Elimination & Detox 2: Proteinuria & PLN Flashcards
what is the FUNCTIONAL UNIT of the KIDNEY?
what 2 things MAKE IT UP?
FUNCTIONAL UNIT = NEPHRON
2 things?
1. GLOMERULUS
2. TUBULES
how do we define PATHOLOGICAL RENAL PROTEINURIA in DOGS & CATS?
DOGS = ≥ 0.5 UPC (URINE PROTEIN:CREATININE RATIO)
CATS = ≥ 0.4 UPC (URINE PROTEIN:CREATININE RATIO)
MAJORITY of PROTEIN that is FILTERED by the ____ IS REABSORBED by the ____ in a HEALTHY KIDNEY
GLOMERULUS, TUBULES
3 ways we can QUANTIFY PROTEINURIA?
- CONVENTIONAL UA
- URINE PROTEIN:CREATININE RATIO
- URINE ALBUMIN CONCENTRATION
PROTEINURIA can be both a ____ or ____ of RENAL DZ
WHAT TYPE of PROTEINURIA is MOST COMMON in DOGS?
WHAT TYPE of PROTEINURIA is MOST COMMON in CATS?
PROTEINURIA can be both a CAUSE or EFFECT of RENAL DZ
DOGS = GLOMERULAR proteinuria
CATS = TUBULAR proteinuria
GLOMERULAR PROTEINURIA..
usually ___ to ___ proteinuria
what do we see on UPC? this can be used as a…
this is CAUSED by what three things…?
the PROTEIN in the urine tends to be… & give 1 example
MODERATE to SEVERE PROTEINURIA
UPC >2, this can be used as a PRESUMPTIVE DIAGNOSIS of GLOMERULONEPHROPATHY
this is CAUSED by issue with GLOMERULAR CAPILLARY WALLS from…
1. HYPERTENSION
2. INFLAMMATION
3. IMMUNE COMPLEX DEPOSITION
PROTEIN in the urine tends to be HIGH MOLECULAR WEIGHT such as ALBUMIN
TUBULAR PROTEINURIA..
often ____ severity
what do we expect on UPC?
the PROTEINS in the urine tend to be…
often MILD severity
UPC = <2
the PROTEINS in the urine tend to be LOW MOLECULAR WEIGHT
why should we NEVER IGNORE PERSISTENT PROTEINURIA? (2)
- if left UNTREATED, causes RENAL DAMAGE and PERPETUATE RENAL DZ!
- associated with RENAL MORBIDITY, RENAL MORTALITY & OVERALL MORTALITY of ALL CAUSES
3 CLINICAL consequences of PERSISTENT PROTEINURIA?
give 3 subs for first, 1 sub for second
- HYPOALBUMINEMIA
–> EFFUSIONS
–> EDEMA
–> NEPHROTIC SYNDROME - COAGULOPATHIES (loss of ANTITHROMBIN III)
–> increased risk of THROMBOEMBOLIS - PROGRESSIVE RENAL DZ
PRE-RENAL PROTEINURIA…
= due to WHAT?
2 examples?
how do we RESOLVE this proteinuria?
how should we ASSESS this?
= due to ABNORMAL PLASMA CONTENT of PROTEINS that CAN TRAVERSE GLOMERULAR CAPILLARY WALLS
2 examples of these proteins?
1. NORMAL PROTEIN that is USUALLY NOT IN BLOOD = Hb or MYOGLOBIN
2. ABNORMAL PROTEIN like BENCE-JONES in MULTIPLE MYELOMA
RESOLUTION occurs with CONTROL & REMISSION of PRIMARY DZ
ASSESS this if we see PROTEINURIA & should see ANEMIA along with ABNORMAL PROTEINS IN BLOOD (HEMOGLOBIN, MYOGLOBIN)
RENAL PROTEINURIA
= due to…
2 categories? each has 3 subs (just names)
= due to ABNORMAL RENAL HANDLING of NORMAL PLASMA PROTEINS; KIDNEY IS ABNORMAL
2 categories?
- FUNCTIONAL = ABNORMAL RENAL PHYSIOLOGY that’s MILD/TRANSIENT in response to…
–> HEAT STROKE
–> FEVER
–> STRENUOUS EXERCISE - PATHOLOGIC = due to STRUCTURAL or FUNCTIONAL LESIONS within the KIDNEYS
–> GLOMERULAR dz
–> TUBULAR dz
–> INTERSTITIAL dz
HEREDITARY GLOMERULAR DISEASE…
predisposed in WHAT BREEDS? (6)
generally, patients present with clinical signs at WHAT AGE? progression?
