• Correlation between spot UPro/Cr ratio and 24 hour urine? --> moderate accuracy (R 0.8)
  • Still very useful for clinical practice, limitation is mostly for research purposes (UPro < 3g is often treatment goal)
  
  

  Posted 11/29/16 09:09:54 AM by Matthew Cummings

• Renal US for the assessment of chronic kidney disease chronicity?
  • US can help assess for chronicity if kidneys are SMALL in size (echogenicity is less reliable)
  
  

  Posted 11/29/16 09:11:41 AM by Matthew Cummings

• Concern for plasma cell disorder/amyloidosis and associated renal disease?
  • Must send serum free light chains (SFLC) -- can detect the low levels of FLCs (may be below threshold detected by SPEP/UPEP) AND SFLC can detect changes in kappa/lambda ratio (excess plasma cell clone)
  
  

  Posted 11/29/16 09:16:43 AM by Matthew Cummings

• Nephrotic syndrome in African-American population:
  • FSGS (#1 in African Americans -- also think FSGS due to HIV, viral hepatitis)
  • Membranous (also think underlying malignancy)
  • MCD (think Hodgkin's disease)
  • Amyloidosis (primary or secondary)
  • DM (usually after 5-10 yrs of poor control)
  
  

  Posted 11/29/16 09:21:07 AM by Matthew Cummings

• Minimal change disease + interstitial nephritis? Think NSAIDS
  
  

  Posted 11/29/16 09:21:25 AM by Matthew Cummings

• Nephrotic syndrome and edema formation
  • Likely NOT due to oncotic pressure imbalance -- rat model with undetectable albumin NOT edematous 
  • Loss of glomerular integrity --> glomerular filtrate/protein --> activates sodium channel --> sodium/fluid retention
  
  

  Posted 11/29/16 09:28:31 AM by Matthew Cummings

• Nephrotic syndrome and risk of VTE
  • Highest in membranous -- loss of anti-thrombin
  • Hypoalbuminemia = most significant predictor of thrombotic risk (especially <2 g/dL). 
  • Low index of suspicion for renal vein thrombosis/PE
  
  

  Posted 11/29/16 09:30:56 AM by Matthew Cummings

• For further reading...

  The pathophysiology of edema formation in the nephrotic syndrome (Siddall, Radhakrishnan)
  Correlation between random and 24-hour urine protein excretion in patients with glomerular diseases
  Renal vein thrombosis and hypercoagulable state in nephrotic syndrome (Radhakrishnan)
  
  

  Posted 11/29/16 09:35:47 AM by Matthew Cummings

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