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Annales de Biologie Clinique Feb 2019The typing of proteinuria is one of the complementary examinations carried out during the exploration of proteinuria. It aims to separate and identify the different... (Review)
Review
The typing of proteinuria is one of the complementary examinations carried out during the exploration of proteinuria. It aims to separate and identify the different proteins, or fractions of proteins, that make up proteinuria. The nature and relative importance of the proteins present reflect the location of the renal involvement and help to determine the etiology. The typing of a proteinuria also allows the detection of a monoclonal component in urine and its quantification. Finally, it allows highlighting the existence of a proteinuria of overload that can occur in the absence of kidney damage. Many methods allow the typing of proteinuria, and these have benefited in recent years from technological advances. The purpose of this review is to summarize typing methods currently used, their benefits and limitations, and the help that these diagnostic tools can provide to the management of patients.
Topics: Diagnosis, Differential; Glomerular Filtration Rate; Humans; Kidney Diseases; Kidney Function Tests; Patient Selection; Proteinuria; Urinalysis
PubMed: 30799294
DOI: 10.1684/abc.2018.1401 -
Pediatrics in Review Dec 2018Pediatricians must be aware of screening indications and the evaluation and management of a child with hematuria and/or proteinuria. (Review)
Review
PRACTICE GAP
Pediatricians must be aware of screening indications and the evaluation and management of a child with hematuria and/or proteinuria.
OBJECTIVES
After completing this article, readers should be able to: 1. Understand the common causes of proteinuria and hematuria and be able to differentiate between benign and serious causes. 2. Describe screening techniques for initial evaluation of hematuria and proteinuria. 3. Recognize the criteria for diagnosis of proteinuria and hematuria. 4. Plan the appropriate initial evaluation for hematuria and proteinuria and interpret laboratory findings essential for diagnosis. 5. Recognize serious causes of hematuria and proteinuria that warrant immediate referral.
Topics: Adolescent; Child; Child, Preschool; Hematuria; Humans; Proteinuria; Urinalysis
PubMed: 30504250
DOI: 10.1542/pir.2017-0300 -
Journal of Veterinary Internal Medicine 2005Emerging data indicate that more attention should be given to the detection, evaluation, monitoring, and treatment of dogs and cats with proteinuria. The purposes of... (Review)
Review
Emerging data indicate that more attention should be given to the detection, evaluation, monitoring, and treatment of dogs and cats with proteinuria. The purposes of this consensus statement are to describe an appropriate approach for accomplishing these tasks and to provide specific recommendations for assessing and managing dogs and cats with proteinuria based on data that are currently available. Because proteinuria and albuminuria have numerous possible causes, they must be assessed appropriately to determine their implications for the patient. This assessment involves localization of the origin of the proteinuria as well as determination of its persistence and magnitude. Because persistent renal proteinuria usually indicates presence of chronic kidney disease, which sometimes is a progressive disorder, its detection identifies dogs and cats that have increased risk for adverse health outcomes. Thus, urine testing that will detect proteinuria should be a component of the clinical evaluations of dogs and cats under all circumstances that prompt their veterinarians to also perform comprehensive hematologic and serum biochemical evaluations. At a minimum, this testing should consist of a complete urinalysis that includes a satisfactorily accurate semiquantitative test for protein, and positive reactions should be properly followed with further testing. The appropriate response to persistent renal proteinuria depends on the magnitude of proteinuria and the status of the patient. The recommended response generally involves continued monitoring, further investigation, and therapeutic intervention, which should be implemented as an escalating series of inclusive, stepwise responses.
Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Kidney Diseases; Proteinuria
PubMed: 15954557
DOI: 10.1892/0891-6640(2005)19[377:aamopi]2.0.co;2 -
BMJ (Clinical Research Ed.) Feb 2006
Review
Topics: Family Practice; Humans; Medical History Taking; Proteinuria; Referral and Consultation
PubMed: 16455729
DOI: 10.1136/bmj.332.7536.284 -
Pediatric Annals Jun 2020Although the American Academy of Pediatrics (AAP) removed the screening urinalysis from its health supervision guidelines in 2007, the use of the urinalysis remains an... (Review)
Review
Although the American Academy of Pediatrics (AAP) removed the screening urinalysis from its health supervision guidelines in 2007, the use of the urinalysis remains an important part of pediatric care. Thus, the incidental finding of proteinuria is still commonplace when a urine sample is collected for various complaints, such as fever and abdominal pain. Knowing when to reassure a patient with proteinuria versus when to perform additional testing is a situation that general practitioners face regularly, but also one that not all may be comfortable dealing with due to the possibility of missing a diagnosis. In addition, proteinuria in certain conditions can signify renal disease and worse outcomes, so general practitioners should know how to screen and interpret the results. Understanding the common benign and pathological causes of proteinuria helps medical providers to better inform and treat their patients, and possibly avoid unnecessary additional testing or subspecialty referrals. [Pediatr Ann. 2020;49(6):e268-e272.].
