Edited, memorised or added to reading list

on 15-Nov-2020 (Sun)

Do you want BuboFlash to help you learning these things? Click here to log in or create user.

Eukaryoten:
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

pdf

cannot see any pdfs




Total urinary protein excretion in the normal adult should be less than 150 mg/day.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

UpToDate
opics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Oct 2020. | This topic last updated: Jan 22, 2020. INTRODUCTION — <span>Total urinary protein excretion in the normal adult should be less than 150 mg/day. Higher rates of protein excretion that persist beyond a single measurement should be evaluated, as they often imply an increase in glomerular permeability that allows the filtration of




In this study of 1011 patients, of whom 68 had a kidney biopsy, the ratio of the urine albumin to total protein concentration was generally less than 0.4 in patients with tubular or overflow proteinuria and greater than 0.4 in patients with predominantly glomerular proteinuria
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

UpToDate
se. Measuring the urine concentrations of both albumin and total protein (with either two separate tests or with a urine protein electrophoresis) can help determine the type of proteinuria [2]. <span>In this study of 1011 patients, of whom 68 had a kidney biopsy, the ratio of the urine albumin to total protein concentration was generally less than 0.4 in patients with tubular or overflow proteinuria and greater than 0.4 in patients with predominantly glomerular proteinuria. Glomerular proteinuria — Glomerular proteinuria is due to increased filtration of macromolecules (such as albumin) across the glomerular capillary wall. This is a sensitive marker for




In one study of more than 2000 patients, for example, a urine dipstick for proteinuria of 2+ or higher was predictive of significant proteinuria (urine protein-to-creatinine ratio (UPCR) greater than or equal to 500 mg/g) regardless of the specific gravity; however, a urine dipstick for proteinuria of trace or 1+ was only predictive of significant proteinuria if the specific gravity was 1.025 or less [9]
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

UpToDate
n urine concentration. Limited data suggest that using the urine-specific gravity to judge urine concentration may improve the ability to identify abnormal proteinuria with the dipstick [9,10]. <span>In one study of more than 2000 patients, for example, a urine dipstick for proteinuria of 2+ or higher was predictive of significant proteinuria (urine protein-to-creatinine ratio (UPCR) greater than or equal to 500 mg/g) regardless of the specific gravity; however, a urine dipstick for proteinuria of trace or 1+ was only predictive of significant proteinuria if the specific gravity was 1.025 or less [9]. False positive urine dipstick results may occur in the following settings: ●After the use of iodinated radiocontrast agents [11]. Thus, the urine should not be tested for protein with




False positive urine dipstick results may occur in the following settings:

● After the use of iodinated radiocontrast agents [11]. Thus, the urine should not be tested for protein with the standard dipstick for at least 24 hours after a contrast study.

● With a highly alkaline urine (pH greater than 8) [12,13].

● In the presence of gross hematuria and a urocrit (the percent of urine volume comprised of red blood cells) greater than 1 percent [14].

● When specific antiseptics (eg, chlorhexidine, benzalkonium) are used for clean-catch urine samples [15]

statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

UpToDate
mg/g) regardless of the specific gravity; however, a urine dipstick for proteinuria of trace or 1+ was only predictive of significant proteinuria if the specific gravity was 1.025 or less [9]. <span>False positive urine dipstick results may occur in the following settings: ●After the use of iodinated radiocontrast agents [11]. Thus, the urine should not be tested for protein with the standard dipstick for at least 24 hours after a contrast study. ●With a highly alkaline urine (pH greater than 8) [12,13]. ●In the presence of gross hematuria and a urocrit (the percent of urine volume comprised of red blood cells) greater than 1 percent [14]. ●When specific antiseptics (eg, chlorhexidine, benzalkonium) are used for clean-catch urine samples [15]. Sulfosalicylic acid test — In contrast to the urine dipstick, which primarily detects albumin, SSA detects all proteins in the urine at a sensitivity of 5 to 10 mg/dL [1]. Use of SSA i




As a general rule in adults under the age of 50 years, daily creatinine excretion should be 20 to 25 mg/kg (177 to 221 micromol/kg) of lean body weight in men and 15 to 20 mg/kg (133 to 177 micromol/kg) of lean body weight in women. From the ages of 50 to 90 years, there is a progressive 50 percent decline in creatinine excretion (to approximately 10 mg/kg in men, lower in women) due primarily to a fall in muscle mass. Formulas that incorporate race and weight with or without serum phosphorous in addition to age and sex may improve the estimation of creatinine excretion
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

