Moffitt AM renal report PEARLS 8/14/15: renal emergencies and proteinuria

Overnight management of AKI – 2 reasons not to wait to call your friendly renal fellow!

  • Need for urgent dialysis (AEIOU – acidemia, hyperkalemia, ingestion, overload, uremia refractory to medical therapy)
  • RPGN (rapidly progressive GN) – anti-GBM, SLE, vasculitis (GPA/MPA), idiopathic


Proteinuria myths and truths

  • Urine dipstick/UA only measures albumin (misses things like light chains)
    • 1+ on dipstick ~ 30mg /dL
    • 2+ on dipstick ~100
    • 3+ on dipstick ~300
    • 4+ on dipstick ~2000
  • Urine protein:Cr ratio captures all proteins
  • Spot urine prot:Cr is internally consistent (good for comparing a pt’s prot:Cr between time points) and generally correlates with 24h urine protein.
    • However, understand the limitations of using this to estimate 24h urine protein excretion!
      • Assumes a certain creatinine excretion over 24h (~1g/day), which varies by gender and body mass
      • Varies based on eGFR and urine volume (e.g. a pt with oliguria may have high spot urine prot:Cr but absolute urine protein excretion is low!)
      • Not reliable in some intrarenal causes of AKI where dead renal tissue is excreted (eg renal cortical necrosis)
    • Proteinuria does not directly cause hypoalbuminemia! The amount of protein excreted in the urine is far lower than one’s protein intake. Think about a more systemic process causing the hypoalbuminemia!



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