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Ellen, a 47-year-old woman who has suffered kidney disease for several years, has been diagnosed with proteinuria. Her legs and feet are so swollen that she has difficulty walking. Her hands and her left arm are also swollen. What is proteinuria and could this condition be playing a role in her swollen limbs?
Proteinuria, also called albuminuria is a condition in which urine contains an abnormal amount of protein. Proteins in the blood, like albumin, help coagulation, balance body fluids and fight infection. In a healthy person, the kidneys remove wastes from protein-rich blood through glomeruli. Glomeruli consist of capillaries that are permeable to fluid and small solutes but effective barriers to plasma proteins. Most proteins are too large to pass through the glomeruli into the urine and since glomeruli are negatively charged, they repel negatively charged proteins. But when glomeruli are damaged, proteins pass through them and are excreted in the urine. Albumin is the main protein in the blood. Proteins are the building blocks for all body parts, including muscles, bones, hair, and nails. Proteins in the blood also perform a number of important functions such as, protect the body from infection, help blood clot, and keep the right amount of fluid circulating throughout the body. Hypertension and diabetes are the two biggest risk factors for proteinuria. Proteinuria in a person with high blood pressure is an indicator of declining kidney function. As the kidney function declines, the amount of albumin in the urine increases. Two of the most prominent signs and symptoms include foamy urine and swelling, or edema. Excess protein can cause the urine to foam in water; this is because protein changes the surface tension between urine and water. Edema usually indicates a more severe case of Proteinuria. Albumin is particularly useful in absorbing bodily fluid into the blood. Due to its small size, albumin is usually one of the first proteins to enter urine after glomeruli are damaged. The reduced albumin level in the blood causes fluid retention in the tissue space, which causes swelling that is first noticeable in the hands, lower legs, and feet. As a healthcare professional who came in complaining of swelling in their limbs and their urine is foamy, I would first ask if they have any risk factors that are associated with proteinuria, such as high blood pressure, diabetes, or congestive heart failure. If the patient were to have any of these risk factors, especially diabetes or hypertension, I would take a urine test to measure the amount of albumin in the urine and compare it to the amount of creatine, which is a waste product of normal muscle breakdown. If the test 30 mg/g of albumin, then I would run another test 1-2 weeks later. If the second test still shows high levels I would then be able to determine the patient has persistent proteinuria, which is a sign of declining kidney function. I would then run additional testes to evaluate the kidney function. If my patient had diabetes or hypertension, the first goal of treatment would be to control their blood glucose levels and blood pressure. For patients with diabetes, I would advise them that they should test their blood glucose levels often, follow a healthy eating plan, exercise regularly and take their prescribed medications.

American Kidney Fund. "Proteinuria." Protein in Your Urine (Proteinuria) - American Kidney Fund. American Kidney Fund, 12 Aug. 2012. Web. 22 Aug. 2012. http://www.kidneyfund.org/kidneyhealth/kidney-problems/protein-in-your-urine.html

Describe the mechanisms by which the kidneys remove hydrogen ions from the body. 1011-1012
The kidneys maintain homeostasis, remove waste products, filter the blood and balance the volume of fluids in the body. The essential functions are accomplished via a complex filtration system in the nephrons of the kidneys. Once fluids are processed through the renal tubules, the resulting fluid moves into collecting ducts. Hydrogen ions are released into the collecting ducts, which is important for the regulation of pH in the body. In order to keep a normal alkalinity of the extra cellular fluid (pH 7.4), there must be a hydrogen-ion balance. Tubule cells, including collecting ducts, respond to the pH of the ECF and alter their rate of H secretion accordingly. The kidney cells produce a constant amount of hydrogen ion and bicarbonate because of their own cellular metabolism. Through a carbonic anhydrase reaction, hydrogen ions get produced and secreted into the lumen of the nephron and bicarbonate ions get produced and secreted into the blood. In the lumen of the nephron, filtered bicarbonate combines with secreted hydrogen ions to form carbon dioxide and water. Whether the kidney removes hydrogen ions or bicarbonate ions in the urine depends upon the amount bicarbonate filtered in the glomerulus from the blood relative to the amount of hydrogen ions secreted by the kidney cells.