41. Proteinuria Send this activity to a colleague. proteinuria. After completing this case, theparticipant should be able to Recite the definition of abnormal proteinuria; http://www.clevelandclinicmeded.com/DecisionMaking/proteinuria/intro1.asp

Send this activity to a colleague PROTEINURIA Lesson Release Date: 1/9/03 Lesson Expiration Date: 1/9/05 Target Audience: Directed to primary care physicians including family practitioners and internists. Objectives After completing this case, the participant should be able to: Recite the definition of abnormal proteinuria Describe how to evaluate proteinuria Discuss the significance of orthostatic proteinuria Explain what criteria to use to refer a patient to a kidney specialist Lesson Design Each lesson within the Clinical Decisions series includes an interactive case, supporting educational materials from leading medical journals and national practice guidelines, a CME test and an evaluation. Throughout the interactive case, you may proceed to the next question once you answer each question correctly. In addition to allowing you to proceed, the correct answer also reveals the rationale for the answer. In the CME test section, you may not proceed until you select the correct answer.

42. Proteinuria This particular chapter, authored by PM Hall, MD, deals with proteinuria. The ClevelandClinic. Published May 29, 2002. PM Hall, MD. Department of Nephrology. http://www.clevelandclinicmeded.com/diseasemanagement/nephrology/proteinuria/pro

Published May 29, 2002 P.M. Hall, MD Department of Nephrology Print Chapter The Cleveland Clinic Foundation Definition Prevalence Pathophysiology Signs and ... References National Guidelines National Kidney Foundation: Assessment of Proteinuria DEFINITION Proteinuria usually reflects an increase in glomerular permeability for normally non-filtered plasma macromolecules such as albumin. A 24-hour urine collection containing more than 150 mg of protein is abnormal. Significant proteinuria is suspected when a dipstick test of the urine is persistently positive for protein. In such a situation the daily protein excretion will usually exceed 300-500 mg per day. Since the dipstick method can detect urine protein concentration of as little as 30 mg/dL, a very concentrated urine specimen might test positive for protein even though the quantitative amount of proteinuria is less than 150 mg/day. of proteins in the urine. The SSA test is carried out by mixing 1 part urine supernatant (eg, 2.5 mL) with 3 parts 3% sulfosalicylic acid and grading the resultant turbidity

43. A Proteinuria - Haematuria... A proteinuria haematuria syndroma diagnosztikai jelentosége. Berta Kláradr., Székács Béla dr. SOTE II. sz. proteinuria, nephrosis syndroma. http://www.sote.hu/htsz/bertakl.htm

A proteinuria - haematuria syndroma diagnosztikai jelentõsége Berta Klára dr., Székács Béla dr. SOTE II. sz. Belklinika, Budapest A proteinuria és haematuria együttes elõfordulása a vesebetegségek fõ tünete, amely leggyakrabban glomeruláris betegségekben, glomerulonephritisekben fordul elõ, de a veseparenchyma számos más eredetû elváltozásai is okozhatják. Differenciáldiagnosztikai szempontból sokszor nem egyszerû a haematuriával és proteinuriával járó kórképek elkülönítése, amely a beteg további sorsa szempontjából nem közömbös: urológiai betegség vagy nephrológiai kezelést igénylõ állapot kerül felismerésre. Haematuria A vörösvérsejtek izolált, proteinuria nélküli megjelenése a vizelet üledékben nagyobb mértékben, mint 3 vvs látóterenként, további vizsgálatokat igényel, elsõsorban a húgyutak betegségeinek felismerésére (1. táblázat) (1). Leukocyturiával, bakteriurával együttes elõfordulása esetén a háttérben elsõsorban húgyúti fertõzésre kell gondolnunk. Antibiotikus kezelésre nem reagáló esetekben további, elsõsorban képalkotó vizsgálatok elvégzése szükséges és keresni kell húgyúti obstrukció vagy reflux okozta elváltozásokat A haematuria azonban a primer glomerulonephritiseknek is gyakori jele, amit csaknem patognosztikus értékûvé tesz különbözõ fokú proteinuria társulása. Az