- SHAR PEI
- BERNESE MOUNTAIN DOG
- SIAMESE
- ABYSSINIAN
- WHEATEN TERRIER
- DOBERMAN
generally presents with clinical signs (PROTEINURIA) at YOUNG AGE & RAPID PROGRESSION
POST-REAL PROTEINURIA…
= due to…
2 sub-categories?
= due to ENTRY OF PROTEIN into the URINE AFTER IT ENTERS THE RENAL PELVIS (not an issue with the kidney)
2 subs…
1. URINARY PROTEINURIA
–> hemorrhage
–> stones in renal pelvis/ureters/bladder/urethra
–> inflammation
–> infection
- EXTRA-URINARY PROTEINURIA = proteins derived from EXTERNAL or INTERNAL GENITALIA due to SECRETIONS, HEMORRHAGE, INFLAMMATION or INFECTION
potential DRUG/DIET causes of PROTEINURIA? (5)
what do these drugs/diets usually CAUSE that then LEADS to PROTEINURIA?
- PHENYLPROPANOLAMINE
- STEROIDS
- SULFONAMIDES
- TYROSINE KINASE INHIBITORS
- RAW FOOD DIET that’s VERY HIGH IN PROTEIN
all can usually cause HYPERTENSION, which then LEADS to PROTEINURIA
most COMMON causes of PROTEINURIA in DOGS & CATS? (10)
- CKD
- CUSHING’S or EXOGENOUS GCCs (steroid use)
- HYPERTHYROIDISM
- HYPERTENSION
- PANCREATITIS
- PRIMARY GLOMERULAR DZ
- NEOPLASIA
- FEVER
- UTI
- DIABETES MELLITUS
how do we DIAGNOSE PROTEINURIA? give 3 diagnostics
also include PARAMETERS
which one can be used if DIPSTICK IS NEGATIVE?
which one is the GOLD STANDARD to determine the MAGNITUDE of PROTEINURIA?
only do these tests WHEN..
- DIPSTICK
–> URINE ALBUMIN + at 0.3 g/L
–> results should ALWAYS correlate with USG - MICROALBUMINURIA ASSAY
–> detects >0.01 to <0.3 g/L
–> detects VERY SMALL CHANGES IN PROTEIN to check for animals that you PREDICT WILL BECOME PROTEINURIC but ARE NOT YET ON DIPSTICK - URINE PROTEIN:CREATININE RATIO (UPC)
–> MAGNITUDE of/QUANTIFY proteinuria
only do these tests WHEN WE ARE SURE THERE’S NO PRE- OR POST-RENAL COMPONENT, so URINE SEDIMENT/CULTURE IS NEGATIVE because can SKEW RESULTS
what should NORMAL URINE ALBUMIN be?
VERY LOW at < 0.01 g/L
3 reasons for FALSE POSITIVE HIGH URINE ALBUMIN on DIPSTICK?
- VERY HIGHLY CONCENTRATED URINE (high USG above 1.040 or 1.045)
- if pH of urine is VERY HIGH/BASIC
- if there’s PIGMENTURIA
if URINE SEDIMENT is ____, then we can measure UPC via a ____ ____
but when we’re MONITORING the patient AFTER STARTING THERAPY, then take UPC on ____ ____ ____ & ___ it
–> why?
if URINE SEDIMENT is NEGATIVE, then we can measure UPC via a SINGLE SAMPLE
but when we’re MONITORING the patient AFTER STARTING THERAPY, then take UPC on 3 DIFFERENT DAYS & POOL it
–> why? = SIGNIFICANT VARIABILITY of PROTEINURIA during the DAY related to ACTIVITY, PROTEIN IN DIET, etc.
ASSESSMENT of proteinuria requires WHAT 3 ELEMENTS?
include some parameters/what we look for in each
- PERSISTENCE of proteinuria = the test should be REPEATED 3 OR MORE OCCASIONS at 2 OR MORE WEEKS APART
- MAGNITUDE of proteinuria = UPC RATIO, helps with MONITORING & DECISIONS to TREAT OR NOT
–> if UPC >0.5 in DOG, needs tx
–> if UPC >0.4 in CAT, needs tx
–> if UPC LOWER than these values, JUST NEED TO MONTIOR - LOCALIZATION = WHAT IS CAUSING the PROTEINURIA?
