复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）肾与尿路_Glomerular disease

Glomerular proteinuria Sustained proteinuria 1-2g/24hour Heavy proteinuria >3.5g/24hour, nephrotic syndrome I Non-selective- Adults Albumin and a mixture of other plasma proteins Selective- children Albumin Minimal change disease

Glomerular proteinuria  Sustained proteinuria > 1-2g/24hour  Heavy proteinuria >3.5g/24hour, nephrotic syndrome  Non-selective - Adults  Albumin and a mixture of other plasma proteins  Selective – children  Albumin  Minimal change disease

Benign proteinuria Non-sustained, generally <1g/24hour Functional or transient proteinuria d Fever Orthostatic proteinuria d EXercise Obesity Sleep apnea Emotional stress Congestive heart failure

Benign proteinuria  Non-sustained, generally <1g/24hour  Functional or transient proteinuria  Fever  Exercise  Obesity  Sleep apnea  Emotional stress  Congestive heart failure  Orthostatic proteinuria

EVALUATION OF PROTEINURIA URINE DIPSTICK PROTEINURIA Quantify 24-h excretion, or spot moming protein/creatinine ratio(mg/g) 30-300 mg/d or 300-3500 mg/d or>3500 mg/d or 30350mgg 300-3500mgg >3500mgg Microalbuminuria RBCs or RBC casts on urinalysis Go to Fig 45-2 Consider In addition to disorders listed Nephrotic syndrome Early diabetes under microalbuminuria conside Diabetes Essential hypertension Intermittent proteinuria Amyloidosis Early stages of Postural proteinuria Minimal change disease glomerulonephritis Congestive heart failure FSGS (especially with RBCs,Fever Membranous glomerulopathy RBC casts Exercise MPGN UPEP Glomerular Tubular Abnormal proteins Tamm-Horsfall Light chains B2-microglobulin (x or a) Selective(mostly Nonselective(reflects Tubular injury, any cause Plasma cell albumin;e.g, minimal all plasma proteins; Hypertension dyscrasias change disease e.g,FSGS, diabetes) Chronic renal failure HPIM 17e

HPIM 17e

Pyuria Urinary tract infection u Bacteria u Virus Tubculosis Active inflammation of glomerulus interstitium Acute poststreptococcal glomerulonephritis Membranoproliferative glomerulonephritis MPGN Lupus a Allergy

Pyuria  Urinary tract infection  Bacteria  Virus  Tubculosis  Active inflammation of glomerulus / interstitium  Acute poststreptococcal glomerulonephritis  Membranoproliferative glomerulonephritis (MPGN)  Lupus  Allergy

⊙ RBCs in the urine, isomorphic Round or biconcave, or crenated with regular spikes

RBCs in the urine, isomorphic Round or biconcave, or crenated with regular spikes