Proteinuria

24th June 2011Rachel Lennon

The Spectrum of Glomerular Disease

Minimal change

Proteinuria

FSGS

IgA nephropathyMembranous

Diabetic nephropathy

MCGN

SLE

Post infectious nephritis

Anti-GBM disease

Small vessel vasculitis

Endothelial cells

Podocyte

GBM

1 million in each adult human kidney

Glomerular filtration barrier

Podocytes

Glomerular endothelial cells

GBM

180 litres of water and small solutes- almost no

proteins

Slit diaphragm

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

• 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