Proteinuria

Pathophysiology, Diagnosis, and Management of Proteinuria – JAAPA

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KEY POINTS

Microalbuminuria tends to occur long before clinical proteinuria becomes evident.

Proteinuria results when the glomerular basement membrane allows excess proteins into the tubular filtrate and when the proximal tubules are unable to reabsorb low-molecular-weight proteins.

False-negative dipstick results may occur if the urine is dilute or if protein loss is mild.

Correlation between the urine protein-creatinine ratio (UPCR) and the 24-hour urine collection has been demonstrated in several diseases, and recent evidence indicates that the UPCR ratio is more accurate than the 24-hour measurement.

The albumin-to-creatinine ratio is more sensitive than the UPCR.

Renal biopsy should be considered in adults with persistent proteinuria because results are likely to guide specific therapy.

via The pathophysiology, diagnosis, and management of proteinuria – JAAPA.

MKSAP: 22-year-old man with T1DM

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Key Point  -Because factors such as fever and exercise can cause a transient increase in protein excretion, patients with type 1 diabetes mellitus who have abnormal findings on annual measurement of the urine albumin excretion should undergo repeat urinalyses twice within the next 6 months; positive findings on two of the three urine samples would confirm a diagnosis of microalbuminuria defined as a urine albumin-creatinine ratio between 30 and 300 mg/g.

via MKSAP: 22-year-old man with type 1 diabetes mellitus.