Rationale

Proteinuria is often the first indicator of potentially serious underlying renal disease.

Causal Conditions

(list not exhaustive)

1. Orthostatic proteinuria

2. Tubulointerstitial (interstitial nephritis)

3. Glomerular

   1. Active urine sediment

      • Primary (e.g., IgA nephropathy, membranoproliferative glomerulonephritis)

      • Secondary (e.g., systemic lupus erythematosus (SLE), post-infectious)

   2. Non-active urine sediment

      • Primary (e.g. minimal change, focal segmental glomerulosclerosis)

      • Secondary (e.g., diabetes, amyloid)

Key Objectives

Given a patient with proteinuria, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan. In particular, the candidate should recognize the importance of proteinuria as a predictor of chronic kidney disease.

Enabling Objectives

Given a patient with proteinuria, the candidate will

1. list and interpret critical clinical findings, including

   1. perform a history and physical exam to elicit symptoms and signs of underlying diseases associated with kidney disease (e.g., diabetes mellitus, connective tissue diseases);

2. list and interpret critical investigations, including

   1. quantitative measures of proteinuria (e.g., albumin/creatinine ratio, 24 hour protein collection) to guide further diagnostic work-up;

   2. tests to determine the underlying cause of the proteinuria (e.g., blood glucose, serum protein electrophoresis);

3. constuct an effective initial management plan, including

   1. initiate measures to delay progression of chronic kidney disease associated with proteinuria (e.g., angiotensin-converting enzyme inhibition, treatment of hypertension and diabetes);

   2. refer the patient for specialized diagnostic tests and care (e.g., renal biopsy), if necessary.