Calgary Blackbook @CalgaryBlackBook · 4 years ago
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Causes of Proteinuria - Differential Diagnosis Algorithm Persistent Proteinuria >150mg/d protein present on repeat testing including overnight
blackbook.ucalgary.ca 
Causes of Proteinuria - Differential Diagnosis Algorithm
Persistent Proteinuria >150mg/d protein present on repeat testing including overnight testing
Transient Proteinuria
 • Exercise
 • Fever
 • UTI
Orthostatic Proteinuria
 • Tall adolescents
Tubular Proteinuria (Negative urine dip = no albuminuria)
 - Overflow
     • Multiple Myeloma
     • MGUS
 - Poor reabsorption
     • RTA
     • Fanconi's syndrome
     • Drugs
Glomerular Proteinuria (Positive urine dip = albuminuria)
 - Active urine sediment - WBC/RBC casts
     • IgA nephropathy
     • Membranoproliferative GN
     • Mesangial proliferative
     • Anti-GBM antibodies
     • Granulomatosis with polyangiitis (GPA) / microscopic polyangiitis (MPA)
     • SLE
     • HSP
     • Post-infectious GN
 - Bland urine sediment
     • FSGS
     • Minimal change disease
     • Membranous nephropathy
     • HTN
     • Diabetes
     • Protein deposition (eg. Amyloidosis)

#Proteinuria #Nephrology #Differential #Diagnosis #Algorithm #Causes
Calgary Blackbook @CalgaryBlackBook · 4 years ago
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Algorithm - Approach to the differential diagnosis of the patient presenting with overt glomerular proteinuria. CMV
Algorithm - Approach to the differential diagnosis of the patient presenting with overt glomerular proteinuria. CMV = Cytomegalovirus; GBM = glomerular basement membrane; GN = glomerulonephritis; HUS = hemolytic-uremic syndrome; aHUS = atypical HUS; MPGN = membranoproliferative glomerulonephritis; TTP = thrombotic thrombocytopenic purpura. Overglomerular proteinuria is arbitrarily defined as urine protein >1.0 g/ days in a collection that is documented to be a complete 24-hour collection based on its creatinine content [85].2>5 red blood cells/high-power field + acanthocytes or red cell/white cell casts. One or more of the following are involved: abdomen (enteritis, colitis, pancreatitis), joints (arthritis), central nervous system (stroke, seizure, cognitive impairment), heart disease, ear (unexplained effusions), extremities (ischemia, infarction), eye (inflammation of the retina, uveae, plexus, or sclera), lungs (hemoptysis, infiltrates, lymphadenopathy, pleuritic pain, pleural effusion), mouth (ulcers), nose (epistaxis), skin (alopecia, purpura, palpable purpura, maculopapular rash vesicular rash, sclerosis). In each diagnosis cluster, the diseases are listed in order of approximate incidence. Diabetic nephropathy and scleroderma are listed in 2 diagnosis clusters because nephritic urine sediment may or may not be present. Nephrocalcinosis causes nephron loss, causing secondary FSGS. Hematuria may be present. #Algorithm #differential #diagnosis #glomerular #proteinuria #nephrotic #syndrome #nephrology
Podocytopathies - Differential Diagnosis Algorithm No podocytopenia - EM shows minimal change disease • Minimal Change Nephropathy Podocytopenia
Podocytopathies - Differential Diagnosis Algorithm No podocytopenia - EM shows minimal change disease • Minimal Change Nephropathy Podocytopenia - LM shows segmental sclersosis • FSGS Tip Variant • FSGS cellular variant • FSGS NOS Podocyte Proliferation - LM shows capillary collapse or mesangial sclerosis • Low - Diffuse mesangial Sclerosis • High - Collapsing GN Dr. Kenar Jhaveri @kdjhaveri #Podocytopathies #Podocytopathy #podocytes #Differential #Diagnosis #Algorithm #nephrology
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HSCT related renal disease - AKI and CKD Acute Kidney Injury: Acute GvHD 2-4, Pre renal state,