–> PRE-RENAL (hemolysis)
–> RENAL (active sediment, glycosuria, normoglycemia)
–> POST-RENAL
if UPC >2, then how can you DESCRIBE the PROTEINURIA?
GLOMERULAR PROTEINURIA
if we have MODERATE, SEVERE PROTEINURIA that is RENAL, what 2 reasons should we start workup?
- ID UNDERLYING cause of DZ (inflammatory, infectious, neoplastic) that is CAUSING PROTEINURIA
- to monitor if PROTEINURIA is associated with OTHER FINDINGS like AZOTEMIA, HYPOALBUMINEMIA, HYPERTENSION that can all AGGRAVATE EXISTING RENAL DZ
in PLE, patients lose….
in PLN, patients lose…
PLE = LOSES BOTH ALBUMIN & GLOBULIN EQUALLY
PLN = tend to lose ALUBUMIN > GLOBULIN
HYPOALBUMINEMIA with PROTEINURIA differentials? (4)
what CLINICAL SIGN can we see when severe? how would we classify it?
- PLN
- PLE
- LIVER DZ
- ACUTE PHASE INFLAMMATION
when SEVERE, can see ASCITES (abdominal effusion); likely a LOW PROTEIN TRANSUDATE on ABDOMINOCENTESIS
if a patient presents with the FOLLOWING diagnostics, would the PROTEINURIA be PRE-RENAL, RENAL or POST-RENAL? (give justification for each)
NORMAL HCT
LEUKOCYTOSIS
AZOTEMIA
HYPERPHOSPHATEMIA
HYPOALBUMINEMIA
LOW USG
INACTIVE SEDIMENT
NEGATIVE UC
PRE-RENAL = NO EVIDENCE of HEMOLYSIS/ABNORMAL PLASMA PROTEINS
RENAL =
1. LOW USG
2. HYPOALBUMINEMIA
3. HYPERPHOSPHATEMIA
4. AZOTEMIA
5. UPC 20.22 when <0.5 is normal (GLOMERULAR)
POST-RENAL =
1. INACTIVE SEDIMENT (no evidence of INFLAMMATION)
2. UC NEGATIVE (not UTI)
if we run a GEL ELECTROPHORESIS on the URINE, what are we looking to define? (2)
- if PROTEINS GO FAR = NOT AS HIGH A MOLECULAR WEIGHT = likely TUBULAR cause of proteinuria
- if PROTEINS DON’T GO FAR = HIGH MOLECULAR WEIGHT = likely GLOMERULAR cause of proteinuria
what is the MOST IMPORTANT VALUE that can help you DETERMINE a RENAL PROTEINURIA?
USG BEING SUBOPTIMAL when the PATIENT IS DEHYDRATED
if a patient has PRIMARY RENAL PROTEINURIA & signs of DEHYDRATION & VOMITING, tx…
2 SUPPORTIVE therapies?
4 MONITORING parameters?
2 SUPPORTIVE…
1. ANTI-EMETICS like MAROPITANT & ONDANSETRON
2. CAUTIOUS FLUID THERAPY
4 MONITORING…
1. HYDRATION/WEIGHT
2. BP
3. HR, RR, CRT, pulse QUALITY
4. URINE OUTPUT
if an animal is HYPERTENSIVE, what does this mean about PROTEINURIA?
what is the SPECIFIC PARAMETER of HYPERTENSION? (2)
what is the OPTIMAL BP GOAL RANGE?
we should REPEAT MEASUREMENT to CONFIRM
HYPERTENSION defined as..
1. NORMALLY >180 mmHg
2. if AZOTEMIC >160 mmHg
OPTIMAL BP GOAL RANGE = >120 mmHg but <160 mmHg
4 INFECTIOUS DISEASES that can CAUSE PROTEINURIA in DOGS & CATS?
in EVERY PROTEINURIC patient….
what 3 EASY TESTS could we run? can the tests 100% RULE THEM OUT?
3 diseases?
1. BORRELIA BURGDORFERI (lyme)
2. LEISHMANIA SPP
3. LEPTOSPIRA SPP
4. FeLV/FIV (cats only)
in EVERY PROTEINURIC patient, we should RULE OUT THESE 3 DISEASES
what 3 EASY TESTS?
