Approach to Proteinuria, Pyelonephritis and Renal Neoplasia Flashcards
What are some physiological causes of proteinuria
Strenuous exercise, seizure, fevers, stress
What are some Pre-renal causes of proteinuria
Abnormal concentration of protein presented to kidney
What are some renal causes of proteinuria
Defective renal function or inflammation of renal tissue
What are some post-renal causes of proteinuria
Inflammation in the ureter, bladder, urethra or prostate
What is the most common cause of proteinuria
Post Renal Causes. Inflammation in the ureter, bladder, urethra or prostate
Name of protein that the dipstick test is most sensitive to
Albumin
Haematuria has an effect on urine protein concentration (T/F)
False! Haematuria has little effect on urine protein concentration unless the urine is discoloured red
List 4 reasons for renal proteinuria
- Renal inflammation
- Glomerular diseases
- Tubular diseases
- Chronic renal failure
How do we quantify severity of proteinuria
Urine protein:creatinine ratio (UPCR)
24 hour protein measurement
What is the normal level of Urine protein:Creatine (UPCR) for dogs and cats
<0.2
What are abnormal levels of Urine protein:Creatine (UPCR) for dogs and cats
Dog: >0.5
Cat: >0.4
Why does renal inflammation cause a high UPCR
Inflammation in the kidney can cause protein to leak into the filtrate
Give an example of types of renal inflammation that causes high UPCR
Pyelonephritis, Acute tubular nephrosis
Why does glomerular diseases cause a high UPCR
Due to increased glomerular permeability
Glomerular disease is more common in cats than dogs (T/F)
False!
What is the UPCR of a patient with glomerular disease
2.0
Protein-losing nephropathy
Term used for conditions which cause severe proteinuria due to primary glomerular diseases
Why does tubular disease cause a high UPCR
Proteinuria due to reduced tubular reabsorption of normally filtered proteins
What dog breed is predisposed to have tubular disease and what is the disease name
Fanconi syndrome (Basenji breed)
Why does CKD cause a high UPCR
In CKD, adaptive changes to nephron loss cause hyperfiltration in remaining nephrons, leading to glomerular protein loss. Simultaneously, tubular dysfunction reduces protein uptake, contributing to tubular protein loss and overall proteinuria.
What is the magnitude of proteinuria in CKD
Usually low [unless the CKD is a consequence of primary glomerular disease (dogs)]
What are three categories of protein losing nephropathies
Developmental abnormalities in basement membrane (rare)
Amyloid deposits in glomerulus
Glomerulonephritis due to immune-complex deposition in glomerulus
What breeds are predisposed to Developmental abnormalities in basement membrane causing protein losing nephropathies
Defects in type IV collagen in English Springer spaniels & bull terriers
What breeds are predisposed to Amyloid deposits in glomerulus
Shar pei, Beagle, Abyssinian & Siamese
What is Glomerulonephritis and Immune Complex Deposition
Cause: Formation of immune complexes in the bloodstream.
Effect: Deposition in glomeruli triggers inflammation and damages filtration membrane.
Consequence: Increased permeability leads to proteinuria and reduced kidney function.
Clinical signs for protein losing nephropathies
Early:
May be no clinical signs
Loss of body condition
Lethargy, anorexia
Later:
Abdominal/pleural effusions
Subcutaneous pitting oedema
Acute onset blindness (hypertensive retinopathy)
Thromboembolic disease (eg. pulmonary thromboembolism)
Very late:
Uraemia (due to CKD)
What are some haemotology/biochemistry findings expected from a patient with PLN
Low serum albumin
Normal or mildly increased globulin
Possibly increased cholesterol
Patients with protein losing nephropathies have a problem with coagulation (T/F)
True! Multifaceted reasons
What are some clinical findings of nephrotic syndrome
Proteinuria
Hypoalbuminaemia
Ascites/oedema
Hypercholesterolaemia
Drugs used to manage coagulopathies from PLN
Clopidogrel, aspirin, rivaroxaban
Drugs used to manage proteinuria from PLN
ACE-I, ARBs, renal specific diets
One should always drain abdominal effusion and administer diurects
DO NOT:
Drain abdominal effusion unless difficulty breathing
Treat with diuretics unless difficulty breathing
Due to RAAS system
Pyelonephritis
Interstitial inflammation of the kidney associated with bacterial infection
Causes of pyelonephritis
Usually ascendingfrom lower urinary tract
May also be haematogenous(in circulation)
Risk factors for pyelonephritis
Immunosuppression, structural renal disease, degenerative renal disease
Drug to treat pyelonephritis
Fluroquinolones
What differentiate pyelonephritis from bacterial cystitis
History: quick recurrence of confirmed bacterial cystitis after antimicrobials
Physical exam: painful retroperitoneal space / kidneys
CBC: + / - neutrophilia
Biochemistry: + / - azotaemia
Abdominal imaging: + / - dilated ureters, enlarged kidneys (renomegaly)
How many days after introducing ACE/ARBS do you check and what do you check
10-14days: Access BP/Serum electrolyes/Renal perameters
28 days: Pooled UP:C/ Aim 50% reduction
Does renal megaly mean neoplasia? What other conditions can cause renalmegaly
No.
Renal inflammation
Amyloidosis
Polycystic kidney disease
Feline infectious peritonitis
What cat breed is predisposed to polycystic kidney disease
Persians
Renal carcinoma clinical signs
Hematuria and weight loss
Few clinical signs
Unilateral renalmegaly
Why can Renal carcinoma can cause polycythemia
Polycythemia due to EPO by tumour
Name of surgery to remove kidney
Nephrectomy
