Dx and Managing Proteinuria Flashcards
When is proteinuria clinically significant
Magnitude exceeds normal
Persistent ( with hypoalbuminea)
Associated with dz that effects health of patient
Why is proteinuria important?
Marker for dz
Acceelerates progression of kidney failure
How is proteinuria a maker for dz?
Kidney dz (glomeruli, renal tubules)
Inflamm/ infection (ticke borne)
Hypertension
Blood dz
Cancer
T/F: Proteinuria accelerates kidney failure
TRUE
Tests for proteinuria
Urine dipstick (albumin)
Urine protein to creatine ratio (UPC)
Sulfasalicylic acid turbidity
Electrophoresis
What are the sources of proteinuria
Pre-renal (↑ conc. of small proteins in blood)
Renal (glo and renal tubular dz)
Post-renal (ureter, bladder, urethra obstruction/ urine leakage → from trauma)
Which stages of azotemia is UPC not useful for?
Pre and post renal azotemia
Pre-renal proteinuria
Tubular overload of prerenal proteinuria (intravasc hemolysis, myoglobinemia, myeloma)- abnorm in blood
Functional (exercise, seizure)
Dx of pre-renal proteinuria
Red urine with 0 RBCs
Ocult blood and protein
Renal proteinuria
Damage to go to glomerular capillary wall
Large protein and volume moving through
Pathological renal proteinuria
Glomerular:
Moderate to large quantitiy
Albumin-sized proteins and larger
More severe and chr. forms will cause hypoalbuminemia
Dx of protein-losing glomerulonephropathy
Persistent heavy proteinuria with inactive urine sediment
Normal color urine
Urine protein creatinine ratio
Urine protein (mg/dl)/ urine creatinine
Abnormal UPC
> 0.5 in dogs
0.4 in cats
What causes post-renal proteinuria
Most common
Inflamm, trauma, neoplasia, ischemia
Dx post-renal proteinuria
↑ protein with inflammatory evidence
Protein below the level of glo
Most common dz causing PU/PD in cats
Kidney dz
DM
Hyperthyroidism
CS of glomerular dz
Vague: WL, lethargy, PU, anorexia, V
+/- edema/ascites, hypertension, azotemic/uremic
Tx of glomerular proteinuria
Dx early to correct the underlying dz
Minimize azotemia (diets)
Inhibit RAAS
Reduce thrombosis (clopidogrel)
Immunosuppression (Pred, mycophenolate)
Why does blocking RAAS ↓ glomerular proteinuria?
↓ P in the glomerular capillaries
Restore slit diaphragm integrity and ↑ negative charge on glomerular membrane
How is RAAS inhibited?
Angiotensin converting enzyme inhibitors, angiotensin receptor blockers
Goal: reduce UPC at least by half by dose effect
What does it mean if the creatinine ↑ a lot with ACEI or ARB
Patient has prerenal crisis
Stop the drug → administer fluid and monitor
Controlling hypertension
Reduce BP @ least below 160 mmHg
Use Ca channel blockers (patients severely hypertensive)
Preventing thrombosis
Reduce risk of thrombosis due to los of antithrombin 3 in urine
Use clopidrogel
Contraindications when using clopidrogel to reduce thrombosis
Thrombocytopenia and bleeding
Glomerular dz
Immune and non immune-complex mediated glomerulonephritis
Amyloidosis (shar-pei and cats)
Dx glomerular pathology
Renal bx: stain for amyloid and EM complexes in glomerular BM
Immune-complex mediated glomerulonephritis tx
Immunosuppression trial if azotemia >3 mg/dL or progressive and hypoalbuminemia is severe
Which diseases are associated with Immune-complex mediated glomerulonephritis
HW dz
Lyme dz
Rickettsial dz
Protozoal dz
Neoplasia
Chr. bacterial infections
Peracute and rapidly progressive glomerular dz tx
Mycophenolate
Cyclophosphamide
both +/- glucos
Nephrotic syndrome
Occurs with marked proteinuria
Hypoalbuminemia, hypercholesterolemia and edema
Difficult to tx and poor prognosis
