3/4/2017 EvaluationofproteinuriaHistory&ExamEpocratesOnline

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Evaluationofproteinuria
History&Exam
Common
Differential History Exam
Fever fever elevatedtemperature>100.4F(38.0C)

Heavyphysicalexertion recentstrenuousexercise nospecificfindings

Urinarytractinfection dysuriacloudyfoulsmellingurineurinaryurgency flanktenderness(ifpyelonephritis)bladdertenderness

urinaryfrequency onpalpation

Urologichemorrhage recentinstrumentationortraumatourologicsystem grosshematuria

Orthostaticproteinuria usuallychildrenandadolescents nospecificfindings

Minimalchangedisease mostcommoninchildrenandolderpeoplebutoccurs markededemaBPoftennormaltolow

atallagesoftensuddenonsetwithmarkededema
maybeassociatedwithnonsteroidalantiinflammatory
drugs(NSAIDs),interferon,lithium,lymphoma,bee
stings,stemcelltransplant

Focalsegmentalglomerulosclerosis morecommoninblackpeopleandinpatientswithHIV edemahypertension

infectioncanbesecondarytohypertension,diabetes,
priorrenalinjury,obesity,bisphosphonates,heroinuse

Membranousnephropathy morecommoninolderadultsmaybeassociatedwith edemaoftenhypertensive

nonsteroidalantiinflammatorydrugs(NSAIDs),gold,
penicillamine,adenocarcinoma,SLE,hepatitisB,
hepatitisC,syphilis,stemcelltransplant

Membranoproliferative idiopathicisraregenerallyhxofanotherdiseasesuch edemaoftenhypertensivemayhaveevidenceof

glomerulonephritis asSLE,hepatitisC,postinfectiousglomerulonephritis, arthritis/rash/otherendorganinvolvementwithSLE
endocarditis,cryoglobulinemia,thrombotic murmurwithendocarditisteacoloredurinewith
microangiopathy postinfectiousglomerulonephritis

IgAnephropathy mostcommonglomerulonephritisworldwidehigh mayormaynothaveedemaandhypertensionoften

incidenceinAsianshxofgrosshematuriaassociated discoveredincidentallywhileevaluatingmicroscopic
withupperrespiratoryinfectionhxofCrohndiseaseor hematuria
celiacdisease

Systemiclupuserythematosus hxofrash,photosensitivity,oralulcers,arthritis, malarrasharthritisedemahypertensionoralulcers

serositis,renaldisease,neurologicchanges(psychosis, pleuraleffusionneuropathyRaynaudphenomena
seizures),hematologicdisease

Postinfectiousglomerulonephritis recenthxofinfectioncanoccurwithvirtuallyany edemahypertensionteacoloredurineinsomecases

infectiousagentclassicdescriptionis
poststreptococcalStaphylococcusaureus
superantigenscanresultinrapidacutekidneyinjury

Acutetubularinjury recentnephrotoxicinjurysuchashypotension, nospecificfindings

nonsteroidalantiinflammatorydrugs(NSAIDS),
aminoglycosides,amphotericinB,zoledronicacid,oral
phosphatebowelpreparations,IVcontrast,mechanical
ventilation,ischemia

Interstitialnephritis exposuretotypicaloffendingmedicationssuchas mayhaverashandfeveranterioruveitisin

nonsteroidalantiinflammatorydrugs(NSAIDs), tubulointerstitialnephritisanduveitissyndrome
antibiotics,allopurinol,protonpumpinhibitorsuveitisin
thetubulointerstitialnephritisanduveitissyndrome
infectiousagents(e.g.,viruses)systemicdisease(e.g.,
sarcoidosis,Sjogrendisease)

Urinarytractobstruction hxofBPH,kidneystones,urinaryretention, palpablebladdermaybepresentenlargedprostateon

gynecologiccancermayhavedecreased,normal,or rectalexam
increasedurineoutputflankorsuprapubicpain

Metabolicsyndrome overweighthxofhypertension,insulin BP130/85mmHgwaist40inchesinmenor35

resistance/diabetes,dyslipidemia inchesinwomen

Diabeticnephropathy increaseswithdurationofdiabetesretinopathyis retinopathyneuropathyoftenhypertensivewith

typicallypresent macrovascularcomplications

Hypertension longstandinghxofhypertension evidenceofhypertensiveendorgandamage(e.g.,

retinopathy,leftventricularhypertrophy)

Differential History Exam

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3/4/2017 EvaluationofproteinuriaHistory&ExamEpocratesOnline

Mediumandsmallvesselvasculitis multiorgandisorderrash,neuropathy,headache,CVA, specificorganinvolvementdictatesfindingstypically

changeinmentalstatus,shortnessofbreath, multiplesystemsareinvolvedsimultaneously
hemoptysis,abdominalpain,acuterenalfailure

Rhabdomyolysis(myoglobinuria) musclepainrecentcrushinjuryprolongedimmobility, muscletendernessdarkurine

orviralinfectionuseofdrugssuchasstatinsand
cocaineinbornerrorsofmusclemetabolismmay
presentinyoungadults

Uncommon
Differential History Exam
Pregnancy worseningofpreexistingchronickidneydisease hypertensionedemabruising/petechiae(withTTP
developmentofnewonsethypertensionand/oredema HUS)
duringpregnancy(e.g.,preeclampsia)possible
thromboticthrombocytopenicpurpura(TTP)hemolytic
uremicsyndrome(HUS)

