
O AmyloIdosIs
O |yeloma
O CongestIve cardIac faIIure
O ypertensIon

|gns and symptoms
O 9roLelnurla ls usually asympLomaLlc alLhough paLlenLs may complaln of some froLhlness of
Lhelr urlne
O eavy and perslsLenL proLelnurla resulLs ln hypoalbumlnaemla @hls may produce ankle
swelllng abdomlnal paln and breaLhlessness
O 9aLlenLs wlLh asympLomaLlc proLelnurla usually have no slgns buL ln more severe cases
(such as wlLh nephroLlc syndrome) Lhere may be oedema asclLes hydroceles and pleural
effuslons as a resulL of decreased oncoLlc pressure
O @he nephroLlc syndrome conslsLs of proLelnurla hypoalbumlnaemla and oedema
O @here may also be sympLoms and slgns relaLlng Lo Lhe underlylng cause
O
nephrlLlc syndrome
O eamaLurla
O 9roLelnurla mlld
O luld reLenLlon
4 dema
4 llgourla
4 yperLenslon
O educed can produce uraemla needs dlalysls
O lalysls more llkely Lhan ln nephroLlc syndrome

O @reaLmenL
4 ce lnhlblLors for @n LreaL aggreslvley
4 lalysls