44. Proteinuria From Pediatrics / Nephrology proteinuria proteinuria in children poses a diagnostic dilemma.The investigator must differentiate between proteinuria that is http://author.emedicine.com/PED/topic1911.htm

eMedicine Journal Pediatrics Nephrology Proteinuria Author Information Introduction AUTHOR INFORMATION Section 1 of 2 Authored by Watson Arnold, MD , Director, Department of Pediatric Nephrology, Cook Children's Medical Center Coauthored by Ronald J Kallen, MD , Associate Professor, Department of Pediatrics, Northwestern University; Consulting Staff, Department of Pediatrics, Division of Pediatric Kidney Disease, Children's Memorial Hospital of Chicago Watson Arnold, MD, is a member of the following medical societies: American College of Medical Quality American Federation for Medical Research American Society for Nutritional Sciences American Society of Nephrology ... Texas Medical Association , and Texas Pediatric Society Edited by Laurence Finberg, MD , Clinical Professor, Department of Pediatrics, University of California at San Francisco and Stanford University; Robert Konop, PharmD , Clinical Assistant Professor, Department of Pharmacy, Section of Clinical Pharmacology, University of Minnesota; Luther Travis, MD , William W Glauser Professor of Pediatrics and Pediatric Nephrology, Department of Pediatrics, Divisions of Nephrology and Diabetes, University of Texas Medical Branch and Children's Hospital;

45. Increased Risk Of Proteinuria Among A Cohort Of Lead-exposed Pregnant Women Increased Risk of proteinuria among a Cohort of Leadexposed Pregnant Women. Similarly,the adjusted odds ratio for trace proteinuria was 2.3 (95% CI 1.3, 4.1). http://ehpnet1.niehs.nih.gov/docs/1993/101-5/factor-abs.html

Environmental Health Perspectives, Volume 101, Number 5, October 1993 Citation in PubMed Related Articles Increased Risk of Proteinuria among a Cohort of Lead-exposed Pregnant Women Pam Factor-Litvak, Zena Stein, Joseph Graziano Divisions of Epidemiology, Environmental Science, and The Sergievsky Center, Columbia School of Public Health, New York, NY 10032 USA; Department of Pharmacology, College of Physicians and Surgeons, Columbia University, New York, NY 10032 USA Abstract 1+ proteinuria, measured using a urinary dipstick. Comparing the women in the upper 10th percentile of exposure to those in the lowest 10th percentile, the adjusted odds ratio for 1+ proteinuria was 4.5 (95% CI 1.5, 13.6). Similarly, the adjusted odds ratio for trace proteinuria was 2.3 (95% CI 1.3, 4.1). Similar to other studies showing associations between chronic exposure to lead and renal dysfunction, our data suggest that long-term exposure to environmental lead may be associated with proteinuria. Key words: epidemiology, lead exposure, pregnancy, proteinuria. Environ Health Perspect Address correspondence to P. Factor-Litvak, Division of Epidemiology, Columbia School of Public Health, 600 W 168th Street, New York, NY 10032 USA.

46. Blood Pressure Control, Proteinuria, And..., Annals 15 Nov 95 Blood Pressure Control, proteinuria, and the Progression of Renal Disease. BloodPressure Control, proteinuria, and the Progression of Renal Disease. http://www.acponline.org/journals/annals/15nov95/bprenal.htm

Annals of Internal Medicine Current Issue Past Issues Library for Internists Subscriptions ... Email this page Annals of Internal Medicine Blood Pressure Control, Proteinuria, and the Progression of Renal Disease The Modification of Diet in Renal Disease Study Annals of Internal Medicine 15 November 1995. 123:754-762. John C. Peterson, MD; Sharon Adler, MD; John M. Burkart, MD; Tom Greene, PhD; Lee A. Hebert, MD; Lawrence G. Hunsicker, MD; Andrew J. King, MD; Saulo Klahr, MD; Shaul G. Massry, MD; and Julian L. Seifter, MD, for the Modification of Diet in Renal Disease (MDRD) Study Group* Objective: To examine the relations among proteinuria, prescribed and achieved blood pressure, and decline in glomerular filtration rate in the Modification of Diet in Renal Disease Study. Design: 2 randomized trials in patients with chronic renal diseases of diverse cause. Setting: 15 outpatient nephrology practices at university hospitals. Patients: ). Diabetic patients who required insulin were excluded. Interventions: Patients were randomly assigned to a usual blood pressure goal (target mean arterial pressure, less than or equal to 107 mm Hg for patients less than or equal to 60 years of age and less than or equal to 113 mm Hg for patients