Topics: Child; Diagnosis, Differential; Humans; Incidental Findings; Kidney Diseases; Missed Diagnosis; Practice Guidelines as Topic; Proteinuria; Risk Factors
PubMed: 32520368
DOI: 10.3928/19382359-20200520-04 -
Kidney International Mar 2003Proteinuria is consequence of two mechanisms: the abnormal transglomerular passage of proteins due to increased permeability of glomerular capillary wall and their... (Review)
Review
Proteinuria is consequence of two mechanisms: the abnormal transglomerular passage of proteins due to increased permeability of glomerular capillary wall and their subsequent impaired reabsorption by the epithelial cells of the proximal tubuli. In the various glomerular diseases, the severity of disruption of the structural integrity of the glomerular capillary wall correlates with the area of the glomerular barrier being permeated by "large" pores, permitting the passage in the tubular lumen of high-molecular-weight (HMW) proteins, to which the barrier is normally impermeable. The increased load of such proteins in the tubular lumen leads to the saturation of the reabsorptive mechanism by the tubular cells, and, in the most severe or chronic conditions, to their toxic damage, that favors the increased urinary excretion of all proteins, including low-molecular-weight (LMW) proteins, which are completely reabsorbed in physiologic conditions. Recent clinical studies showed that in patients with glomerular diseases the urinary excretion of some HMW proteins [immunoglobulins G and M (IgG and IgM)] and of some LMW proteins, alpha1-microglobulin, beta2-microglobulin, correlates with the severity of the histologic lesions, and may predict, better than the quantity of proteinuria, the natural course, the outcome, and the response to treatment. It is suggested that some patients have already, at the time of clinical presentation, a structural damage of the glomerular capillary wall (injury of podocytes) and of the tubulointerstitium, the severity and scarce reversibility of which are reliably indicated by an elevated urinary excretion of HMW and LMW proteins.
Topics: Animals; Humans; Kidney Glomerulus; Proteinuria
PubMed: 12631062
DOI: 10.1046/j.1523-1755.2003.00840.x -
Clinics in Laboratory Medicine Sep 1988Proteinuria is one of the most common manifestations of renal disease. Changes in plasma protein concentration, glomerular permeability, tubular reabsorption, or renal... (Review)
Review
Proteinuria is one of the most common manifestations of renal disease. Changes in plasma protein concentration, glomerular permeability, tubular reabsorption, or renal hemodynamics can affect the rate of urinary excretion and the composition of urinary proteins. Determination of the significance of the proteinuria requires an evaluation of the amount and type of proteinuria in the context of the clinical setting. In addition, the clinician must be familiar with the laboratory evaluation of proteinuria and its limitations in order to correctly interpret these tests.
Topics: Colorimetry; Humans; Immunoassay; Kidney Diseases; Proteinuria
PubMed: 3048856
DOI: No ID Found -
Journal of Veterinary Internal Medicine Jul 2021Use of telmisartan for the treatment of proteinuria in dogs has not been thoroughly investigated.
BACKGROUND
Use of telmisartan for the treatment of proteinuria in dogs has not been thoroughly investigated.
HYPOTHESIS/OBJECTIVES
Telmisartan can be effective for the treatment of proteinuria in dogs.
ANIMALS
Forty-four client-owned dogs with proteinuria.
METHODS
Retrospective study. Dogs diagnosed with clinically relevant proteinuria (nonazotemic dogs with a urine protein-to-creatinine ratio [UPC] ≥2 and azotemic dogs with UPC ≥0.5) were separated into 3 groups: telmisartan alone, with benazepril, or with mycophenolate. The UPC was recorded before treatment and at subsequent follow-ups (1, 3, 6, and 12 months, as available). Response to treatment was categorized as complete (UPC ˂0.5), partial (UPC decreased by ≥50% but still ≥0.5), or no response (UPC decreased by <50%). Serum creatinine and potassium concentrations and arterial pressure also were recorded.
RESULTS
In the telmisartan group, treatment response (UPC ˂0.5 or decreased by ≥50%) was observed in 70%, 68%, 80%, and 60% of dogs at 1, 3, 6, and 12 months follow-up, respectively. No significant changes were noted in serum creatinine or potassium concentrations, or in arterial blood pressure at all follow-up times. Adverse effects consisted of mild self-limiting gastrointestinal signs in 5 dogs. Two dogs developed clinically relevant azotemia that required discontinuation of the treatment before the first follow-up.
CONCLUSIONS AND CLINICAL IMPORTANCE
Telmisartan can be considered for treatment of proteinuria in dogs, alone or in combination with other treatments for proteinuria.
Topics: Animals; Creatinine; Dog Diseases; Dogs; Proteinuria; Retrospective Studies; Telmisartan
PubMed: 33969924
DOI: 10.1111/jvim.16146 -
Pediatric Clinics of North America Dec 2022Proteinuria and/or hematuria are common findings in ambulatory settings. Proteinuria can be glomerular and/or tubular in origin and it may be transient, orthostatic, or... (Review)
Review
Proteinuria and/or hematuria are common findings in ambulatory settings. Proteinuria can be glomerular and/or tubular in origin and it may be transient, orthostatic, or persistent. Persistent proteinuria may be indicative of a serious kidney pathology. Hematuria, which denotes the presence of an increased number of red blood cells in the urine, can be gross or microscopic. Hematuria can originate from the glomeruli or other sites of the urinary tract. Asymptomatic microscopic hematuria or mild proteinuria in an otherwise healthy child is less likely to be of clinical significance. However, the presence of both requires further workup and careful monitoring.
Topics: Child; Humans; Hematuria; Proteinuria; Ambulatory Care
PubMed: 36880921
DOI: 10.1016/j.pcl.2022.07.002 -
MMW Fortschritte Der Medizin Jun 2022
Review
Topics: Hematuria; Humans; Kidney Diseases; Proteinuria; Urinalysis
PubMed: 35731406
DOI: 10.1007/s15006-022-1166-7