PATHOPHYSIOLOGY

OF PROTEINURIA
A R E P O RT BY
RC JAN APIONG
HAZEL ASPERA
PHYSIOLOGY
REVIEW!
3 ACTIVITIES OF RENAL FUNCTION

FILTRATION TUBULAR TUBULAR

SECRETION REABSORPTION
 FOR PROTEINURIA, IT’S
IMPORTANT TO UNDERSTAND
FILTRATION AND
TUBULAR REABSORPTION
 The charge and size of the glomerular
capillary wall prevent significant

FILTRATION amounts of albumin, globulin, and other

large plasma proteins from entering the
urinary space.
 1 2 3
Capillary Glomerular Pedicels
Endothelium Basement
Membrane

COMPONENTS OF FILTRATION
 -
+

+ FILTRATION
+

ISTAP!
-

•  Fenestrations of
capillary endothelium
blocks blood cells and
platelets
 FILTRATION
+
- +
+
-

ISTAP!

•  Thick,
combined basal
laminae (GBM)
restricts large
CHONs and some
organic anions
 -

-
FILTRATION
+
- +
+

ISTAP!

•  Filtration slit
diaphragms between
pedicels restricts some
small CHONs and organic
anions
 -

-
FILTRATION

Filtrate includes water, glucose, amino acids, +

ions, urea, many hormones, vitamin B and C, +

ketones, and very small amounts of protein.
+
TUBULAR
ABSORPTION
TUBULAR REABSORPTION

Just a quick review of

the transporters in the
early proximal tubule 
 TUBULAR REABSORPTION

In both
Reabsorbed cases, AA
Degraded in are released
via receptor-
the cuboidal at the
mediated
Small proteins cells basolateral
endocytosis
in the filtrate cell surfaces
Degraded by for uptake
(at the PCT)
peptidases on by
luminal capillaries
surface
• A very small amount of
protein that normally
appears in the urine is
the result of normal
tubular secretion.
• The normally excreted
protein consists mostly of
Tamm-Horsfall protein
(uromodulin),
a protective glycoprotein
secreted by tubules that
inactivates cytokines.
PATHOPHYSIOLOGY
3 POSSIBLE MECHANISMS OF
PROTEINURIA

Glomerular proteinuria Tubular proteinuria Increased

production/release of
plasma proteins
MECHANISM NO. 1
G LO M E R U L A R P R O T E I N U R I A
 -
+

- GLOMERULAR
+ PROTEINURIA
+

NUUU!
-
Can’t keep
it in!


 Disruption of
glomerular
capillary wall
MECHANISM NO. 2
TUBULAR PROTEINURIA
TUBULAR REABSORPTION

Zz
z. ..

Tubular injury or dysfunction

 ineffective reabsorption of
most LMW CHONs
MECHANISM NO. 3
INCREASED PRODUCTION/
RELEASE OF PLASMA PROTEINS

May occur in
(1)multiple myeloma,
(2)rhabdoymyolysis, or
(3)hemolysis.
INCREASED
PRODUCTION
AND RELEASE OF
PLASMA
PROTEINS
INCREASED PRODUCTION AND RELEASE OF PLASMA
PROTEINS
• Amounts overwhelm
the absorptive
capacity of the
proximal tubule
WHY IS THIS
IMP ORTA NT?
WHY IS THIS
IMPORTANT?
• Proteinuria can be detected through a
variety of methods (urine dipstick, urine
protein to creatinine measurement, etc.)
• When studying the conditions that cause
proteinuria, ask yourself which
mechanism/s of proteinuria has/have
occurred.
• Your management of the disease may
vary according to the mechanism
involved.
THANK
YOU!
REFERENCES
Marcdante, K.J., et al. (2019) Nelson
Textbook of Pediatrics, 21st ed.
Philadelphia, USA: Elsevier, Inc.
Navarro, X.R., et al. (2014) Fundamentals
of Pediatrics. Quezon, Philippines:
C&E Publishing, Inc.
Mescher, A.L. (2013) Junquiera’s Basic
Histology Text and Atlas, 13th ed. New
York, USA: McGraw-Hill Education.
Khan Academy. (2019) Tubular
reabsorption article. Retrieved 22
November 2019, from
https://www.khanacademy.org/test-
prep/mcat/organ-systems/the-renal-
system/a/tubular-reabsorption-article