47. Health Ency.: Test: Protein - Urine Alternative names Urine protein; Albumin urine; Urine albumin;proteinuria; Albuminuria. Definition A urine albumin is a test http://www.accessatlanta.com/shared/health/adam/ency/article/003580.html

SEARCH: The Web Yellow Pages HOME AJC.COM Illustrated Health Encyclopedia Important notice Ency. home Test P Protein - urine See images Overview Risks Results Alternative names: Urine protein; Albumin - urine; Urine albumin; Proteinuria; Albuminuria Definition: A urine albumin is a test that measures the amount of protein in urine. How the Test is Performed Urine is collected by 1 of 2 methods. Urine protein can be detected in a "spot test" by dipstick (a specially treated stick is dipped into a random sample of urine), or quantitated in a 24 hour sample. The health care provider will instruct you, if necessary, to discontinue drugs that may interfere with the test. The procedure for collecting urine over 24 hours is as follows: On day 1, urinate into the toilet upon arising in the morning. Collect all subsequent urine (in a special container) for the next 24 hours. On day 2, urinate into the container in the morning upon arising. Cap the container. Keep it in the refrigerator or a cool place during the collection period. Label the container with your name, the date, the time of completion, and return it as instructed. Infant: Thoroughly wash the area around the urethra. Open a urine collection bag (a plastic bag with an adhesive paper on one end), and place it on your infant. For males, the entire

48. PROTEINURIA AND RENAL DISEASE PROGRESSION DISCUSSION BOARD PANEL DE DISCUSION. proteinuria AND RENAL DISEASE PROGRESSION. DGFR improved in parallel with a significant reduction on proteinuria. http://www.uninet.edu/cin2000/conferences/remuzzi/remuzzi.html

DISCUSSION BOARD PANEL DE DISCUSION PROTEINURIA AND RENAL DISEASE PROGRESSION Giuseppe Remuzzi Mario Negri Institute for Pharmacological Research, Unit of Nephrology and Dialysis Ospedali Riuniti di Bergamo Correspondence to: Giuseppe Remuzzi, MD. Mario Negri Institute for Pharmacological Research Via Gavazzeni 11, 24125 Bergamo - Italy Tel. +39-035-319888; Fax +39-035-319331 E-mail: gremuzzi@cyberg.it Introduction Progression to irreversible renal parenchymal damage and end-stage renal disease is the final common pathway of chronic proteinuric nephropathies and is relatively independent of the type of initial insult [1]. In animals, a reduction in nephron mass exposes the remaining nephrons to adaptive hemodynamic changes that are intended to sustain renal function but may be detrimental in the long term [2,3]. High glomerular capillary pressure impairs glomerular permeability to proteins, which are then filtered in excessive quantities and reach the lumen of the proximal tubule [4]. In the past the amount of proteins found in the urine, taken as an indicator of the underlying abnormality in glomerular permeability, was considered by most nephrologists simply as a marker of the severity of renal lesions. Today the results of many studies indicate that proteins filtered through the glomerular capillary may have intrinsic renal toxicity, which together with other independent risk factors such as hypertension, can play a contributory role in the progression of renal damage [1,5]. Indeed, the secondary process of reabsorption of filtered proteins can contribute substantially to renal interstitial injury by activating intracellular events, including up-regulation of vasoactive and inflammatory genes. The corresponding molecules formed in excessive amounts by the renal tubules cause an interstitial inflammatory reaction that normally precedes renal scarring and correlates with declining renal function [1] (Figure 1).

