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!Small Animal Medicine > Dx and Managing Proteinuria > Flashcards

Dx and Managing Proteinuria Flashcards

1
Q

When is proteinuria clinically significant

A

Magnitude exceeds normal
Persistent ( with hypoalbuminea)
Associated with dz that effects health of patient

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2
Q

Why is proteinuria important?

A

Marker for dz
Acceelerates progression of kidney failure

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3
Q

How is proteinuria a maker for dz?

A

Kidney dz (glomeruli, renal tubules)
Inflamm/ infection (ticke borne)
Hypertension
Blood dz
Cancer

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4
Q

T/F: Proteinuria accelerates kidney failure

A

TRUE

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5
Q

Tests for proteinuria

A

Urine dipstick (albumin)
Urine protein to creatine ratio (UPC)
Sulfasalicylic acid turbidity
Electrophoresis

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6
Q

What are the sources of proteinuria

A

Pre-renal (↑ conc. of small proteins in blood)
Renal (glo and renal tubular dz)
Post-renal (ureter, bladder, urethra obstruction/ urine leakage → from trauma)

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7
Q

Which stages of azotemia is UPC not useful for?

A

Pre and post renal azotemia

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8
Q

Pre-renal proteinuria

A

Tubular overload of prerenal proteinuria (intravasc hemolysis, myoglobinemia, myeloma)- abnorm in blood
Functional (exercise, seizure)

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9
Q

Dx of pre-renal proteinuria

A

Red urine with 0 RBCs
Ocult blood and protein

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10
Q

Renal proteinuria

A

Damage to go to glomerular capillary wall
Large protein and volume moving through

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11
Q

Pathological renal proteinuria

A

Glomerular:
Moderate to large quantitiy
Albumin-sized proteins and larger
More severe and chr. forms will cause hypoalbuminemia

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12
Q

Dx of protein-losing glomerulonephropathy

A

Persistent heavy proteinuria with inactive urine sediment
Normal color urine

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13
Q

Urine protein creatinine ratio

A

Urine protein (mg/dl)/ urine creatinine

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14
Q

Abnormal UPC

A

> 0.5 in dogs
0.4 in cats

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15
Q

What causes post-renal proteinuria

A

Most common
Inflamm, trauma, neoplasia, ischemia

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16
Q

Dx post-renal proteinuria

A

↑ protein with inflammatory evidence
Protein below the level of glo

17
Q

Most common dz causing PU/PD in cats

A

Kidney dz
DM
Hyperthyroidism

18
Q

CS of glomerular dz

A

Vague: WL, lethargy, PU, anorexia, V
+/- edema/ascites, hypertension, azotemic/uremic

19
Q

Tx of glomerular proteinuria

A

Dx early to correct the underlying dz
Minimize azotemia (diets)
Inhibit RAAS
Reduce thrombosis (clopidogrel)
Immunosuppression (Pred, mycophenolate)

20
Q

Why does blocking RAAS ↓ glomerular proteinuria?

A

↓ P in the glomerular capillaries
Restore slit diaphragm integrity and ↑ negative charge on glomerular membrane

21
Q

How is RAAS inhibited?

A

Angiotensin converting enzyme inhibitors, angiotensin receptor blockers
Goal: reduce UPC at least by half by dose effect

22
Q

What does it mean if the creatinine ↑ a lot with ACEI or ARB

A

Patient has prerenal crisis
Stop the drug → administer fluid and monitor

23
Q

Controlling hypertension

A

Reduce BP @ least below 160 mmHg
Use Ca channel blockers (patients severely hypertensive)

24
Q

Preventing thrombosis

A

Reduce risk of thrombosis due to los of antithrombin 3 in urine
Use clopidrogel

25
Q

Contraindications when using clopidrogel to reduce thrombosis

A

Thrombocytopenia and bleeding

26
Q

Glomerular dz

A

Immune and non immune-complex mediated glomerulonephritis
Amyloidosis (shar-pei and cats)

27
Q

Dx glomerular pathology

A

Renal bx: stain for amyloid and EM complexes in glomerular BM

28
Q

Immune-complex mediated glomerulonephritis tx

A

Immunosuppression trial if azotemia >3 mg/dL or progressive and hypoalbuminemia is severe

29
Q

Which diseases are associated with Immune-complex mediated glomerulonephritis

A

HW dz
Lyme dz
Rickettsial dz
Protozoal dz
Neoplasia
Chr. bacterial infections

30
Q

Peracute and rapidly progressive glomerular dz tx

A

Mycophenolate
Cyclophosphamide
both +/- glucos

31
Q

Nephrotic syndrome

A

Occurs with marked proteinuria
Hypoalbuminemia, hypercholesterolemia and edema
Difficult to tx and poor prognosis

!Small Animal Medicine (32 decks)

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