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This book describes Proteinuria, Diagnosis and Treatment and Related Diseases.Proteinuria indicates the leakage of protein in the urine.It is often defined as a quantity in excess of 300 mg per day.Proteinuria is linked with cardiovascular and renal disease and is an indicator of end organ damage in patients with hypertension.The detection of a rise in protein excretion is believed to have both diagnostic and prognostic effect in the early detection and confirmation of renal diseaseProtein should not normally pass out in the urine in detectable quantities.Micro-albuminuriaMicro-albuminuria is protein between 30 and 300 mg per 24 hours.This may occur with diabetes.Bence-Jones proteinBecause it may occur with multiple myeloma, this may also not be detectable on standard dipstick testing.These are the light chains of immunoglobulins.AlbuminuriaThis is often the same as proteinuria:While plasma contains both albumin and globulin, the latter tends less likely to appear in the urine.If the filtration system of the glomeruli may be regarded as like a sieve or a mesh then small holes or tears will allow larger particles than normal to pass through.The smaller rather than the larger of the particles will normally be retained back, unless damage is severe.With mild or moderate damage, smaller proteins such as albumin will pass and only with severe injury will globulins pass.CausesWith a healthy kidney, when the body removes waste, protein is kept in the blood stream.This is because protein in the blood is too large to pass through the tiny holes in the kidney filters.When the filter is damaged in kidney disease, protein can pass into the urine.Protein in the urine can be a marker of almost any type of kidney disease, so investigations are always required if the cause of proteinuria is to be confirmed:1.High blood pressure2.Infection3.Reflux nephropathy4.Diabetes5.Glomerulonephritis6.Minimal change nephritisSome people get more protein into urine while standing than while lying down.That is called orthostatic proteinuria.SymptomsNormally there are no symptoms, but protein can be found by a routine urine test.Patients with asymptomatic proteinuria normally have no physical signsIn more serious cases (nephrotic syndrome) there may be:1.Edema,2.Ascites,3.Hydroceles4.Pleural effusionsDiagnosisA urine sample is analysed the levels of protein and creatinine (protein-creatinine ratio or PCR for short)It is more usual to test for albumin so the result is an albumin-creatinine ratio (ACR).An ACR of 3-30 does not normally require actionAn ACR of higher than 30 indicate considerable leakage of protein through the kidneys, and the higher the level the more concern, particularly if it is over 100The size and shape of the kidneys may be measured in the X-ray department with an ultrasoundFinally, to make a firm diagnosis of the cause of proteinuria, it is required to perform a kidney biopsyTreatmentProteinuria is not a specific disease.So its treatment is dependent on identifying and treating its underlying cause.In mild or temporary proteinuria, no treatment may be requiredMedicines are given for high blood pressure:1.ACE inhibitors2.ARBsTreatment is also given for Diabetes to avoid the progressive kidney damage causing the proteinuriaWater retention can be treated by reducing the amount of saltIf proteinuria is high >1.5 g a day, this is likely to need treatment by a specialist from the outset and further investigation may be:1.Urine microscopy.2.Glomerular filtration rate.3.Renal ultrasound.4.Possible intravenous urography.5.Possibly renal biopsyTABLE OF CONTENTIntroductionChapter 1 ProteinuriaChapter 2 CausesChapter 3 SymptomsChapter 4 DiagnosisChapter 5 TreatmentChapter 6 PrognosisChapter 7 Kidney FailureChapter 8 Nephrotic SyndromeEpilogue
