Download Persistent proteinuria

Proteinuria
24th June 2011
Rachel Lennon
The Spectrum of Glomerular Disease
SLE
Minimal
change
IgA
nephropathy
Membranous
FSGS
Diabetic
nephropathy
Anti-GBM
disease
MCGN
Proteinuria
Post
infectious
nephritis
Small vessel
vasculitis
Endothelial cells
GBM
Podocyte
1 million in each
adult human kidney
Glomerular filtration barrier
180 litres of water and small
solutes- almost no proteins
Glomerular endothelial cells
GBM
Slit
diaphragm
Podocytes
Mundel et al: Kidney International 2010 77 (7) p571-80
Definition
• Protein:creatinine ratio (PCR)
– 20mg/mmol
– 200mg/mmol nephrotic range
• Albumin: creatinine ratio (ACR)
– 30mg/mmol
Case-1
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•
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13 year old boy
No PMH/FH renal disease
BP and renal function normal
Incidental finding
– Urinalysis: 2+protein
– Mild proteinuria (PCR 20-50)
• 3 early morning urines: PCR
• Orthostatic proteinuria
Case-2
• 5 year old boy
• BP and renal function normal
• Urinalysis 2+ protein, 2+ blood
–
–
–
–
PCR 40-50
ACR 20
Calcium:creatinine: 1.5mmol/mmol
USS: Nephrocalcinosis
• NAG/RBP:creatinine
• Dent’s disease: CLC5/OCRL-1 mutations
Case-3
• 8 year girl
– PMH: Bilateral VUR and recurrent UTI
– FH: VUR
• DMSA: Bilateral renal scarring
• BP normal, eGFR 65ml/min/1.73m2
• Urinalysis 2+ protein PCR 30-50
• Enalapril 5mg od
• Renal function before and at 2 weeks
• Reflux nephropathy
Case-4
•
•
•
•
•
•
8 year old girl
HSP
Urinalysis: Protein 3+, blood 2+
PCR 100-150: Persistent at 4 weeks
BP 95th centile
Normal renal function
• Renal biopsy: Crescentic GN, IgA deposition
• Steroids/Azathioprine/Enalapril
• HSP nephritis
Summary
• Investigate persistent proteinuria
– Orthostatic
– Tubular disease
– Nephropathy
• Use of anti-proteinuric agents to limit
secondary injury