HEMATURIA Proteinuria(>500 mg/24 h) Dysmorphic RBCs or RBC casts Pyuria, WBC casts Urine culture Serologic and Urine eosinophils hematologic evaluation: blood cultures, anti-GBM antibody, ANCA complement levels Hemoglobin electrophoresis cryoglobulins, Urine cytology hepatitis B and c UA of family members serologies, VDRL 24 h urinary calcium/uric acid HIV, ASLO IVP +/-Renal As indicated: retrograde ultrasound Renal biopsy pyelography or arteriogram. or cyst aspiration
IVP +/-Renal As indicated: retrograde ultrasound pyelography or Renal biopsy arteniogram or cyst aspiration Cystoscopy Biopsy and evaluation Renal CT scan Open renal biopsy Follow perodic urinalysis Harrisons PIM 17e
Harrison’s PIM 17e
Proteinuria Asymptomatic Edematous or foamy urine on voiding Dipstick examination bur- Test ■ Sensitive to albumin Newly available ultrasensitive dipstick to detect microalbuminuria Not sensitive for non-albumin protein -Bence-Jones protein in multiple myeloma False positive when pH>7 False negative for very dilute urine
Proteinuria Asymptomatic Edematous or foamy urine on voiding Sensitive to albumin Newly available ultrasensitive dipstick to detect microalbuminuria Not sensitive for non-albumin protein – Bence-Jones protein in multiple myeloma False positive when pH>7 False negative for very dilute urine Dipstick examination
Urine albumin/protein detection 24 hour Dipstick 24 hour Albumin urine albumin creatinine proteinuria protein (mg/24h) (mg/24h) ratio(mg/g) Normal <150 8-10 <30 Micro- albuminuria/-/trace/1+ 30-300 30-300 Proteinuria Trace-3+>150 300 >300
Urine albumin/protein detection Dipstick proteinuria 24 hour urine protein (mg/24h) 24 hour albumin (mg/24h) Albumin / creatinine ratio (mg/g) Normal - <150 8-10 <30 Microalbuminuria -/trace/1+ - 30-300 30-300 Proteinuria Trace – 3+ >150 >300 >300
Proteinuria pattern a Urine protein electrophoresis a Glomerular plasma albumin, globulins, and other large molecular-weight proteins u Tubular Tamm-Horsfall, Iga, and urokinase a Abnormal Overproduction of abnormal proteins exceeding tubular reabsorption ability, eg, light chains in multiple meyloma, lymphoma, amyloidosis
Proteinuria pattern Urine protein electrophoresis Glomerular plasma albumin, globulins, and other largemolecular-weight proteins Tubular Tamm-Horsfall, IgA, and urokinase Abnormal Overproduction of abnormal proteins exceeding tubular reabsorption ability, eg, light chains in multiple meyloma, lymphoma, amyloidosis