49. Avera Health - Proteínas En La Orina proteinuria.Forma en que se realiza el examen Existen dos métodos http://www.avera.org/adam/esp_ency/article/003580.htm

Enfermedades Lesiones Nutrici³n Envenenamiento ... Resultados Prote­nas en la orina Definici³n: Es un examen que mide la cantidad de prote­na en la orina. Nombres alternativos: Albºmina en orina; albuminuria; proteinuria Forma en que se realiza el examen: Existen dos m©todos para recolectar la orina para este examen. En el primero, la proteinuria puede detectarse en un "examen de mancha" por medio de una cinta de prueba (una tirilla especialmente tratada que se sumerge en una muestra de orina al azar) y en el segundo, se puede cuantificar en una muestra de 24 horas. El m©dico le solicitar¡ a la persona descontinuar medicamentos que pueden interferir con el examen si es necesario. Se necesita una muestra de orina de 24 horas recolectada de la siguiente manera: El d­a 1: la persona debe orinar en la taza del ba±o al levantarse en la ma±ana. Recolectar toda la orina subsiguiente (en un recipiente especial) durante las siguientes 24 horas. El d­a 2: la persona debe orinar en el recipiente al levantarse en la ma±ana. Tapar el recipiente y guardarlo en el refrigerador o en un lugar fresco durante el per­odo de recolecci³n. Se debe marcar el recipiente con el nombre, fecha, hora de terminaci³n y retornarlo de acuerdo con las instrucciones.

50. ThirdAge - Adam - Protein - Urine Alternative Names Urine protein; Albumin urine; Urine albumin; proteinuria;Albuminuria. How the test is performed Urine is collected by 1 of 2 methods. http://www.thirdage.com/health/adam/ency/article/003580.htm

document.write(''); document.write(''); document.write('<'); document.write('/SCRIPT>'); document.write(''); document.write(''); document.write('<'); document.write('/A>'); document.write('<'); document.write('/NOSCRIPT>'); document.write('<'); document.write('/IFRAME>'); Activities Computers Family Tree Health ... Results Protein - urine Definition: A urine albumin is a test that measures the amount of protein in urine. Alternative Names: Urine protein; Albumin - urine; Urine albumin; Proteinuria; Albuminuria How the test is performed: Urine is collected by 1 of 2 methods. Urine protein can be detected in a "spot test" by dipstick (a specially treated stick is dipped into a random sample of urine), or quantitated in a 24 hour sample. The health care provider will instruct you, if necessary, to discontinue drugs that may interfere with the test. The procedure for collecting urine over 24 hours is as follows: On day 1, urinate into the toilet upon arising in the morning. Collect all subsequent urine (in a special container) for the next 24 hours. On day 2, urinate into the container in the morning upon arising.

51. Proteinuria proteinuria. proteinuria (pro t* nur e *) is the existence of proteinin the urine, which is usually in the form of albumin. proteinuria http://www.rush.edu/worldbook/articles/016000a/016000341.html

52. Proteinuria proteinuria. proteinuria refers to the presence of protein in the urine. Theterm albuminuria may be used interchangeably with proteinuria. http://www.rnceus.com/ua/uapro.html

Proteinuria Proteinuria refers to the presence of protein in the urine. In healthy persons, the urine contains no protein or only a trace amount of protein. Proteins in the urine are comprised of albumin and globulin from the plasma. Because albumin is filtered more easily than globulin, it is the predominant type of protein that may appear in the urine. The term albuminuria may be used interchangeably with proteinuria. Detection of protein in the urine, combined with a microscopic exam of urinary sediment, provides the basis for the differential diagnosis of renal disease. Normally, the glomeruli prevent passage of protein from the blood to the glomerular filtrate. A small amount of filtered plasma proteins and proteins secreted by the nephrons can be found in normal urine; however, in healthy individuals, protein excretion does not exceed 150 mg in 24 hours or 10 mg per 100 ml of any single specimen. Glomerular injury causes increased permeability to plasma proteins, resulting in proteinuria. A persistent finding of proteinuria is the single most important indication of renal disease. If more than a trace of protein is found on a routine UA, a quantitative 24-hour evaluation of protein excretion is done. The dipstick method of checking for protein does not detect the presence of abnormal proteins such as globulins and Bence-Jones proteins excreted in multiple myeloma. Persons with diabetes have a higher than normal potential for renal disease, so they may have regular checks for proteinuria. If random samples are persistently positive for protein, a quantitative (24-hour) sample may be done.

