Fixed Proteinuria

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Chapter 520 Fixed Proteinuria

Priya Pais, Ellis D. Avner

Persons found to have significant proteinuria on a first morning urine sample on 3 consecutive days (>1+ on dipstick with urine specific gravity >1.015 or protein : creatinine ratio >0.2) have fixed proteinuria. Fixed proteinuria indicates renal disease and may be caused by either glomerular or tubular disorders.

520.1 Glomerular Proteinuria

Priya Pais, Ellis D. Avner

The glomerular capillary wall consists of 3 layers: the fenestrated capillary endothelium, the glomerular basement membrane, and the podocytes (with foot processes and intercalated slit diaphragms). Glomerular proteinuria results from alterations in the permeability of any of the layers of the glomerular capillary wall to normally filtered proteins and occurs in a variety of renal diseases (Table 520-1). Glomerular proteinuria can range from <1 g to >30 g/24 hr.

Table 520-1 CAUSES OF PROTEINURIA

TRANSIENT PROTEINURIA

Congestive heart failure

ORTHOSTATIC (POSTURAL) PROTEINURIA

GLOMERULAR DISEASES CHARACTERIZED BY ISOLATED PROTEINURIA

Idiopatic (minimal change) nephrotic syndrome

Focal segmental glomerulosclerosis

Mesangial proliferative glomerulonephritis

Membranous nephropathy

Membranoproliferative glomerulonephritis

Diabetic nephropathy

Sickle cell nephropathy

GLOMERULAR DISEASES WITH PROTEINURIA AS A PROMINENT FEATURE

Acute postinfectious glomerulonephritis

Immunoglobulin A nephropathy

Henoch-Schönlein purpura nephritis

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