0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

A 5-year-old male presents to the ED with 3 days of “brown urine” and

facial swelling. One week earlier he had experienced a URI with fevers and

sore throat. On examination, he is mildly hypertensive and has periorbital

edema but is otherwise normal. His BUN and creatinine are elevated. What UA

findings would confirm your suspicion of poststreptococcal glomerulonephritis?

Proteinuria, dysmorphic RBCs, and RBC casts.

PROTEINURIA

Proteinuria can be divided into four basic groups: Glomerular (increased
glomerular permeability), tubular (decreased tubular reabsorption), overflow
(excess production exceeding normal kidney capabilities), and functional
(benign causes).

SYMPTOMS/EXAM

■ Varies with underlying cause
■ As most cases are functional, exam is often normal.
■ Patients with glomerular proteinuria classically present with edema, rang-
ing from dependent peripheral edema to anasarca.
■ Ask about history of recent viral or systemic illness, change in medications,
hypertension, diabetes, cardiac, or renal disease.

DIAGNOSIS

■ Evaluate urinalysis to look for markers of disease:
■ RBC casts and hematuria →glomerulonephritis (GN).
■ Fatty casts or oval fat bodies →nephrotic syndrome.
■ WBCs, WBC casts without bacteria →interstitial nephritis.
■ Hyaline casts →benign causes.
■ Obtain BUN/Cr in patient with evidence of underlying renal disease.

TREATMENT

■ Depends on underlying etiology
■ Patients at minimum need primary care follow-up to evaluate for persistent
proteinuria.

Nephrotic Syndrome

A form of glomerular proteinuria characterized by nephrotic-range proteinuria
(3.5 g/24 hours), hypoproteinemia, hyperlipidemia, and peripheral edema, it
may be caused by a primary glomerular disease process or secondary to diabetes,
lupus, etc.

SYMPTOMS/EXAM

■ Gradual onset of edema
■ Foamy urine, due to high levels of protein

DIAGNOSIS

■ Based on characteristic clinical and laboratory findings