53. APPROACH TO PROTEINURIA APPROACH TO proteinuria MANAGEMENT. OF NEPHROTIC SYNDROME. proteinuria isusually due to renal disease with particular involvement of glomerulus. http://www.imakerala.org/cme/proteinuria.htm

Indian Medical Association Kerala State Branch Continuing Medical Education OF NEPHROTIC SYNDROME Dr. Gomathy S., Nehrologist, Medical College Hospital, Alappuzha Kidneys are a pair of retroperitoneal organs which perform very important functions to maintain the normal homeostasis. One such function is the fluid balance which is brought about by conservation of essential substances and excretion of certain others, of which proteins play an important role in maintaining plasma oncotic pressure. Reduction in plasma protein below a critical level due to its leak in kidneys leads to oedema formation which is the hallmark of nephrotic syndrome. Normal glomerular filtration is highly efficient producing @ 18OL of ultrafiltrate per day, which contains @ 11,000 to 14,000 gm of protein, yet the final urine is virtually protein free. This conservation of essential proteins is necessary for oncotic regulation as mentioned before. In addition, it is also important for the normal coagulation and immunological functions. Proteinuria is usually due to renal disease with particular involvement of glomerulus. It may be due to primary glomerulopathies or glomerulopathies secondary to systemtic diseases like DM, SLE, Amyloidosis, Lymphoma etc.

54. CTF Full Text Review: Dipstick Proteinuria Screening And Renal Disease Dipstick proteinuria Screening of Asymptomatic Adults to Prevent Progressive RenalDisease. Figure 1 Algorithm for dipstick positive proteinuria. Full Citation. http://www.ctfphc.org/Full_Text/Ch38full.htm

Canadian Task Force on Preventive Health Care Full Text Review Dipstick Proteinuria Screening of Asymptomatic Adults to Prevent Progressive Renal Disease Prepared by Ryuta Nagai, MD, FRCPC, Research Associate, Department of Preventive Medicine and Biostatistics, Elaine E.L. Wang, MD, FRCPC, Associate Professor of Pediatrics and of Preventive Medicine and Biostatistics, and William Feldman, MD, FRCPC, Professor of Pediatrics and of Preventive Medicine and Biostatistics, University of Toronto, Ontario These recommendations were finalized by the Task Force in June 1993 Contents Overview Burden of Suffering Maneuver Effectiveness of Prevention and Treatment ... Figure 1 Overview Although the cost of screening the general adult population would be equivalent to the cost of caring for 5 hemodialysis patients for one year, effective nontoxic therapy is not available for most renal diseases detected by dipstick urine testing. Thus, screening is not advocated except in those patients with IDDM. Burden of Suffering Over 3,000 patients are on ESRD programs (dialysis and transplantation) in Canada. An additional 2,000 patients enter dialysis programs every year, an annual increase of 7%.

55. CTF Selected References: Dipstick Proteinuria Screening And Renal Disease Dipstick proteinuria Screening of Asymptomatic Adults to Prevent ProgressiveRenal Disease. 6. Muth RG Asymptomatic mild intermittent proteinuria. http://www.ctfphc.org/References/Ch38bib.htm

Canadian Task Force on Preventive Health Care Selected References Dipstick Proteinuria Screening of Asymptomatic Adults to Prevent Progressive Renal Disease Prepared by Ryuta Nagai, MD, FRCPC, Research Associate, Department of Preventive Medicine and Biostatistics, Elaine E.L. Wang, MD, FRCPC, Associate Professor of Pediatrics and of Preventive Medicine and Biostatistics, and William Feldman, MD, FRCPC, Professor of Pediatrics and of Preventive Medicine and Biostatistics, University of Toronto, Ontario These recommendations were finalized by the Task Force in June 1993 1. von Bonsdorff M, Koskenvuo K, Salmi HA: Prevalence and causes of proteinuria in 20-year-old Finnish men. Scand J Urol Nephrol 2. Alwall N, Lohi A: A population study on renal and urinary tract diseases. Acta Med Scand 3. Chen BT, Ooi B-S, Tan K-K, et al: Comparative studies of asymptomatic proteinuria and hematuria. Arch Intern Med 4. Levitt JI: The prognostic significance of proteinuria in young college students. Ann Intern Med 5. Haug K, Bakke A, Daae LN

56. Viasalus / Enciclopedia / proteinuria.Forma en que se realiza el examen Existen dos métodos para http://www.viasalus.com/vs/B2C/cn/enciclopedia/ESP/ency/article/003580.jsp