HSCT related renal disease - AKI and CKD Acute Kidney Injury: Acute GvHD 2-4, Pre renal state, Antibiotics, Sepsis, Acyclovir, Amp B, ACE Inhibitor use, Contrast, Calcineurin Inhibitors, Veno occlusive disease(VOD) Chronic Kidney Disease: • Glomerular Diseases - Membranous Nephropathy (75%), Minimal Change Diseases, FSGS, Proliferative GN • Viral: BK virus, CMV virus, Adenovirus, HHV6 and 8 • TMA: Calcineurin inhibitors, Viruses, GVHD, Conditioning regimen, Total body irradiation, Complement deficiencies • Idiopathic: GVHD Dr. Kenar Jhaveri @kdjhaveri #stemcell #transplant #HSCT #renal #disease #AKI #differential #diagnosis #algorithm
Hematuria - Differential Diagnosis Framework Gross Hematuria: Red/Dark urine • 1ml blood/liter urine can induce color change
Hematuria - Differential Diagnosis Framework Gross Hematuria: Red/Dark urine • 1ml blood/liter urine can induce color change • Gross hematuria + clots ➔ Lower Urinary tract source • Hematuria: 3 or more RBC/HPF spun urine sediment Microscopic Hematuria: • Detectable by examination of urine sediment by microscopy (Urinalysis or dipstick) Glomerular Hematuria: • Immune mediated injury • Noninflammatory glomerulopathies • Causes of Glomerular Bleeding - IgA nephropathy - Thin basement membrane disease - Alport syndrome - Mesangioproliferative GN without IgA deposits - Post-infectious GN - Loin pain hematuria syndrome: • Flank pain + gross or microscopic hematuria • Signs of glomerular hematuria: - RBC casts → Diagnostic of GN or vasculitis - Dysmorphic RBC - Brown urine - Proteinuria → Suggestive of glomerular disease Renal Causes of Hematuria: • Pyelonephritis • Hydronephrosis • Malignant HTN • Renal vein thrombosis • Renal artery embolism • AVM • Papillary necrosis (Sickle cell) • Renal Mass Ureteral Causes of Hematuria: • Stone • Stricture • Malignancy • Fistula • Post-procedural • Nutcracker syndrome: - Compression of left renal vein between aorta and SMA - Can cause microscopic and gross hematuria Bladder Causes of Hematuria: • Malignancy • Cystitis • Bladder stones/polyps • Radiation • Rapid decompression • Diverticulum Urethra/Prostate Causes of Hematuria: • Urethritis • Urethral diverticulum • Traumatic catheterization • BPH • Prostate cancer • TURP/Biopsy Renal/Ureter/Bladder (Upper and Lower urinary tract) Causes of Hematuria: • Infection (Viral/Bacterial) • TB • Schistosomiasis • Urolithiasis • Malignancy • Trauma • Intervention • Exercise induced bleeding • Anticoagulation Pseudohematuria: • GI bleed • Menstruation/Postpartum • Drugs: Pyridium, Phenytoin, Rifampin • Beets • Pigmenturia #Hematuria #Differential #Diagnosis #causes #urology #nephrology #renal #urine #blood
Causes of Polyuria - Differential Diagnosis Algorithm Polyuria - Urine Output > 3L/day, Increased Urine Volume (>2ml/min) Osmotic
Causes of Polyuria - Differential Diagnosis Algorithm Polyuria - Urine Output > 3L/day, Increased Urine Volume (>2ml/min) Osmotic Diuresis Urine Osmolality > Serum Osmolality • Hyperglycemia (Uncontrolled Diabetes Mellitus) • Mannitol administration • Increased urea concentration (e.g. Recovery from Acute Renal Failure, increased protein feeds, Hypercatabolism [Burns, Steroids], GI Bleed) • NaCl administration Hypertonic Urine Following Water Deprivation Test • Primary polydipsia Hypotonic Urine Following Water Deprivation Test - Excessive Loss - DDAVP -> Uosm Increased by >50% - Proper kidney response • Central Diabetes Insipidus - DDAVP -> Uosm unchanged or increased by <50% - Unresponsive Kidney • Nephrogenic Diabetes Insipidus #Polyuria #Nephrology #Differential #Diagnosis #Algorithm #Causes
Causes of Nephrolithiasis - Differential Diagnosis Algorithm Radio-opaque - Calcium-containing - 90% of stones Radiolucent - Non-calcium 10%
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Causes of Hyperkalemia - Reduced Excretion - Differential Diagnosis Algorithm Reduced flow through distal nephron - TTKG
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Causes of Acute Kidney Injury (AKI) - Differential Diagnosis Algorithm Acute Kidney Injury (AKI) - Acute increase
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