Outcomes of monitoring suspected acute and chronic glomerular injuries with random and 24 hour urinary protein creatinine estimations along with patient events
PROBLEM STATEMENT / BACKGROUND
"In most patients with evidence of glomerular disease there is no single measure that provides a specific diagnosis, not even kidney biopsy. To achieve a specific diagnosis, and all that this implies for appropriate management, it is often necessary to test broadly and use a systematic approach."
Quoted from : Cravedi P, Remuzzi G. Pathophysiology of proteinuria and its value as an outcome measure in chronic kidney disease. Br J Clin Pharmacol. (2013) 76:516–23. 10.1111/bcp.12104
However in many patients the glomerular disease may progress and an important factor that is linked to patient survival is residual renal function, clinically assessed as the amount of daily urinary output. Many factors conspire against this important variable: aging, the etiologies of renal failure and time on dialysis.
Quoted from : Trimarchi, H. (2013). Remnant Proteinuria in Chronic Hemodialysis. In (Ed.), Hemodialysis. IntechOpen.https://doi.org/10.5772/53657
AIM :
To study outcomes of monitoring suspected acute and chronic glomerular injuries with random and 24 hour urinary protein creatinine estimations along with patient events.
OBJECTIVES:
• To assess various clinical and investigational characteristics of patients with suspected glomerular injury in relation to the initial disease events in individual patients and their outcomes.
• To analyse patient outcomes based on morbidity (physical, social & psychological limitations)
PATIENTS AND METHODS:
PLACE OF STUDY: Department of General medicine
STUDY PERIOD: November 2022- October 2024
STUDY DESIGN : Non experimental (Observational) qualitative Prospective Study
SAMPLE SIZE: 50 patients
INCLUSION CRITERIA:
• Proteinuria patients of any gender above or equal to 18yrs of age at the time of presentation.
• Patients presenting with a combination of proteinuria and complex etiological events and outcomes.
EXCLUSION CRITERIA:
1.Patients below 18 yrs of age (minors)
2.Patients not capable of giving consent (mentally-ill patients)
3.Patients not willing to participate in study (non-consenting patients)
PROFORMA (data to be captured)
Demographics
Patient event data reflected in a narrative history of the sequence of events leading to the current presentation and outcomes
Body data from clinical general and systemic examination
Pallor
Lymphadenpathy
Nails
Organomegaly
Skin
Muscle mass
Mid arm circumference
Visceral fat
Body data from laboratory investigation :
- CBP with peripheral smear
- Urine for cue
- Urine for random protein creatinine ratio
- Urine for 24 hour urine protein and creatinine and electrolytes where indicated
- Iron profile with serum ferritin
- Serum albumin
- Serum urea and creatinine, RFT
- Special tests on indication :
- Thyroid function tests
- Chest X-ray -PA view
- ECG
- 2D ECHO
- Renal biopsy if indicated
Data from treatment instituted :
Data from Patient reported outcomes :
Daily functionality (in terms of routine activities)
Daily diet in the form of meal images captured before consumption
Daily intake output
Sample proteinuria patient events and outcomes case report forms linked below :
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