Proteinuria presentation

Proteinuria is early indicator of renal disease.

1. TOPIC : PROTEINURIA Presented by : Kehkashan sabir M.Muzamil Arshad BS CHEMISTRY Islamia college Peshawar

2. PROTEINURIA/ALBUMINURIA ASPECTS OF DISCUSSION: 1) Definition 2) Types 3) Symptoms 4) People at risk for Proteinuria. 5) Tests for Proteinuria. 6) Precautionary measures and medications for proteinuria.

3. PROTEINUIA ( Protein in urine ) What is it? proteins form the major building blocks for our bodies . The right amount of protein is important in our diets, for growth and repair. Protein is present in the blood; healthy kidneys should only filter tiny (trace) amounts into the urine as most protein molecules are too large for the filters (glomeruli). It is not usual to lose protein in the urine. When this does happen it is known as ‘ Proteinuria’ .

4. ALBUMINURIA Albuminuria  is a   condition wherein the protein  albumin  is abnormally present in the  urine . Albumin is a major  plasma protein  (normally circulating in the blood); in healthy people . only trace amounts  of it are present in urine, whereas larger amounts occur in the urine of patients with  kidney disease .

5. ALBUMINURIA Albumin is the main protein in the blood. Its function is to maintain osmotic pressure and transport some nutrient. It is a chronic kidney disease (CKD), which can result from diabetes, high blood pressure and diseases that causes inflammation in the kidneys. Kidney disease is sometimes called renal disease . If CKD progresses, it can lead to end-stage renal disease (ESRD), when the kidneys fails completely.

6. Normal urinary protein excretion In normal adult, normal urinary protein excretion should be < 150 mg/day. Normal rate of albumin excretion is < 20 mg/day (15 mcg/min), increases with age and higher body weight.

7. Types of proteinuria

8. Glomerular proteinuria increased filtration of macromolecules (such as albumin ) across the glomerular capillary wall.

9. Tubular proteinuria Tubular proteinuria: is  proteinuria  (excessive protein in the urine) caused by renal  tubular  dysfunction. Proteins of low molecular weight are normally filtered at the glomerulus of the kidney and are then normally reabsorbed by the  tubular  cells, so that less than 150 mg per day should appear in the urine . Low-molecular-weight proteins' appearing in larger quantities than this is tubular proteinuria, which points to failure of reabsorption by damaged tubular cells.

10. Low-molecular weight proteins   Symbols   Molecular weights Amount in normal serum (plasma) (mg   /100ml)     Lysozymes   14,000 0.5-1.5    Basic protein B1 B1 11,000 –    Basic protein B2 B2 8,800 <1    0.6 S γ 2 - Globulin – 5,100 <1    2 S γ 2 - Globulin – 14,000 0.1    Post γ- globulin P γ 13,260

11. Overflow proteinuria: Overflow proteinuria:  that due to hemoglobin, myoglobin, or immunoglobulin loss into the urine due to excessive amounts in the bloodstream, such as in multiple myeloma ; ( It  is a cancer that forms in a type of white blood cell )

12. SYMPTOMS In most cases, proteinuria has no symptoms and is detected during a routine screening in people with high blood pressure or diabetes. If protein loss is severe, swelling or edema can occur. Edema can be present in the: Face and around the eyes Arms, hands, legs, ankles and feet Abdomen

13. Other symptoms can include: Foamy urine Weight gain caused by fluid retention Diminished appetite (loss of hunger) Hypertension

14. Introduction My name Muhammad Muzamil Arshad. And I will further carry on with the presentation discussing Some of the remaining aspects of PROTEINURIA.

15. People at risk for proteinuria Mainly three types of people are at great risk to suffer through Proteinuria.

16. Diabetic People Diabetic people are one of the major suffers of proteinuria. In both diabetes type 1,2 the albumin presence in urine is the first sign of deteriorating kidney functions Kidney functions decline with increase in the albumin Concentration in the urine.

17. KIDNEY STRUCTURE

18. Hypertensive People Hypertensive people are also at risk to have proteinuria. Since in hypertension.

19. Obese People In obese people accumulation of fats on the walls of vessels occurs. Which results in increased blood flow. And may lead to proteinuria. Some other peoples having family history of diabetes and renal Diseases are also at risk.

20. Tests for Proteinuria Earlier researchers though that for protein measurements a 24 hours urine sample collection was required. But in recent years researchers have found that a single sample is enough for the protein measurement of the patients. For this purpose URINE ALBUMIN TO CREATININE RATIO TEST is Carried out.

21. URINE ALBUMIN TO CREATININE RATIO In newer technique the amount of albumin is compared with creatinine. Creatinine is the waste product of muscles breakdown. This test is called urine albumin to creatinine ratio. If the sample contains more than 30mg albumin per gram of creatinine the patient is said to have Persistent Proteinuria. Beside ATCR there is an additional test for proteinuria which is called Estimated glomerulus filtration rate (eGFR).

22. ESTIMATED GLOMERULUS FILTRATION RATE (eGFR) Amount of creatinine in blood shows a persons kidney is removing wastes efficiently. Chronic Kidney Disease (CKD) is present when eGFR is less than 60ml/minute. Which is an indicator for person suffering through proteinuria.

23. PRECAUTIONARY MEASURES & MEDICATION Persons with diabetes and hypertension should control their blood sugar and pressure. This is the only precautionary measure. The medication for proteinuria includes ACE Inhibitor (angiotensin converting enzyme inhibitor). ARB’s (angiotensin receptor blockers). ACE Inhibitor & ARB’s reduce the intra glomerular pressure on kidney by inhibiting angiotensin II-medicated efferent arteriolar vasoconstriction. These drugs also have a proteinuria reducing effect which is independent of their antihypertensive effect.

24. THANK YOU FOR YOU PATIENCE