Proteinuria means the presence of protein, typically albumin in the urine. High protein concentrations result in a frothy and soapy urine. Proteinuria comes in many renal diseases together with other Harnanomalien before (eg. As hematuria). Isolated Proteinuria means protein in the urine without other symptoms or Harnanomalien. Though pathophysiology of the glomerular basement membrane is a very effective barrier against large molecules (eg. As most plasma proteins, v. A. Albumin), passes a small amount of the protein through the capillary basement membrane in the glomerular filtrate. A portion of this filtered protein is degraded and absorbed by the proximal tubule, but another is excreted in the urine. The upper limit of the normal urinary protein excretion is 150 mg / day, which can be estimated measured at a 24-hour urine collection, or by the protein / creatinine ratio of spot urine (values ??<0.3 are abnormal); wherein albumin is 30 mg / day. An albumin excretion between 30 and 300 mg / day (20-200 g / min) is referred to as microalbuminuria and higher concentrations than macroalbuminuria. Mechanisms of proteinuria can be categorized as glomerular tubularly Overflowing Suitably glomerular proteinuria results from glomerular diseases that typically affect an increased glomerular permeability, this permeability enables the increased amounts of plasma proteins (sometimes very large amounts) to pass into the filtrate. Tubular proteinuria results from renal tubulointerstitialen disorders affecting the absorption of protein by the proximal tubule, which (usually of smaller proteins, such as immunoglobulin light chains as albumin) resulting in proteinuria. Causative disorders are often accompanied by other defects of the tubule (z. B. HCO3- loss, glycosuria, aminoaciduria) and sometimes by "glomerular pathology" (which also contributes to the development of proteinuria). "Overflow proteinuria" occurs when large amounts of small plasma proteins (eg. B. immunoglobulin light chain, resulting in multiple myeloma) exceeds the reabsorptive capacity of the proximal tubules. Functional proteinuria occurs when increased renal blood flow returns (eg. As a result of exercise, or fever, rhythmogenic heart failure) increased amounts of protein in the nephron, which (usually <1 g / day) leads to increased protein in the urine. Functional proteinuria regresses when the renal blood flow returns to normal. Orthostatic proteinuria is a benign disease (most common in children and adolescents) mainly occurs in proteinuria when the patient is upright. Therefore, the urine usually contains more protein during wakefulness (when people are often standing) than during sleep. She has a very good prognosis and requires no special intervention. Follow Proteinuria caused by renal dysfunction is persistent usually (d. E. Present in a range of Untersuchungsverfahern) and can result in nephrotic range in significant protein deficiency. Protein in the urine is toxic to the kidneys and cause kidney damage. Etiology causes can be divided by the mechanism. The most common causes of proteinuria are glomerular diseases that typically manifest themselves usually as nephrotic syndrome (see table: causes of proteinuria). The most common causes of proteinuria (and nephrotic syndrome) in adults are focal segmental glomerulosclerosis membranous nephropathy Diabetic nephropathy, the most common causes in children are minimal change disease (in young children) focal segmental glomerulosclerosis (in older children) causes of proteinuria mechanism Examples glomerular Primary glomerular diseases (eg. as membranous nephropathy, minimal change disease, focal segmental glomerulosclerosis) Secondary glomerular diseases (eg. as d iabetische nephropathy, pre-eclampsia, post-infectious glomerulonephritis, lupus nephritis, amyloidosis) tubules Fanconi syndrome Acute tubular necrosis tubulointerstitial nephritis Polycystic kidney disease overflow Acute monocytic leukemia with lysozyme monoclonal gammopathy Multiple myeloma Myelodysplastic syndrome Appropriately fever heart failure intensive sports or activities Unknown Ortho Static Assessment history and physical examination history of the present illness can cause symptoms of fluid overload or hypoalbuminemia, such as eyes swelling after waking and leg or abdominal swelling reveal. Proteinuria itself may lead to strong foam formation of urine. However, patients may have with proteinuria and no obvious fluid overload any symptoms. The examination of the body systems is looking for symptoms to causes, including red or brown urine (glomerulonephritis) or bone pain (myeloma) point. Patients will be asked about pre-existing conditions that may cause proteinuria, including the recent severe illness (especially with fever), intense exercise, known kidney disease, diabetes, pregnancy, sickle cell anemia, SLE and cancer (particularly myeloma and related diseases). The physical examination is of limited use, but the vital signs should be checked for high blood pressure, indicating glomerulonephritis. In the investigation should be paid to signs of peripheral edema and ascites fluid overload or low serum albumin widerspiegelt.Tests Urine tests detect primarily albumin. Pr√§zipationstechniken such as heating and sulfosalicylic test strips detect all proteins. Therefore, a random recognized isolated proteinuria is usually a albuminuria. Strip tests are usually not sensitive enough for the detection of microalbuminuria, so that a positive urine strip test usually indicates a manifested proteinuria. Strip tests can also be less accurate detect the excretion of smaller proteins that are characteristic of a tubular and "Overflow" -Proteinurie. Patients with a positive test strips (for protein or other component) should routine microscopic urinalysis. Abnormalities in urine analysis (eg cylinder and dysmorphic erythrocytes suggestive of glomerulonephritis;. Glucose, ketones, or both that may indicate diabetes). Or diseases that are determined by history and physical examination (eg, peripheral edema, let off with a glomerular disease) require further investigation. If the urinalysis is otherwise normal, further testing may be postponed, in the assessment of repeated urinary protein pending. Is proteinuria no longer in front, especially in patients who have recently driven intensive sport, had fever or exacerbation of congestive heart failure, a functional proteinuria is likely. Persistent proteinuria is a sign of glomerular disease and needs further testing and referral to a nephrologist. Other tests include blood count; Measurement of serum electrolytes, BUN, creatinine and glucose, determination of GFR (study of nephrology patients: assessment of renal function); Quantification of protein in the urine (by 24-hour measurement, or protein / creatinine ratio in the urine); and evaluation of renal size (by ultrasound or CT). In most patients with glomerulopathy proteinuria in the nephrotic range (> 3.5 / day or urine protein / creatinine ratio> 2.7). Other tests are generally carried out to determine the cause of glomerular disease, including lipid profile, complement levels, cryoglobulins, hepatitis B and C serology, antinuclear antibody test and urine and serum protein, HIV testing and “rapid plasma Reagin- test for syphilis. ” If these non-invasive tests are not diagnostic (the case as it is often), a renal biopsy is necessary. Unexplained proteinuria and renal failure, especially in the elderly could, due to myelodysplastic disorders (e. As multiple myeloma) or amyloidosis. In patients <30 years, one orthostatic proteinuria should be considered. Diagnosis requires two urine collections, one from 7 am to 23 pm (Tagprobe) and the other of 23 pm to 7 am (night sample). The diagnosis is confirmed when the protein value in the urine at the Tagprobe exceeds the normal values ??(or when the protein / creatinine ratio in the urine> 0.3) but not during the night sample. Treatment Treatment is aimed at eliminating the causes.

Health Life Media Team

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