1. 4DX SNAP TEST = for LYMES
2. WITNESS LEPTO
3. FeLV/FIV TEST
NOT 100% because SEROLOGICAL TEST
what are 2 IMAGING diagnostics we can perform when we suspect a patient has GLOMERULAR RENAL PROTEINURIA?
list 3 things we’re looking for in first
list 6 things we’re looking for in second
- THORACIC RADS
–> INFECTION
–> NEOPLASIA
–> EFFUSION - ABDOMINAL US
–> NEOPLASIA
–> RENAL CHANGES
–> STONES
–> EVALUATION OF REPRODUCTION SYSTEM
–> EFFUSION
–> ADRENOMEGALY
5 common reasons for EXTRARENAL causes of HYPERTENSION we should INVESTIGATE if ALSO PROTEINURIC?
- HYPERADRENOCORTICISM (cushing’s)
- PHEOCHROMOCYTOMA (adrenal medulla tumor)
- HYPERALDOSTERONISM
- ADVERSE DRUG EFFECTS
- FLUID and/or SALT OVERLOAD
ANY DISEASE that causes ____ ____ can cause PROTEINURIA, such as…. (3)
ANY DISEASE that causes SYSTEMIC INFLAMMATION can cause PROTEINURIA, such as…
1. IMPA
2. IMHA
3. LYMPHOMA
when is RENAL BIOPSY recommended? (2)
BEFORE taking a RENAL BIOPSY, what 2 things should be true?
RENAL BIOPSY recommended when…
1. PROTEINURIA is…
–> SUBSTANTIAL >3.5
–> remains PROGRESSIVE & SEVERE DESPITE TREATMENT
- if PROTEINURIA is caused by IMMUNE-MEDIATED GLOMERULONEPHRITIS & IMMUNOSUPPRESSIVE THERAPY has been STARTED or is CONTEMPLATED
BEFORE RENAL BIOPSY…
- CONTROL HYPERTENSION or patient could have EXCESSIVE BLEEDING
- have NORMAL PLATELET # & FUNCTION or discontinue ANTITHROMBOTIC for AT LEAST 3 DAYS
when doing a RENAL BIOPSY..
what are 3 difficulties?
what MUST the LAB have access to that we SUBMIT THE SAMPLE TO?
–> why?
what are 3 difficulties?
1. EXPENSIVE
2. INVASIVE PROCEDURE
3. can be HARD to CHOOSE PROPER LAB to ANALYZE SAMPLE
what MUST the LAB have access to that we SUBMIT THE SAMPLE TO?
1. ELECTRON MICROSCOPY
2. IMMUNOFLUORESCENCE MICROSCOPY (immunostaining)
3. LIGHT MICROSCOPY
–> why? = IF NOT, can LIKELY MISDIAGNOSE patient!
RENAL BIOPSY should NEVER BE DONE in an ANIMAL WITH… (4)
- END STAGE CKD (stage 4) because it can PROGRESS DZ
- COAGULOPATHY
- POLYCYSTIC RENAL DZ
- PYELONEPHRITIS
2 MAIN GOALS of THERAPY for PROTEINURIA in DOGS?
3 OVERALL steps for Tx for PROTEINURIA in DOGS?
2 GOALS?
1. to ACHIEVE A REDUCTION in the UPC <0.5
2. OR, if that’s not possible, to ACHIEVE AT LEAST 50% REDUCTION in UPC
3 OVERALL steps…
1. when PRESENT, TREAT PRIMARY DZ
2. DIET CHANGE
3. MEDICAL MANAGEMENT
in PROTEINURIC, NON-AZOTEMIC dog…
a RENAL DIET includes WHAT 3 THINGS?
what MEDICATION can this be combined with?
what 2 things can be IMPROVED?
however, we should NOT start animal on the RENAL DIET if…
RENAL DIET…
1. MODIFIED or LOWER PROTEIN
- REDUCED SODIUM CONTENT to help with NEPHROTIC SYSTEM & HYPERTENSION
- POLYUNSATURATED FATTY ACIDS with ratio of OMEGA 6:OMEGA 3: close to 5:1
–> reduces PROTEINURIA, INFLAMMATION & VASOCONSTRICTION
–> INCREASE GFR
can combine with BENAZEPRIL
RENAL DIET + BENAZEPRIL = CONTROL PROTEINURIA & SYSTOLIC BP
however, we should NOT start animal on the RENAL DIET if NOT EATING AT ALL, ESPECIALLY IN CATS!
RAAS control…
how does RAAS system basically work? (4, end with OVERALL what it does)
2 types of drugs & what part they act on?
OVERALL, both drugs will…
how does it basically work?
