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Module 17-Urinary, Endocrinology, Oncology > Approach to Proteinuria, Pyelonephritis and Renal Neoplasia > Flashcards

Approach to Proteinuria, Pyelonephritis and Renal Neoplasia Flashcards

1
Q

What are some physiological causes of proteinuria

A

Strenuous exercise, seizure, fevers, stress

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2
Q

What are some Pre-renal causes of proteinuria

A

Abnormal concentration of protein presented to kidney

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3
Q

What are some renal causes of proteinuria

A

Defective renal function or inflammation of renal tissue

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4
Q

What are some post-renal causes of proteinuria

A

Inflammation in the ureter, bladder, urethra or prostate

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5
Q

What is the most common cause of proteinuria

A

Post Renal Causes. Inflammation in the ureter, bladder, urethra or prostate

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6
Q

Name of protein that the dipstick test is most sensitive to

A

Albumin

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7
Q

Haematuria has an effect on urine protein concentration (T/F)

A

False! Haematuria has little effect on urine protein concentration unless the urine is discoloured red

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8
Q

List 4 reasons for renal proteinuria

A
  1. Renal inflammation
  2. Glomerular diseases
  3. Tubular diseases
  4. Chronic renal failure
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9
Q

How do we quantify severity of proteinuria

A

Urine protein:creatinine ratio (UPCR)
24 hour protein measurement

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10
Q

What is the normal level of Urine protein:Creatine (UPCR) for dogs and cats

A

<0.2

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11
Q

What are abnormal levels of Urine protein:Creatine (UPCR) for dogs and cats

A

Dog: >0.5
Cat: >0.4

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12
Q

Why does renal inflammation cause a high UPCR

A

Inflammation in the kidney can cause protein to leak into the filtrate

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13
Q

Give an example of types of renal inflammation that causes high UPCR

A

Pyelonephritis, Acute tubular nephrosis

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14
Q

Why does glomerular diseases cause a high UPCR

A

Due to increased glomerular permeability

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15
Q

Glomerular disease is more common in cats than dogs (T/F)

A

False!

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16
Q

What is the UPCR of a patient with glomerular disease

A

2.0

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17
Q

Protein-losing nephropathy

A

Term used for conditions which cause severe proteinuria due to primary glomerular diseases

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18
Q

Why does tubular disease cause a high UPCR

A

Proteinuria due to reduced tubular reabsorption of normally filtered proteins

19
Q

What dog breed is predisposed to have tubular disease and what is the disease name

A

Fanconi syndrome (Basenji breed)

20
Q

Why does CKD cause a high UPCR

A

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.

21
Q

What is the magnitude of proteinuria in CKD

A

Usually low [unless the CKD is a consequence of primary glomerular disease (dogs)]

22
Q

What are three categories of protein losing nephropathies

A

Developmental abnormalities in basement membrane (rare)
Amyloid deposits in glomerulus
Glomerulonephritis due to immune-complex deposition in glomerulus

23
Q

What breeds are predisposed to Developmental abnormalities in basement membrane causing protein losing nephropathies

A

Defects in type IV collagen in English Springer spaniels & bull terriers

24
Q

What breeds are predisposed to Amyloid deposits in glomerulus

A

Shar pei, Beagle, Abyssinian & Siamese

25
Q

What is Glomerulonephritis and Immune Complex Deposition

A

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.

26
Q

Clinical signs for protein losing nephropathies

A

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)

27
Q

What are some haemotology/biochemistry findings expected from a patient with PLN

A

Low serum albumin
Normal or mildly increased globulin
Possibly increased cholesterol

28
Q

Patients with protein losing nephropathies have a problem with coagulation (T/F)

A

True! Multifaceted reasons

29
Q

What are some clinical findings of nephrotic syndrome

A

Proteinuria
Hypoalbuminaemia
Ascites/oedema
Hypercholesterolaemia

30
Q

Drugs used to manage coagulopathies from PLN

A

Clopidogrel, aspirin, rivaroxaban

31
Q

Drugs used to manage proteinuria from PLN

A

ACE-I, ARBs, renal specific diets

32
Q

One should always drain abdominal effusion and administer diurects

A

DO NOT:
Drain abdominal effusion unless difficulty breathing
Treat with diuretics unless difficulty breathing
Due to RAAS system

33
Q

Pyelonephritis

A

Interstitial inflammation of the kidney associated with bacterial infection

34
Q

Causes of pyelonephritis

A

Usually ascendingfrom lower urinary tract
May also be haematogenous(in circulation)

35
Q

Risk factors for pyelonephritis

A

Immunosuppression, structural renal disease, degenerative renal disease

36
Q

Drug to treat pyelonephritis

A

Fluroquinolones

37
Q

What differentiate pyelonephritis from bacterial cystitis

A

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)

38
Q

How many days after introducing ACE/ARBS do you check and what do you check

A

10-14days: Access BP/Serum electrolyes/Renal perameters
28 days: Pooled UP:C/ Aim 50% reduction

39
Q

Does renal megaly mean neoplasia? What other conditions can cause renalmegaly

A

No.
Renal inflammation
Amyloidosis
Polycystic kidney disease
Feline infectious peritonitis

40
Q

What cat breed is predisposed to polycystic kidney disease

A

Persians

41
Q

Renal carcinoma clinical signs

A

Hematuria and weight loss
Few clinical signs
Unilateral renalmegaly

42
Q

Why can Renal carcinoma can cause polycythemia

A

Polycythemia due to EPO by tumour

43
Q

Name of surgery to remove kidney

A

Nephrectomy

Module 17-Urinary, Endocrinology, Oncology (28 decks)

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