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Proteinuria (protein in the urine)

 

Proteinuria (protein in the urine)

Proteinuria - is the presence of protein in the urine. Under physiological conditions, the passage of proteins through the glomerular filter is determined by the pore size of the basement membrane, molecular weight protein (MM), shape and electrical charge of its molecules, the relationship between protein concentration in plasma and filtrate.

However, the presence of protein in the urine does not mean that the protein of renal origin. Proteinuria - a cardinal symptom of kidney disease, but may also indicate a pathological condition of the body.

Strengthening of proteinuria depends on:

  • destruction of the basement membrane and podocytes (cells of the capsule of the nephron)
  • lack of tubular reabsorption
  • filtration of pathological proteins (paraproteins) with low moleklyarnoy mass, which, because of the large number of or in connection with their qualitative features are not fully reabsorbed
  • increased secretion of protein (slime), the epithelium of kidneys, urinary tract, the auxiliary glands

 

Types of proteinuria

Identify several types of proteinuria:

  1. Prerenal proteinuria
  2. Renal proteinuria
  3. Postrenalnuyu proteinuria
     

I. Prerenal proteinuria is characterized by the inflow into the urine through the intact kidney filter pathologic plasma proteins with low MW.

Prerenal proteinuria observed at:

  • monoclonal gammopathy due to increased synthesis of immunoglobulin light chains
  • hemolytic anemia with intravascular hemolysis of red blood cells
  • with necrotic, traumatic, toxic and other muscle injuries involving mioglobinemiey and myoglobinuria

These conditions only at low concentrations and in the beginning does not cause the destruction of renal nephron. High concentrations and / or prolonged disease process eventually leads to disruption of the renal filter and the development of acute renal failure.

 

II.Renal proteinuria is divided into:
  1. functional proteniuria:
    • transient or transient
    • working or voltage
    • congestive
    • febrile and toxic
    • orthostatic
    • hyperlordosys
  2. organic proteniuriyu caused the damage of the renal nephron.

Functional proteinuria is observed more frequently in the age of 20-30 years. The protein concentration of urine in proteinuria is not functional is usually massive.

When transient - the selection of the protein does not exceed 1 -2 g / day. Congestive proteinuria characteristic decrease in amount of urine with a high density of protein in the presence of 1 -2 g / l, and sometimes even higher (up to 10 g / day). Violation of hemodynamics (coronary proteinuria) develops as a result of changes in electrical charge of albumin molecules adsorbed on the membrane pores, and is accompanied by albuminuria.

Coronary proteinuria may occur when cardiac decompensation, flat, pregnancy.

Proteinuria extrarenal origin may occur in myocardial infarction, apoplexy, cerebrocranial (CCI) injury, seizures, colic, feverish, in the postoperative period and disappears after removal of the cause.

Organic proteinuria may be the glomerular and tubular origin.

Glomerular (glomerular) proteinuria develops due to the damage the glomerular filter, resulting in broken filtration and diffusion in the glomerulus.

Glomerular proteinuria is observed in all kidney diseases, occurring with lesions of glomerula:

  • acute and chronic glomerulonephritis
  • diabetes mellitus
  • kidney tumor
  • toxicosis pregnant
  • nephrosis
  • gout
  • kidney cyst
  • chronic potassium deficiency
  • collagen
  • hypertonic disease

Tubular (tubular) proteinuria is due to inhibition or deficiency of enzyme systems of the renal epithelium as a result of toxic exposure.

Tubular proteinuria develops in hereditary (congenital) or acquired tubulopatiyah:

  • acute and chronic renal failure
  • acute and chronic pyelonephritis
  • tubular nephropathy caused by poisoning with heavy metals (mercury, lead), toxic and nephrotoxic drugs

Depending on the integrity of the basement membrane and its ability to pass a urine protein isolated:

  1. Selective proteinuria
  2. Non-selective proteinuria

Selective proteinuria, in turn, prodrazdelyayut on high-, moderate-and nizkoselektivnuyu.
Selective proteinuria is characterized by selective ability of the basement membrane in which proteins are filtered low MW (albumin, transferrin).

When nizkoselektivnoy proteinuria in the urine passes not only low molecular weight, but also high-molecular proteins. Nizkoselektivnaya protenuriya observed when expressed in glomerular lesions, such as chronic nephritis in acute stage.

Subacute illness characterized by more umerennoselektivnaya proteinuria.

Microalbuminuria - a urinary excretion per day from 30 to 300 mg of protein, there is in impairment of filtration of albumin in the glomeruli and is a criterion for early nephropathy in diabetes.


III. Postrenalnaya proteinuria may occur if the secretion of proteins (mukoidov) epithelium of the urinary tract. Slight protein are dead blood cells, including red blood cells in the form of microhematuria (blood in the urine) with urinary stones, passing through the urinary paths, epithelial cells of the urinary tract, and neoplasms and mucus.

 

If you have any questions about the diagnosis or treatment of proteinuria, you can specify them with our urologist or a nephrologist on the phone: (499) 130-08-09

 

 
 

 

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