Proteinuria & Hematuria

▶️ Watch Dr Anupam Roy Explain about Proteinuria & Hematuria

Proteinuria - How to Detect, Causes & Management

Common cause of Hematuria blood in Urine

Presence of protein in the urine is defined as proteinuria. Normally less than 150 mg of protein appears in urine per day. Massive proteinuria (>3.5 gm/day) is defined as nephrotic syndrome

Symptoms:

Edema (swelling) in the face, legs, or both; frothing of urine.

Causes:

Primary kidney diseases like IgA nephropathy, MPGN, Minimal change disease, Membranous glomerulopathy

Conditions like Diabetes, Hypertension, Renal vasculitis, SLE, Amyloidosis, Post infectious glomerulonephritis can be associated with nephrotic range proteinuria.

Investigations:

(a) Urine testing — 

Dipstick test

A spot urine sample collected at any time (a common and convenient method).

Urine that has been collected over 24 hours (a more exact but somewhat inconvenient method)

Microscopic examination to see whether there are cells, crystals, bacteria, or structures called casts.

(b) Blood tests —
Kidney function tests including BUN and creatinine
Specialised immunological tests.

(c) Kidney biopsy 

Management:

Depends on underlying renal or non renal condition.

Diet: Salt restricted. Protein restriction is controversial. Some studies indicate that it may slow progression of disease but concern exists that it may lead to protein malnutrition. Recommended protein intake is 0.8-1 gm/kg/day. 

Control of diabetes/ hypertension.

In case of immune mediated injury, steroids and other immunosuppressive medications may be required.

Prognosis: depends on cause, degree of proteinuria, and presence/ absence of renal dysfunction.

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Presence of blood in urine is technically known as Hematuria.

Symptoms: 

Can be gross (overtly bloody, smoky or tea coloured urine) or detected only on microscopic examination of urine. May be painless or associated with pain.

Causes:

Kidney diseases like IgAN, Thin BM disease, HUS, MPGN, Lupus Nephritis, Alports syndrome etc.

Non glomerular conditions like fever, trauma, strenuous exercise, menstruation, foreign body, UTI, stones, tumours etc can also have associated hematuria.

Investigations:

Urinalysis, urine c/s

BUN, Creatinine, Hematological & coagulation studies, Serological tests like complement level, ANA, dsDNA.

Imaging studies include USG, CT, radionuclide studies

Kidney biopsy may be required

Management:

Hematuria is a sign and not a disease. Treatment is directed at underlying disease process.

Surgery may be needed in conditions like UPJ obstruction, tumours, stone disease.

Disclaimer: Please consult your nephrologist for detailed opinion.
Key words: Proteinuria, protein in urine, nephrotic syndrome

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Hematuria

▶️ Watch Dr Anupam Roy Explain about Hematuria

Common cause of Hematuria blood in Urine

Presence of blood in urine is technically known as Hematuria.

Renal replacement therapies

Once the stage of End Stage Kidney Disease is reached the treatment options are broadly classified as Renal Replacement Therapies. They include dialysis (hemodialysis/ peritoneal dialysis) and kidney transplantation.

Introduction to nephrotic syndrome

https://www.youtube.com/watch?v=OcCtfHQNMY4

Nocturnal hemodialysis

Nocturnal hemodialysis (NDHD) or night hemodialysis is done at home or in-centre at night. 

This is done with an aim to provide higher dose of dialysis. Nocturnal dialysis is therefore scheduled for 3-5 times a week, each session lasting for 6-8hrs.

Vascular access for hemodialysis

For hemodialysis, blood is taken out of the body, passed through a filter to clean it and then returned to the body. This requires an access which can be used to remove and return blood into the body safely.

An arteriovenous (AV) fistula

Diet advice for diabetics

▶️ Watch Dr Anupam Roy Explain about Eating habits for Kidney Patient

Diet for Kidney Patients

Diet in Kidney Disease

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Water Intoxication

Are you Drinking too much Water

The mantra to enjoy food during festivals for patients with diabetes is self control.

Diabetics should regulate and limit high calorie food intake during festivals. Small frequent meal pattern (the 6-meal pattern) facilitates easy absorption and helps keep blood sugar levels under control.

If you are making sweets yourself (kheer, ladoos etc), use of low fat ingredients- like low fat milk and other dairy products is recommended. Natural sweeteners like honey and dates may be used to make sweets.

There are plenty of recipes for diabetic patients available online and with the help of artificial sweetener you can make sweets and other traditional food items easily. Consult your doctor regarding the intake of artificial sweeteners.

Before eating snacks, drinking water maintains a feeling of fullness.

Fruits like papayas, oranges, apples, and grapes should be taken in each meal to supplement food as well as satisfy the taste buds.  

Carbonated cold drinks are to be avoided.  Instead, natural drinks like lemon juice, coconut water, butter milk or some other fruit juice are perfect thirst –quenchers.

Do not forget your diabetic medicines. Insulin or other medicines if prescribed, has to be taken regularly. Self monitoring of blood glucose is advised and the dose of insulin may be adjusted accordingly.

Exercise regularly to help burn out the extra calories.