1. ANGIOTENSIN transformed not ANGIOTENSIN I via RENIN
- ACE converts ANGIOTENSIN I to ANGIOTENSIN II
- ANGIOTENSIN II binds to ANGIOTENSIN RECEPTOR TYPE 1 to MAKE ADH
- overall helps to INCREASE INTRA-GLOMERULAR PRESSURE
ACE-inhibitors = ENALAPRIL/BENAZEPRIL that blocks ACE (angiotensin I to II)
ARB = TELMISARTAN that blocks ANGIONTENSIN RECEPTOR TYPE I to PREVENT PRODUCTION OF ADH
OVERALL, both drugs will DECREASE INTRA-GLOMERULAR BLOOD PRESSURE so that PROTEINURIA DECREASES
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACE INHIBITORS)
this is the ___ option to TREAT ___ & ____ as a ____-____ THERAPY
2 actions?
2 drug examples? what’s the difference functionally?
we SHOULD NOT use ACE-INHIBITORS if… (2)
this is the FIRST option to TREAT PROTEINURIA & HYPERTENSION as a LONG-TERM THERAPY
2 actions?
1. REDUCE INTRA-GLOMERULAR PRESSURE by preventing ANGIOTENSIN II-MEDIATED EFFERENT ARTERIOLAR VASOCONSTRICTION
- PREVENT BREAKDOWN of BRADYKININ to ALLOW EFFERENT ARTERIOLAR VASODILATION
2 drug examples?
1. ENALAPRIL (excreted by KIDNEY)
2. BENAZEPRIL (excreted by BILIARY system)
–> ARE THE SAME FUNCTIONALLY
we SHOULD NOT use ACE-INHIBITORS if..
1. patient NOT WELL-HYDRATED
2. if patient has AKI or ADVANCED AZOTEMIA/RENAL DZ
ANGIOTENSIN-RECEPTOR BLOCKERS (ARBs)
mechanism of action?
what is the NAME of the drug?
helps to treat ____ ____ ____
mechanism = BLOCKS ANGIOTENSIN II TYPE I RECEPTOR
drug = TELMISARTAN
helps to treat PERSISTENT RENAL PROTEINURIA
should we use COMBINED therapy of ACE-INHIBITORS & ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs)?
NOT AS A FIRST LINE, usually start with ACEi, then consider TELMISARTAN if ACEi NOT WELL TOLERATED OR EFFECTIVE in REDUCING PROTEINURIA
ALDOSTERONE RECEPTOR ANTAGONIST…
drug name?
we should ONLY give this when…
drug name? = SPIRONOLACTONE
we should ONLY give this when ACEi or ARB is NOT EFFECTIVE or NOT WELL TOLERATED in PATIENT
what ELECTROLYTE derangement should we MONITOR when administering RAAS INHIBITION THERAPY?
what is the NUMERICAL PARAMETER we should look out for?
if we see this, what 4 things can we do?
ELECTROLYTE DERANGEMENT = check for HYPERKALEMIA
PARAMETER = i>6 mmol/L
if we SEE HYPERKALEMIA >6 mmol/L, then…
- ECG MONITORING for BRADYARRHYTHMIAS
- REDUCE ACEi or ARB dose
- STOP SPIRONOLACTONE
- consider INTESTINAL POTASSIUM BINDER
BIG CHART for HOW TO MAKE ADJUSTMENTS to RAAS INHIBITION THERAPY in DOGS with GLOMERULAR DISEASE…
start with…
after 1-2 WEEKS, what 3 things should we evaluate?
–> if ALL PARAMETERS NORMAL?
–> if a PARAMETER is ABNORMAL?
after 2-4 WEEKS, what 4 things should we evaluate?
–> if DOING WELL? by what numerical parameters?
–> if NOT DOING WELL? by what numerical parameters?
after 4-6 WEEKS, what 4 things should we evaluate?
–> if DOING WELL? by what numerical parameters?
–> if NOT DOING WELL? by what numerical parameters?
start with ACEi (BENAZEPRIL or ENALAPRIL)
after 1-2 WEEKS = evaluate SERUM CREATININE, POTASSIUM & BP
–> if all parameters within TOLERABLE limits, continue
–> if any parameters ABNORMAL, then STOP ACEi & try ANOTHER THERAPY like ARB
after 2-4 WEEKS = evaluate SERUM CREATININE, POTASSIUM, BP & UPC
–> if UPC <0.5 or REDUCTION >50% = DO NOT DO ANYTHING
–> if UPC >0.5 or REDUCTION <50% & NORMAL K/BP = can INCREASE ACEi dosage & RE-EVALUATE at 4-6 WEEKS
after 4-6 WEEKS = evaluate SERUM CREATININE, K, BP & UPC
–> if UPC <0.5 or >50% reduction = DO NOTHING
–> if UPC >0.5 or <50% reduction WITH ACEi dosage change = INCREASE ACEi DOSAGE & potentially ADD TELMISARTAN (ARB)
what are the 4 TARGET ORGANS for DAMAGE in HYPERTENSION?
how does ONE RELEVANT organ damage manifest? (3)
what is one of the most COMMON drugs we use to MANAGE HYPERTENSION?
