Quantifying proteinuria has confused me for the longest time so I wanted to revisit some definitions. A thread.
1. Proteinuria =/= albuminuria
- Glomerular prot: mostly albumin
- Tubular prot: LMW proteins (e.g., B2M)
- Overflow prot: light chains, myoglobin, hb
- Postrenal prot: inflammation, bleed, malignancy
2. What is proteinuria?
- Normal protein excretion: < 150 mg/24h or spot PCR < 50 mg/g; < 300 mg/24h (pregnancy)
- Moderate prot: 150-500
- Severe prot: 500-3500
- Nephrotic-range: > 3500 mg/24h
- Proteinuria without albuminuria suggests nonglomerular causes
3. What is albuminuria?
- Normal albumin excretion (A1): < 30 mg/24h or spot ACR: < 30 mg/g or albumin-specific spot dipstick < 3 mg/dL
- Moderate albuminuria (A2): 30–300 mg/24h or mg/g (spot ACR)
- Severe or "high-grade" (A3): > 300 mg/24h or mg/g (spot ACR)
Whoops, a typo. Spot PCR < 150 mg/g is normal.
One other pearl: spot proteinuria/albuminuria must be interpreted with caution in
1. Extremities of muscle mass as high muscle mass urine Cr increases and spot readings may underestimate
2. AKI: Cr excretion decreases and spot readings may overestimate

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Matthew Ho, MD PhD 🇸🇬

Matthew Ho, MD PhD 🇸🇬 Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @MatthewHoMD

Feb 26
Summary of oxygen delivery devices taught to me by Mayo RT

Source of oxygen
- Wall taps by bedside: 0–15L/min
- Home concentrator: 0–10L/min

Oxygen delivered at 100%, put through different devices at different rates to adjust the oxygen concentration that the patient inspires
TLDR
- Low oxygen (<35%): nasal prongs
- Moderate oxygen (35-60%): venturi (high flow but mix with room air)
- High oxygen (>60%): non rebreather or HFNC
- PEEP needed (e.g., ADCHF, OSA): CPAP
- Hypercapnic: BiPAP
- Failure, unable to protect airway: mechanical ventilation Image
0. Inogen (pulse-dose oxygen therapy); not used in hospital
- Delivers only during inspiration; not expiration
- Up to 4L but intermittent; much less oxygen as unlike continuous oxygen therapy which fills the oral cavity, naso/oropharyngeal with reservoir of oxygen, this does not Image
Read 12 tweets
Feb 25
Differentials for hypoxemia based on Aa gradient Image
ABG vs VBG:
- pH: VBG
- pCO2: VBG (not accurate in shock or hypercapnia); ABG for severe shock or if precise pCO2 needed in hypercapnia
- PO2: ABG (but SpO2 generally good enough)
- CO or methemoglobin: co-ox
Rough correlation between PaO2 and SpO2. Image
Read 6 tweets
Feb 25
Summary tweet on my approach to anemias. credit to @n_gangat, @RichGodby, @zhuoerxie, Dr Ron Go, @VincentRK for teaching. Comments/critiques welcome!

1. Approach to anemia
2. Approach to iron deficiency anemia
3. Iron deficiency in chronic inflammatory states (ashpublications.org/hematology/art…)
Read 9 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

:(