Proteinuria is the presence of excess protein in the urine. In healthy people, urine contains little protein; The excess is suggestive of the disease. Excess protein in the urine often causes urine to become foamy, although foamy urine can also be caused by urinary bilirubin (bilirubinuria), retrograde ejaculation, pneumaturia (urinary air bubbles) due to fistulas, or drugs such as pyridium.
Video Proteinuria
Cause
There are three main mechanisms for causing proteinuria:
- Because of the disease in the glomerulus
- Due to the increase in protein quantity in serum (abundant proteinuria)
- Because of the low reabsorption of the proximal tubule (Fanconi syndrome)
Proteinuria can also be caused by certain biological agents, such as bevacizumab (Avastin) used in the treatment of cancer. Excessive fluid intake (drinking more than 4 liters of water per day) is another cause.
Also administering leptin for the normotensive Sprague Dawley rat during pregnancy significantly increases urinary protein excretion.
Proteinuria may be a sign of kidney damage (kidney). Since serum proteins are readily reabsorbed from the urine, the presence of excess protein indicates insufficient absorption or impaired filtration. Diabetics may have damaged the nephrons and developed proteinuria. The most common cause of proteinuria is diabetes, and in everyone with proteinuria and diabetes, the underlying cause of proteinuria should be separated into two categories: diabetic proteinuria versus field.
With severe proteinuria, generalized hypoproteinemia may develop which leads to reduced oncotic pressure. Symptoms of reduced oncotic pressure may include ascites, edema and hydrothorax.
Conditions with proteinuria as a sign
Proteinuria may be a feature of the following conditions:
- Nephrotic syndrome (ie intrinsic renal failure)
- Pre-eclampsia
- Eclampsia
- Renal toxic lesions
- Amyloidosis
- Vascular collagen disease (eg systemic lupus erythematosus)
- Dehydration
- Glomerular diseases, such as membranous glomerulonephritis, segmental focal glomerulonephritis, minimal change disease (lipoid nephrosis)
- Weight training
- Stress
- Benign orthostatic proteinuria (postural)
- Focal segmental glomerulosclerosis (FSGS)
- IgA nephropathy (ie Berger's disease)
- IgM nephropathy
- Membranoproliferative glomerulonephritis
- Skipping nephropathy
- Minimal change diseases
- Sarcoidosis
- Alport Syndrome
- Diabetes mellitus (diabetic nephropathy)
- Drugs (eg NSAIDs, nicotine, penicillamine, lithium carbonate, gold and other heavy metals, ACE inhibitors, antibiotics, or opiates (especially heroin)
- Fabry's Disease
- Infection (eg HIV, syphilis, hepatitis, poststreptococcal infection, urinary schistosomiasis)
- Aminoaciduria
- Fanconi's syndrome in relation to Wilson's disease
- Hypertensive nephrosclerosis
- Interstitial nephritis
- Sickle cell disease
- Hemoglobinuria
- Multiple myeloma
- Mioglobinuria
- Organ rejection:
- Ebola virus disease
- Patella nail syndrome
- Familial Mediterranean Fever
- HELLP syndrome
- Systemic lupus erythematosus
- Granulomatosis with polyangiitis
- Rheumatoid arthritis
- Type 1 glycogen storage disease
- Goodpasture Syndrome
- Henoch-SchÃÆ'¶nlein purpura
- Urinary tract infections that have spread to the kidney (s)
- SjÃÆ'¶gren's Syndrome
- Postinfectious glomerulonephritis
- Kidney donor live
- Polycystic kidney disease
The condition with proteinuria consists primarily of Bence-Jones protein as a sign
- Amyloidosis
- Pre-malignant plasma cell diskma:
- Monoclonal Gammopathy of Uncertain Significance
- Smoldering multiple myeloma
- Malignant plasma cell discrasia
- Multiple myeloma
- Waldenstrom macroglobulinemia
- Other malignancies
- Chronic lymphocytic leukemia
- A rare case of other lymphoid leukemia
- A rare case of Lymphomas
Maps Proteinuria
Diagnosis
Conventionally, proteinuria is diagnosed by simple dye tests, although it is possible for tests to provide false negative readings, even with the nephrotic range proteinuria if urine is dilute. False negatives can also occur if the protein in the urine consists primarily of globulin or Bence Jones proteins because the reagents on the test strip, blue bromophenol, are very specific for albumin. Traditionally, the dipstick protein test will be measured by measuring the total amount of protein in a 24-hour urine collection test, and abnormal globulins with specific demand for protein electrophoresis. Trace results can be generated in response to Tamm-Horsfall mopin excretion.
A recently developed technology detects human serum albumin (HSA) through the use of liquid crystals (LCs). The presence of HSA molecules interferes with LCs supported on the AHSA-decorated slides to produce a bright, optical signal that is easily distinguishable. Using this test, HSA concentrations as low as 15 Âμg/mL can be detected.
Alternatively, protein concentrations in urine can be compared with creatinine levels in spot urine samples. This is called the protein/creatinine ratio. Guidelines for Chronic Kidney Disease UK 2005 stated the protein/creatinine ratio is a better test than the 24-hour urine protein measurement. Proteinuria is defined as a protein/creatinine ratio greater than 45 mg/mmol (equivalent to an albumin/creatinine ratio greater than 30 mg/mmol or about 300 mg/g) with a very high proteinuria content of more than 100%. mg/mmol.
The dipstick protein measurements should not be equated with the amount of protein detected in the test for microalbuminuria showing urinary protein values ​​in mg/day versus the dipstick value of urine protein showing values ​​for proteins in mg/dL. That is, there is a basal level of proteinuria that can occur below 30 mg/day that is considered non-pathological. The value between 30-300 mg/day is called microalbuminuria which is considered pathological. Laboratory value of urine protein for microalbumin & gt; 30 mg/day corresponding to detection rates in the range of "traces" to "1" of the urine dipstick protein test. Therefore, a positive indication of any detectable protein on a urine dipstick test eliminates the need to perform a urine microalbumin test because the upper limit for microalbuminuria has been exceeded.
Analysis
It is possible to analyze the urine sample in determining albumin, hemoglobin and myoglobin with the optimized MEKC method.
Treatment
Treating proteinuria especially requires a proper diagnosis of the cause. The most common cause is diabetic nephropathy; in this case, appropriate glycemic controls can slow progress. Medical management consists of angiotensin converting enzyme (ACE) inhibitors, which are usually first-line therapy for proteinuria. In patients with uncontrolled proteinuria with ACE inhibitors, the addition of an aldosterone antagonist (ie, spironolactone) or angiotensin receptor blocker (ARB) may reduce further protein loss. Caution should be used if the agent is added to ACE inhibitor therapy because of the risk of hyperkalemia. Secondary proteinia for autoimmune disease should be treated with steroids or steroid-sparing agents plus use of ACE inhibitors.
See also
- Albuminuria
- Microalbuminuria
- Glossary related to diabetes
- Toxicity of protein
- The main urine protein
References
Source of the article : Wikipedia
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