57. Diabetes Self-Management - Proteinuria proteinuria Published in the July/August 2000 issue. The presenceof protein in the urine, an early sign of kidney disease. One http://www.diabetesselfmanagement.com/article.cfm?aid=387&sid=6

58. Sun Feb 14, 1999 EVALUATION OF HEMATURIA AND PROTEINURIA Downloading ..please wait.. Case Western Reserve University and RainbowChildren's EVALUATION OF HEMATURIA AND proteinuria IRA DAVIS MD. http://education.pedschat.org/logs/davis/PROT_U.HTM

Downloading.....please wait.. Case Western Reserve University and Rainbow Children's EVALUATION OF HEMATURIA AND PROTEINURIA IRA DAVIS MD Sun Feb 14, 1999 12:44:28 PM Mark Cheren:Hello, Friends. Ira and I are here in Cleveland waiting for 2pm to begin. As the slide says, at 2, please introduce yourselves.Sun Feb 14, 1999 12:53:13 PM valcaraz:hi mark Sun Feb 14, 1999 12:53:58 PM Edlavitch:I am in dormatory at U of pennsylvania Sun Feb 14, 1999 12:54:21 PM valcaraz:hope your son has nothing serious Sun Feb 14, 1999 12:55:11 PM Edlavitch:hopefully not too, he is sleeping now Sun Feb 14, 1999 12:55:22 PM Mark Cheren:Hello Vlady and Julius. Karen and Ira are here. Sun Feb 14, 1999 12:55:25 PM Edlavitch:i am nurssing him Sun Feb 14, 1999 12:55:26 PM alfonsopantoja:hello, I am Alfonso Pantoja from Denver Sun Feb 14, 1999 12:55:43 PM Edlavitch:karen i will be in San Diego with you soon Sun Feb 14, 1999 12:55:52 PM Edlavitch:WELCOME ALPHONSO Sun Feb 14, 1999 12:55:54 PM Richard:I'm Richard Ash , pediatrician in Pittsbrugh Sun Feb 14, 1999 12:56:30 PM mattbos:I'm Matthew Bosley, pediatrician in Lincoln, NE

59. Young Woman With Proteinuria March Case Young Woman with proteinuria Steven Eliason, MD L. Salinas,MDE. Taboada, MD Leonard E. Grosso, MD, Ph.D. Discussion Laboratory http://medschool.slu.edu/pathcase/mar97/dis.shtml

March Case Young Woman with Proteinuria L. Salinas,M.D E. Taboada, M.D. Leonard E. Grosso, M.D., Ph.D. Discussion Laboratory Investigation Clinical History References Questions Discussion After studying the pathologic findings of this case, further clinical information was obtained. The patient had a clinical diagnosis of systemic lupus erythematosus (SLE). Complement levels at the time of biopsy were: C3—30 mg/dl (nl:70-200mg/dl), and C4 <10 mg/dl (nl:15-50 mg/dl). The patient had high titers of antinuclear antibody with a speckled pattern. Systemic lupus erythematosus is a complex disease which involves multiple organ systems. It results from poor regulation of the immune response system with the production of numerous antibodies directed against plasma membrane components, plasma proteins, and cytoplasmic and nucleo proteins. As a consequence, immune complexes and subsequent inflammatory responses lead to pathologic tissue reactions in multiple organs. Intravascular thrombosis, associated with the presence of the lupus anticoagulant or anticardiolipin antibodies has also been implicated in the pathogenesis of this disorder. The multiple different morphologic patterns which occur in lupus nephritis is generally thought to be due to differences in immune response in various individuals, or in one individual over a course of time. There is evidence that various characterisitics of the antibodies such as idiotype also plays a role. Membranous glomerulonephritis, for example, develops after unstable immune complexes which dissociate in the peripheral circulation reform in the glomerular capillary wall. Positively charged histone proteins have been shown to have a high affinity to the glomerular capillary wall and may play a role in the development of the membranous version of lupus nephritis.

60. Arch Intern Med -- Page Not Found Arch Intern Med. 162;842843, April 8, 2002, Is There Proof That Captopril Causesproteinuria?, Karl Engelman, MD Barry J. Materson, MD, MBA. http://archinte.ama-assn.org/issues/v162n7/ffull/ilt0408-1.html

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