1. Proteinuria 24 th June 2011 Rachel Lennon

2. The Spectrum of Glomerular Disease Minimal change Proteinuria FSGS IgA nephropathy Membranous Diabetic nephropathy MCGN SLE Post infectious nephritis Anti-GBM disease Small vessel vasculitis

3. Endothelial cells Podocyte GBM 1 million in each adult human kidney

4. Glomerular filtration barrier Podocytes Glomerular endothelial cells GBM 180 litres of water and small solutes- almost no proteins Slit diaphragm

5. Mundel et al: Kidney International 2010 77 (7) p571-80

6. Definition Protein:creatinine ratio (PCR) – 20mg/mmol – 200mg/mmol nephrotic range Albumin: creatinine ratio (ACR) – 30mg/mmol

7. Case-1 13 year old boy No PMH/FH renal disease BP and renal function normal Incidental finding – Urinalysis: 2+protein – Mild proteinuria (PCR 20-50) 3 early morning urines: PCR Orthostatic proteinuria

8. Case-2 5 year old boy BP and renal function normal Urinalysis 2+ protein, 2+ blood – PCR 40-50 – ACR 20 – Calcium:creatinine: 1.5mmol/mmol – USS: Nephrocalcinosis NAG/RBP:creatinine Dent’s disease: CLC5/OCRL-1 mutations

9. Case-3 8 year girl – PMH: Bilateral VUR and recurrent UTI – FH: VUR DMSA: Bilateral renal scarring BP normal, eGFR 65ml/min/1.73m 2 Urinalysis 2+ protein PCR 30-50 Enalapril 5mg od Renal function before and at 2 weeks Reflux nephropathy

10. Case-4 8 year old girl HSP Urinalysis: Protein 3+, blood 2+ PCR 100-150: Persistent at 4 weeks BP 95 th centile Normal renal function Renal biopsy: Crescentic GN, IgA deposition Steroids/Azathioprine/Enalapril HSP nephritis

11. Summary Investigate persistent proteinuria – Orthostatic – Tubular disease – Nephropathy Use of anti-proteinuric agents to limit secondary injury