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RENAL DISEASES — DISORDERS, ORTHOSTATIC PROTEINURIA, CHYLURIA, PNEUMATURIA.

By Dr. T. VISHNU MURTHY
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Orthistatic proteinuria is a condition in which proteinuria occurs in the erect or lorodotic position but disappears in recumbency, and in which there is no other clinical evidence of renal disease,

The condition - hardly a disease appears to be most common in children and young adults, particularly men, although some extent this distribution may be the result of their more frequent urine examinations. Characteristically the proteinuria can’t be demonstrated by conventional tests in urine passed during recumbency, and is therefore absent from the urine passed immediately on waking in the morning, but it reappears after standing or placing the patient in a lorodotic position while still recumbent. It is widely believed, though not proved, that subjects with this condition have a more marked lumbar lordosis on standing than the average for the population ( patients ).

ORTHOSTATIC PROTEINURIA is clinically important for more reasons

  1. It may interfere of young subjects on the threshold of their adult life, because of mistaken belief that their proteinuria is due to serious renal disease.
  2. This diagnosis may be incorrectly made in patients with more sinister types of glomerulonepheritis. In whom proteinuria is increased in standing. For these reasons it is wise to submit subjects suspected of the condition to a full clinical examination, with urine microscopy ( the deposit is normal in orthostatic proteinuria ), determination of creatinine clearance, and intravenous pyelography. Renal biopsy is not indicated unless abnormalities are revealed by the initial investigations.
PROTEINURIA :

Proteinuria exceeding 3 grams per 24 hours is unusual in chronic pyelonephritis, analgesic nephropathy, benign hypertension, urinary obstruction, calculus disease, renal tubular acidosis, and poly cystic disease, it is usual or common in chronic proliferative glomerulonephritis, membranous glomerulonephropathy, amiloidosis, diabetic nephropathy, polyarteritis, disseminated lupus erythematosus and malignant hypertension. Glomerular proteinuria diminishes as GFR falls, but heavy proteinuria may still be encountered in terminal renal failure and the consequent derangements of plasma protein may persist for several weeks after the start of regular hemodialysis. Mild hyper proteinuria accompanies fluid overload in many forms of chronic renal disease, but severe hyper proteinuria ( below 5 grams per 100 ml ) particularly if accompanied by a nephrotic electrophoretic pattern and hyper cholesterolemia, strongly suggest that heavy proteinuria was present in the recent past,even if it is no longer demonstrable. Red cells casts in the urinary deposit in chronic renal failure suggest one of the progressive forms of glomerulonephiritis example : crescent nephritis, mesangiocapillary nephritis, the renal lesion subacute bacterial endocarditis, including the collagenoses or malignant hyper tension.

CHYLURIA

Chyluria is lymph in the urine. The entire has been known since Hippocrates. Biochemically the urine contains a colloidal suspension of fat in molecular form, albumin, lecithin, Cholesterin, Fibrinogen, and soaps producing a milky or creamy appearance resembling lactescent serum. The proteinuria May be sufficient to meet criteria of the nephrotic syndrome.

Parasitic chyluria is caused by Filaria sanguinis hominis. Non parasitic chyluria is due to a rupture of a lymphatic into the collecting system resulting from observation of lymphatics anywhere between intestines and the thoracic duct specific cusses include tumours, fibrosis, pregnancy, and trauma. Milky urine, intermittent or constant is the major sign. It may be mistaken for pyuria. Milky urine is stable, containing 2 to 4 percent fat, doesn’t exhibit for droplets on microscopy. Retrograde pyelography may demonstrate pyrlolymphatic back flow.

Major items to be differentiated are lipiduria and pyuria . Lipiduria has fat droplets that rise to the top on configuration. Am advising for the best self treatment is low fat diet should be undertaken to reduce chyluria.

PNEUMATURIA

Pneumaturia is the passage of gas bubbles in the urine. In non-infected patients, pneumaturia is usually due to a vesicovaginal or vesicoentetic fistula. Vegetable fibers and fecal contamination may be found in the urine. Such fistulas may be congenital in infants, may result from gross infections or neolasms, or may follow radical pelvic surgery. Bubbles may also caused by gas-forming bacteria proliferating in urine. The gas is Carbon dioxide. Pnematuria , although rare , is most frequent in elderly diabetic women.

Bubbling or frothing urine is noted by the patient at the end of micturition. A gas shadow may be seen in the bladder on roentgenographic study The best treatment is available in Ayurvedic research of individual. Am available on email: drvishnu66@yahoo.com and www.nectarhealth.org.