–> what KIND of drug is it?
–> how does it affect ABOVE ORGAN?
–> what OTHER DRUG must it be COMBINED WITH?
- KIDNEY
- EYES
- BRAIN
- CARDIOVASCULAR SYSTEM
on KIDNEY = TARGET ORGAN DAMAGE by HYPERTENSION PROGRESSIVE DECLINE IN RENAL FUNCTION
- INCREASED AZOTEMIA
- WORSE PROTEINURIA
- MORE FREQUENT UREMIC CRISES
AMLODIPINE used for HYPERTENSION in KIDNEY!
–> CALCIUM-CHANNEL BLOCKER
–> works to VASODILATE AFFERENT ARTERIOLE
–> must be COMBINED with ACEi to MAKE SURE WE’RE NOT INCREASING INTRAGLOMERULAR PRESSURE
THROMBOPROPHYLAXIS…
= why do we want to do this in KIDNEY DZ?
2 types of drugs we can use? give 2 specific examples for each
= presence of THROMBOEMBOLISM is SOMEWHAT COMMON in dogs with RENAL DZ
2 types of drugs?
1. ANTIPLATELET AGENTS
–> ASPIRIN
–> CLOPIDOGREL (plavix)
- ANTICOAGULANTS to BLOCK COAGULATION CASCADE
–> DALTEPARIN
–> ROVIROXABAN (anti-factor X)
what are the 2 MOST COMMON diseases on RENAL BIOPSY REPORT?
what KIND OF THERAPY should we consider? what SPECIFIC DRUG is a FIRST/BESTCHOICE?
what is the ~DURATION of this type of therapy before determining IF IT WORKS OR NOT?
- IMMUNE-COMPLEX GLOMERULONEPHRITIS
- GLOMERULOSCLEROSIS
we should consider IMMUNOSUPPRESSIVE THERAPY
–> FIRST/BEST = MYCOPHENOLATE
should keep on IMMUNOSUPPRESSIVE THERAPY for 8-12 WEEKS
if we are NOT sure if PROTEINURIA IS GLOMERULAR, what type of therapy SHOULD WE NOT USE?
or if we see WHAT DZ?
we SHOULD NOT USE IMMUNOSUPPRESSIVE THERAPY
OR if we see AMYLOIDOSIS, DO NOT USE IMMUNOSUPPRESSIVE THERAPY
LYME NEPHRITIS…
usually start with WHAT medication?
if that doesn’t work, use ___ therapy, such as what 2 drugs?
how LONG should we CONTINUE MEDICATION until we STOP?
is TUBULAR/GLOMERULAR?
prognosis?
usually start with DOXYCYCLINE
if that doesn’t work, use IMMUNOSUPPRESSIVE therapy, such as…
1. MYCOPHENOLATE
2. PREDNISONE
continue MEDICATING for AT LEAST 8-12 WEEKS until determining NO IMPROVEMENT
is GLOMERULAR
prognosis is GUARDED to POOR
LEISHMANIASIS..
should we use IMMUNOSUPPRESSIVE therapy?
DO NOT DO IMMUNOSUPPRESSIVE THERAPY, but if PROTEINURIA is still persistent, then CONSIDER STEROIDS along with tx for LEISHMANIOSIS
NEPHROTIC SYNDROME…
= definition based on WHAT 4 findings?
this is a VERY ___ condition & associated with ___ outcome
MST?
if animal is OVERHYDRATED…
if animal is DEHYDRATED…
in worst case scenario, can also consider WHAT tx?
= NEPHROTIC SYNDROME is present when…
1. HYPOALBUMINEMIA
2. PROTEINURIA
3. HYPERCHOLESTEROLEMIA
4. PERIPHERAL EDEMA/CAVITARY EFFUSION
this is a VERY SEVERE condition & associated with POOR outcome
MST = <60 DAYS from PROGNOSIS
if patient is OVERHYDRATED = can give DIURETICS
if animal is DEHYDRATED = CAUTIOUS FLUID THERAPY
in worst case scenario, can consider DIALYSIS
