1 / 16

Proteinuria and Haematuria – an update

Proteinuria and Haematuria – an update. Alex Heaton 11.02.2009. What is normal?. Normal 80 +/- 25 mg/day (<150 mg is quoted as upper normal limit). Adolescents up to 300 mg/day ( ♀ 10-16 years, ♂ 12-18 years). Measurements of proteinuria. Dipstick tests 24 hour urinary protein

chace
Télécharger la présentation

Proteinuria and Haematuria – an update

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Proteinuria and Haematuria – an update Alex Heaton 11.02.2009

  2. What is normal? • Normal 80 +/- 25 mg/day (<150 mg is quoted as upper normal limit). • Adolescents up to 300 mg/day (♀ 10-16 years, ♂ 12-18 years)

  3. Measurements of proteinuria • Dipstick tests • 24 hour urinary protein • Urine protein/creatinine ratio • Urine albumin/creatinine ratio

  4. Why bother testing urine? • Detection of renal disease • Cardiovascular risk factor

  5. Clinical significance of proteinuria Proteinuria on dipstick in healthy patient  ? Any systemic disease, e.g hypertension, diabetes mellitus  likely renal disease  >1 gram a day  likely renal disease  >3.5 g/day  likely glomerular disease

  6. Protein in urine – what next? • establish persistent proteinuria • clinical assessment • interpreting test results

  7. Step 1. Establish persistent proteinuria proteinuria (1+ or more) ↓ exclude urinary infection ↓ repeat urinalysis after at least one week ↓ ↓ 1+ or more continue trace or negative – no action

  8. Step 2. Initial assessment if persistent proteinuria 1+ or more • send early morning urine for albumin/creatinine ratio • blood tests: U & E’s, fasting glucose, cholesterol and albumin • Check blood pressure

  9. Step 3: What to do with an albumin/creatinine(mg/mmol) result • <5 within reference range • 5-30 does not indicate renal disease but consider cardiovascular risk factors • 31-70 check 6 monthly blood pressure and ACR. No need to refer to nephrology unless patient also has haematuria, severe hypertension, eGFR <60 or a systemic disease • >70 refer to Nephrology

  10. Proteinuria - summary • urine protein testing is worthwhile (vs blood) • use dipstix to decide when to test further • albumin : creatinine ratio instead of 24 hour collection. • use ACR to decide who to refer

  11. Haematuria • frank haematuria – high yield on investigation • microscopic haematuria + symptoms – high yield - symptoms – low or very low yield

  12. Microscopic haematuria • trace blood + no symptoms – no investigation • 1+ or more, confirmed on repeat testing – investigate/refer?

  13. Urology Referral • male • >40 years • smoker • industrial exposure to hydrocarbons • chemotherapy = cystoscopy

  14. Renal referral • eGFR < 60 • proteinuria (ACR >30) • hypertension • family history = nephrology

  15. What tests? • eGFR • plain urinary tract X-ray • ultrasound • ? urine microscopy ? cytology

  16. Summary - haematuria • try to avoid testing asymptomatic patients • most asymptomatic patients do not need referral? • limited benefit from renal referral unless specific indication.

More Related