57 PROTEINURIA General Discussion Proteinuria is a frequent finding on dipstick testing of urine specimens, yet fewer than 2% of these represent serious and treatable urinary tract disorders. Proteinuria is defined as urinary protein excretion of greater than 150 mg per day and can be classified pathophysiologically as glomerular, tubular, or overflow. Causes of false-positive results include prolonged immersion of the dipstick, highly concentrated urine, alkaline urine, gross hematuria, the use of penicillin, sulfonamides, or tolbutamide, or the presence of semen, vaginal secretions, or pus. If proteinuria is found on a dipstick urinalysis, the urinary sediment should be examined microscopically. Findings on the microscopic urinalysis are outlined below. If the dipstick urinalysis shows trace to 2 + protein and the results of the microscopic urinalysis are inconclusive, the dipstick test should be repeated on a morning specimen at least twice during the next month. If a subsequent dipstick test is negative, the patient has transient proteinuria, which is associated with high fevers, hard exercise, and CHF. Transient proteinuria does not require follow-up. If the dipstick urinalysis shows persistent proteinuria or if proteinuria of 3+ or 4+ is found, the evaluation should proceed to a quantitative evaluation of a specimen. Quantitative measurement of protein excretion can be performed with a urine protein:creatinine ratio in a random urine specimen or a 24-hour urine specimen. Persons younger than 30 years who excrete less than 2 grams of protein per day and who have a normal creatinine clearance should be tested for orthostatic (postural) proteinuria. This is a benign condition associated with prolonged standing that is confirmed with a negative urinalysis result after 8 hours of recumbency. The diagnosis of isolated proteinuria can be made in a patient who has proteinuria less than 2 grams per day with normal renal function, no evidence of systemic disease affecting renal function, a normal urine sediment, and normal blood pressure. These patients should be observed with blood pressure measurement, urinalysis, and creatinine clearance every 6 months. An adult with proteinuria greater than 2 grams per 24 hours or with proteinuria and decreased creatinine clearance requires aggressive work-up in consultation with a nephrologist. If the creatinine clearance is normal and the patient has a medical diagnosis such as CHF or diabetes mellitus, the underlying disease can be treated with close monitoring of the proteinuria and renal function. A consultation with a nephrologist should be considered if the renal function or amount of proteinuria changes. Causes of Proteinuria Overflow proteinuria • Amyloidosis • Hemoglobinuria • Multiple myeloma • Myoglobinuria Primary glomerular causes • Focal segmental glomerulonephritis • Idiopathic membranous glomerulonephritis • IgA nephropathy • IgM nephropathy • Membranoproliferative glomerulonephritis • Membranous nephropathy • Minimal change disease Secondary glomerular causes • Alport’s syndrome • Amyloidosis • Diabetes mellitus • Drugs – ACE inhibitors – Gold – Heavy metals – Heroin – Lithium Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM TRANSAMINASE ELEVATION Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on PROTEINURIA Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access
57 PROTEINURIA General Discussion Proteinuria is a frequent finding on dipstick testing of urine specimens, yet fewer than 2% of these represent serious and treatable urinary tract disorders. Proteinuria is defined as urinary protein excretion of greater than 150 mg per day and can be classified pathophysiologically as glomerular, tubular, or overflow. Causes of false-positive results include prolonged immersion of the dipstick, highly concentrated urine, alkaline urine, gross hematuria, the use of penicillin, sulfonamides, or tolbutamide, or the presence of semen, vaginal secretions, or pus. If proteinuria is found on a dipstick urinalysis, the urinary sediment should be examined microscopically. Findings on the microscopic urinalysis are outlined below. If the dipstick urinalysis shows trace to 2 + protein and the results of the microscopic urinalysis are inconclusive, the dipstick test should be repeated on a morning specimen at least twice during the next month. If a subsequent dipstick test is negative, the patient has transient proteinuria, which is associated with high fevers, hard exercise, and CHF. Transient proteinuria does not require follow-up. If the dipstick urinalysis shows persistent proteinuria or if proteinuria of 3+ or 4+ is found, the evaluation should proceed to a quantitative evaluation of a specimen. Quantitative measurement of protein excretion can be performed with a urine protein:creatinine ratio in a random urine specimen or a 24-hour urine specimen. Persons younger than 30 years who excrete less than 2 grams of protein per day and who have a normal creatinine clearance should be tested for orthostatic (postural) proteinuria. This is a benign condition associated with prolonged standing that is confirmed with a negative urinalysis result after 8 hours of recumbency. The diagnosis of isolated proteinuria can be made in a patient who has proteinuria less than 2 grams per day with normal renal function, no evidence of systemic disease affecting renal function, a normal urine sediment, and normal blood pressure. These patients should be observed with blood pressure measurement, urinalysis, and creatinine clearance every 6 months. An adult with proteinuria greater than 2 grams per 24 hours or with proteinuria and decreased creatinine clearance requires aggressive work-up in consultation with a nephrologist. If the creatinine clearance is normal and the patient has a medical diagnosis such as CHF or diabetes mellitus, the underlying disease can be treated with close monitoring of the proteinuria and renal function. A consultation with a nephrologist should be considered if the renal function or amount of proteinuria changes. Causes of Proteinuria Overflow proteinuria • Amyloidosis • Hemoglobinuria • Multiple myeloma • Myoglobinuria Primary glomerular causes • Focal segmental glomerulonephritis • Idiopathic membranous glomerulonephritis • IgA nephropathy • IgM nephropathy • Membranoproliferative glomerulonephritis • Membranous nephropathy • Minimal change disease Secondary glomerular causes • Alport’s syndrome • Amyloidosis • Diabetes mellitus • Drugs – ACE inhibitors – Gold – Heavy metals – Heroin – Lithium Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM TRANSAMINASE ELEVATION Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on PROTEINURIA Full access? Get Clinical Tree
