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Medicine

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Kidney

Question
8 out of 17
 

In differentiating glomerular proteinuria from Tubular proteinuria, Glomerular proteinuria is indicated best by: (AIIMS Nov 09)



A Proteinuria >3.0 - 3.5 g/day

B Globulin > Albumin

C Albumin to beta-2 microglobulin ratio of 100:1

D TommHarsfall protein

Ans. A Proteinuria >3.0 - 3.5 g/day
Proteinuria (Ref. H-18th Edi, P- 273, 338)

Urine protein composition (total upto 150 mg/day in adults)

Tomm– Horsfall protein 70 mg Q

Albumin 30 mg Q

Selective proteinuria Q

Minimal change disease in children produces selective proteinuria Q. Because of lower molecular weight there is selective excretion of albumin in urine.

Glomerular proteinuria is associated with albumin > Globulin

Feature

Glomerular proteinuria

Tubular proteinuria

Total protein excretion /day

Usually> 2.0 g/day

Proteinuria may reach nephrotic range> 3.5 g/day

Usually < 2.0 g/day

Proteinuria never reaches nephrotic range.

Protein type

· Proteinuria chiefly consists of albumin

· Albumin is usually greater than globulins (Albumin >Globulin)

· Low molecular weight proteinuria is the hallmark of tubular proteinuria.

· Proteinuria chiefly consists of Low molecular weight proteins (alpha and beta microglobulins). Albumin is invariably present (Globulin > albumin)

Albumin/beta2 microglobulin ratio

Usually exceeds 1000:1

Usually less than 10:1

Tom Horsfall protein

TommHorsfall proteins are not increased as there is no injury to tubular cells

TommHorsfall protein secretion may be increased by injured tubular cells of ascending loop of Henlei.e& distal tubule.

- N Acetyl glucosamine

- Lysozyme

Normal

May be increased (Increased in case of tubular cell injury)

Extra Edge: Raised level of serum beta 2 microglobulin is seen in multiple myeloma

Microalbuminuria (AIIMS Nov 2007)

A. This indicates an daily excretion of albumin in the range of 30 – 300 mg/dayQ.

B. It occurs in diabetes mellitus with early renal involvement

Proteinuria

A. Dipstick testing detects only albumin at concentration more than 250 mg/L Q.

B. False – positive dipstick results for proteinuria are seen when

a. Urine pH is 8 Q, b. Penicillins, c. Aspirin d. Oral hypoglycemic agents.

Kidney Flashcard List

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