Renal Disease in Children
Proteinuria
·
Definition: > 150 mg protein/day
(same cut off as adults)
·
Normally protein is lost from
tubular cells. Pathological if:
o Filtered protein from glomerulus
o Loss from
tubular cells
·
Categories:
o Gross proteinuria: > 1 gm/day (® nephrotic syndrome if severe)
o Acute low grade
o Chronic low grade
· Diagnosis:
o Dipstick: measures concentration of protein, so if urine is concentrated ® protein concentration as well
o 24 hour urine: problem if not continent
· Nephrotic syndrome:
o = Proteinuria + oedema + ¯albumin in blood (hypoproteinaemia)
o Oedema is due to ¯colloid osmotic pressure ® aldosterone ®Na ® H2O retention ® this leaks out as well
o Caused by leaky glomeruli
· Minimal Change Disease:
o = No change under light microscope
o Passing up to 8 – 10 gm per day ® gross oedema
o 3 rare complications:
§ Hypoperfusion: classically the gut ® abdominal pain
§ Loose Ig‟s as well ® risk of bacterial infection (eg pneumococcal)
§ Thrombosis (eg renal vein)
o Usually grow out of it (eg over 6 months, although may persist until an
adult). Unpleasant but not usually life-threatening
o Treatment: steroids but side-effects
o 10 – 20% have other causes which may ® chronic renal failure
·
Acute low-grade proteinuria:
o No long term significance
o Can be:
§ Exercise induced in some teenagers/adults
§ Urinary tract infection
§ Postural proteinuria (when standing up)
o Have to demonstrate that it‟s gone (ie that its not chronic)
·
Persistent/chronic low grade
proteinuria
o Always have some. Exclude exercise and postural
o Significant finding: risk of renal disease, eg in adult
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