java barcode scanner library A Proteinuria in Objective-C

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Proteinuria is defined as excessive protein excretion in the urine, generally greater than 150 160 mg/24 h in adults Significant proteinuria is a sign of an underlying renal abnormality, usually glomerular in origin when greater than 1 g/d It is typically accompanied by other clinical abnormalities elevated blood urea nitrogen (BUN) and serum creatinine levels, abnormal urinary sediment, or evidence of systemic illness (eg, fever, rash, vasculitis) There are four primary reasons for development of proteinuria: (1) Functional proteinuria is a benign process stemming from stressors such as acute illness, exercise, and orthostatic proteinuria The latter condition, generally found in people under age 30 years, results in the excretion of
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Urinalysis
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A urinalysis has been likened to a poor man s renal biopsy The urine is collected in midstream or, if that is not feasible, by bladder catheterization The urine should be examined within 1 hour after collection to avoid destruction of formed elements Urinalysis includes a dip-
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Copyright 2008 by The McGraw-Hill Companies, Inc Click here for terms of use
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biopsy may be indicated, particularly if the renal insufficiency is acute in onset The clinical consequences of proteinuria are discussed in the section on the nephrotic syndrome The benefit of a urine protein-to-creatinine ratio is the ease of collection and the lack of error from overcollection or undercollection In both diabetics and nondiabetics, therapy aimed at reducing proteinuria may also reduce progression of renal disease Angiotensin-converting enzyme (ACE) inhibitors are effective by lowering efferent arteriolar resistance out of proportion to afferent arteriolar resistance, thereby reducing glomerular capillary pressure and lowering urinary protein excretion Other effects include alterations of glomerular mesangial proliferation ACE inhibitors can be used in patients despite compromised GFR as long as significant hyperkalemia does not occur and serum creatinine rises less than 30% and stabilizes over 2 months Large randomized controlled trials (ie, the RENAAL and IDNT studies) have also proved the benefit of angiotensin II receptor blockers in reducing proteinuria and preventing progression of renal disease in diabetic nephropathy Recently, head-to-head comparisons of an ACE-I and an angiotensin receptor blocker (ARB) have shown the ARB to be no better than the ACE-I in preventing progression of renal disease in diabetic persons with proteinuria The consequences of dietary restrictions in patients with proteinuria are discussed in the section on chronic kidney disease
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Table 22 1 Significance of specific urinary casts
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Type Hyaline casts Significance Concentrated urine, febrile disease, after strenuous exercise, in the course of diuretic therapy (not indicative of renal disease) Glomerulonephritis Pyelonephritis, interstitial nephritis (indicative of infection or inflammation) Acute tubular necrosis, interstitial nephritis Nonspecific; can represent acute tubular necrosis Chronic renal failure (indicative of stasis in enlarged collecting tubules)
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Red cell casts White cell casts Renal tubular cell casts Coarse, granular casts Broad, waxy casts
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abnormal amounts of urinary protein, typically less than 1 g/ d The orthostatic nature of the proteinuria is confirmed by measuring an 8-hour overnight supine urinary protein excretion, which should be less than 50 mg (2) Overload proteinuria can result from overproduction of circulating, filterable plasma proteins (monoclonal gammopathies), such as Bence Jones proteins associated with multiple myeloma Urinary protein electrophoresis will exhibit a discrete protein peak Other examples of overload proteinuria include myoglobinuria in rhabdomyolysis and hemoglobinuria in hemolysis (3) Glomerular proteinuria results from effacement of epithelial cell foot processes and altered glomerular permeability with an increased filtration fraction of normal plasma proteins Glomerular diseases exhibit some degree of proteinuria The urinary electrophoresis will have a pattern exhibiting a large albumin spike indicative of increased permeability of albumin across a damaged glomerular basement membrane (GBM) (4) Tubular proteinuria occurs as a result of faulty reabsorption of normally filtered proteins in the proximal tubule, such as 2-microglobulin and immunoglobulin light chains Causes include acute tubular necrosis, toxic injury (lead, aminoglycosides), drug-induced interstitial nephritis, and hereditary metabolic disorders (Wilson s disease and Fanconi s syndrome) Evaluation of proteinuria by urinary dipstick primarily detects albumin and intact globulins, while overlooking positively charged light chains of immunoglobulins These proteins can be detected by the addition of sulfosalicylic acid to the urine specimen Precipitation indicates the presence of paraproteins The next step and the most reliable way to quantify proteinuria is a 24-hour urine collection A finding of greater than 150 mg/24 h is abnormal, and greater than 35 g/24 h is consistent with nephrotic-range proteinuria A simpler but less accurate method is to collect a random urine sample The ratio of urinary protein concentration to urinary creatinine concentration (Uprotein/Ucreatinine) correlates with 24-hour urine protein collection (< 02 is normal and corresponds to excretion of less than 200 mg/24 h) If a patient has proteinuria with loss of renal function, renal
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