Amyloidosis chronicinflammatorydiseasessuchasrheumatoid edemahypertensionmayhavecarpaltunnel

arthritis,restrictiveheartdisease,liverfailure,and syndromecapillaryfragilityautonomicinsufficiency
familialMediterraneanfeverplasmacelldyscrasiasuch
asmultiplemyelomaormonoclonalgammopathyof
undeterminedsignificance

Lightandheavychaindeposition plasmacelldyscrasiasuchasmultiplemyelomaor edemahypertensionautonomicinsufficiency

diseases monoclonalgammopathyofundeterminedsignificance

Fibrillaryandimmunotactoid plasmacelldyscrasiasuchasmultiplemyelomaor edemahypertension

glomerulopathy monoclonalgammopathyhepatitisCsomepatients
haveunderlyinglymphoma

Antiglomerularbasement rapidlyprogressiverenalfailure,hemoptysis, cracklesmayhavegrosshematuria

membrane(antiGBM)disease hematuriaoftenhaspositivesmokinghx
(Goodpasturesyndrome)

Fanconisyndrome canbeinheritedmayhaveunderlyingmultiple microcephaly,hypogonadism,andcafaulaitspots

myeloma,heavymetalexposure,ormedicationssuch withcongenitaldiseaseadultonsetsymptomsspecific
astenofovir tounderlyingetiology

Cystickidneydisease chronickidneydiseaseinchildhoodwith palpablekidneysinPKDretinitispigmentosainsome

nephronophthisismayhaveflankpainorhematuria formsofnephronophthisispolydactylyinBardetBiedl
withpolycystickidneydisease(PKD)cerebral syndrome
hemorrhage/strokeinPKD

Hypercalciuria usuallyasymptomaticmayhavehxofkidneystonesif ifhypercalcemic,mayhavechangeinmentalstatus,

alsohypercalcemic,mayhavenausea,constipation, generalizedweakness
psychosis,polyuria,weakness

Dentdisease Xlinkedrecessive:typicallyonlymalesareaffected fewphysicalfindings

polyuriaandnocturiainchildhoodkidneystones
chronickidneydiseasericketsnephrocalcinosis

Aristolochicacidnephropathy hasbeenassociatedwitharistolochicacidingestion, fewphysicalfindingsmayhavegrosshematuriawith

whichisacomponentofsomeChineseherbsand underlyingurologicmalignancy
weightlossmedicationsandisapartofwheatusedfor
breadintheBalkanregion

Lightchaincastnephropathy plasmacelldyscrasia,suchasmultiplemyelomaor edemahypertension

monoclonalgammopathyofundeterminedsignificance
rapidonsetofrenalfailure

Fabrydisease XlinkedgeneticdeficiencyofalphagalactosidaseA cornealcloudinghypertensionpoorcirculationangina

burningsensationofthehandswithexerciseandheat, angiokeratomashypohidrosisobesitytelangiectasia
eyedisease,peripheralandcoronaryarterialdisease, angiokeratomascornealdeposits
CHF,hypohidrosis,GIdysmotility,renalfailure,and
fever

Hemolyticuremicsyndrome(HUS) recentEscherichiacoliinfectiondiarrheaincasesof edemahypertensionpetechialrashorpurpurafever

atypicalHUS,thereispriorhxofHUS/thrombotic
thrombocytopenicpurpurapositiveFHxhxof
complementregulatoryproteinmutationspriorbone
marrowtransplantassociatedwithmedicationssuch
ascyclosporine,gemcitabine,andbevacizumab
(vascularendothelialgrowthfactorinhibitor)pregnancy
orpostpartumstate

Thromboticthrombocytopenic recentinfectionmentalstatuschangesrangingfrom edemahypertension,petechialrashorpurpurafever

purpura(TTP) headacheandconfusiontoseizurespriorhxofTTP focalneurologicdeficits,andcoma
positiveFHxpriorbonemarrowtransplantassociated
withmedicationssuchascyclosporine,clopidogrel,and
gemcitabine

Sclerodermarenalcrisis usuallywithinfirst5yearsofsclerodermadiagnosis oftenmarkedhypertension(oftenabruptonset)

withdiffuseskininvolvementpatientsoftentaking maskedfaciesofsclerodermatapereddigitswithtight
prednisonenewonsethypertensionandrapidly skin
worseningrenalfunctionmayhaveGIdysmotilityand
pulmonaryhypertension

Differential History Exam

Heavymetalpoisoning hxofindustrial/environmentalexposureoldpaintand gout,neuropathy,developmentaldelay,hyperkeratosis,
moonshinearecommonsourcesforleadpoisoning hypertension
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3/4/2017 EvaluationofproteinuriaHistory&ExamEpocratesOnline
moonshinearecommonsourcesforleadpoisoning hypertension
mayhaveneuropathy,hypertension,abdominalpain,
psychiatricsymptoms,gout,rash

Idiopathicnodular hxofsmokingandobesity obesity,edema

glomerulosclerosis

Proliferativeglomerulonephritiswith hxofmonoclonalgammopathy edema

monoclonalIgGdeposits

Polymyositis hxofmusclepainandweakness muscleweakness

Renalveinthrombosis mostcommoninpatientswithnephroticsyndrome hematuria,edema

(primarilymembranousnephropathy),antiphospholipid
antibodysyndrome,andotherinheritedprothrombotic
defectsextrinsiccompressionoftherenalveinby
retroperitonealfibrosisoraorticaneurysmhxoftrauma
orseveredehydrationinchildrenpresentswithacute
flankpain

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