UpToDate
(Over- and under-collections are common.) The adequacy of the collection can be estimated by quantifying the 24-hour urine creatinine and comparing this value to the expected urine creatinine. <span>As a general rule in adults under the age of 50 years, daily creatinine excretion should be 20 to 25 mg/kg (177 to 221 micromol/kg) of lean body weight in men and 15 to 20 mg/kg (133 to 177 micromol/kg) of lean body weight in women. From the ages of 50 to 90 years, there is a progressive 50 percent decline in creatinine excretion (to approximately 10 mg/kg in men, lower in women) due primarily to a fall in muscle mass. Formulas that incorporate race and weight with or without serum phosphorous in addition to age and sex may improve the estimation of creatinine excretion. This is discussed elsewhere in more detail. (See "Assessment of kidney function", section on 'Limitations of using creatinine clearance' and "Patient education: Collection of a 24-hour




However, the UPCR may produce errors when applied to the individual patient, especially in those who consistently excrete much more (or less) than 1 g/day of creatinine (which is typical for younger men and many younger women) or in those who are losing or gaining muscle mass
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

UpToDate
ine is equivalent to 3.4 mg/mmol creatinine. The UPCR is easy for patients and providers, and the correlation with daily protein excretion is reasonably good on the population level (figure 1). <span>However, the UPCR may produce errors when applied to the individual patient, especially in those who consistently excrete much more (or less) than 1 g/day of creatinine (which is typical for younger men and many younger women) or in those who are losing or gaining muscle mass. (See 'Limitations of the UPCR and UACR' below.) The UPCR and the UACR in spot urine samples are both supported by Kidney Disease: Improving Global Outcomes (KDIGO) as appropriate metho




The UPCR is useful on the population level because the average 24-hour urine creatinine excretion for the population is assumed to be approximately 1000 mg/day (8.84 mmol/day) per 1.73 m2.
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

UpToDate
daily creatinine production. ●Urine protein excretion can vary throughout the day (especially resulting from exercise and posture) and from day to day [27]. Influence of the urine creatinine — <span>The UPCR is useful on the population level because the average 24-hour urine creatinine excretion for the population is assumed to be approximately 1000 mg/day (8.84 mmol/day) per 1.73 m2. Since the denominator of the UPCR is in grams of creatinine (ie, grams of protein per 1 gram of creatinine), the UPCR is an accurate estimate of 24-hour proteinuria only in someone who




● In individuals with large muscle mass, in whom creatinine excretion may be much higher than 1000 mg/day, the UPCR (or UACR) will underestimate proteinuria.

● In a cachectic patient or a patient with small muscle mass, in whom creatinine excretion may be much lower than 1000 mg/day, the UPCR (or UACR) will overestimate proteinuria

statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

UpToDate
1170 mg/day [30]. In addition, the accuracy of the ratio is diminished if creatinine excretion is either markedly higher or lower than the average population value of 1000 mg/day. Specifically: <span>●In individuals with large muscle mass, in whom creatinine excretion may be much higher than 1000 mg/day, the UPCR (or UACR) will underestimate proteinuria. ●In a cachectic patient or a patient with small muscle mass, in whom creatinine excretion may be much lower than 1000 mg/day, the UPCR (or UACR) will overestimate proteinuria. The following studies illustrate how variability in the urine creatinine among individuals can create erroneous estimates of 24-hour proteinuria: ●In a study of 16,000 men and women re




In addition, all patients with persistent proteinuria that is greater than 500 mg/day for total protein (or an estimated protein excretion rate [ePER] greater than 0.5 g/day) or greater than 300 mg/day for albumin (or an estimated albumin excretion rate [eAER] greater than 300 mg/day) should be referred to a nephrologist for decisions regarding further evaluation and management (eg, kidney biopsy, discussed below)
statusnot read reprioritisations
last reprioritisation on reading queue position [%]
started reading on finished reading on

UpToDate
tiple myeloma: Clinical features, laboratory manifestations, and diagnosis".) ●A kidney ultrasound examination to rule out structural causes (eg, reflux nephropathy, polycystic kidney disease). <span>In addition, all patients with persistent proteinuria that is greater than 500 mg/day for total protein (or an estimated protein excretion rate [ePER] greater than 0.5 g/day) or greater than 300 mg/day for albumin (or an estimated albumin excretion rate [eAER] greater than 300 mg/day) should be referred to a nephrologist for decisions regarding further evaluation and management (eg, kidney biopsy, discussed below). Role of kidney biopsy — A kidney biopsy should generally be done in all patients with proteinuria of more than 3.5 g/day (ie, nephrotic range) or if non-nephrotic proteinuria is associ




Flashcard 6035680136460

Question
۴ɤ
Answer
[default - edit me]

statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

pdf

cannot see any pdfs