Glomerular Disease Flashcards
What can be caused by immune disease processes or non-immune disease?
Protein-Losing Nephropathy
What is the space between the podocytes called?
Slit pore*
- they restrict movement based on size and charge
The following substances are listed from smallest to largest. What is the smallest substance that is not filtered substantially?
Sodium
Creatinine
Albumin
Immunoglobulin G (IgG)
Albumin
What is a protein induced by inflammation that deposits in the kidney?
Amyloid
Can amyloid already in the kidney be removed?
No
What is the hallmark of PLN?
Proteinuria
What do many patients with PLN have?
Low albumin
High cholesterol
Hypertension (due to stimulation of RAAS)
What are other causes you need to rule out for proteinuria?
UTI
Stones
PLN can be caused by immune disease processes or non-immune causes.
- What are the immune causes?
Glomerulonephritis, and they can be further classified based on morphology
PLN can be caused by immune disease processes or non-immune causes.
- What are the non-immune causes?
- Glomerulopathies, which are glomerular diseases that don’t have the inflammation of a glomerulonephritis
- Amyloidosis
(T/F) Glomerular disease is more common in Cats
False
What are the breeds that have a high enough incidence of hereditary nephropathy?
- Bernese mountain dog
- Bull terrier
- English cocker spaniel
- Dalmatian
- Doberman pinscher
- Greyhound
- Newfoundland
- Rottweiler
- Soft-coated wheaten terrier
PLN starts as a disease of the glomerulus, which can then cause damage to the ___________ and ____________
tubules, interstitium
What type of sheets does amyloid form?
beta-pleated sheets
What two breed species get amyloidosis?
Shar Pei dogs & Abyssinian cats
A syndrome of recurrent fevers and hock swelling as young dogs. Renal failure and proteinuria don’t appear until middle age
Shar Pei Fever
Amyloid can occur secondary to ______________ or from ______________
Chronic inflammation, Familial problems
Which patient will benefit the most from drugs to inhibit RAAS?
Dog w/ AKI
Cat w/ CKD
Dog w/ PLN
Dog w/ PLN
The nephrotic syndrome consists of 4 components:
Hypoproteinemia
Proteinuria
Hypercholesterolemia
Ascites or Edema (tends to be the last feature to develop)
(T/F) Azotemia is required to be present for a dog to have nephrotic syndrome
False
If the glomerulus is leaky, why does the creatine go up?
The entire nephrons become lost (proteinuria causes fibrosis
of the interstitium) and the global renal function declines, leading to azotemia - an increased creatinine
Glomerular disease ultimately leads to:
Tubulointerstitial damage
Nephron loss from glomerulosclerosis
In a Urinalysis, what is a characteristic of glomerular disease?
Proteinuria (UPC >0.5) with an inactive sediment
Persistent proteinuria due to systemic problems, like fever or myoglobinemia is classified as:
Pre-renal
In a Dipstick, a trace of 1+ protein in concentrated urine may be normal but is rarely normal with ___________
isothenuria
In dogs and cats, what does alkaline urine usually mean?
urinary tract infection
(T/F) Most cases of PLN have High platelet numbers
True
(T/F) Platelet numbers can be low if the PLN is caused by vectorborne infectious
True
What would be considered mandatory testing for all proteinuric dogs?
- 4DX test or similar
- Other infectious disease testing may be warranted also
(T/F) We usually do not biopsy if chronic severe azotemia is present, because of the expectation of finding irreversible fibrosis.
True
What is the role tubule plays in the pathogenesis of glomerular disease?
Tubules can’t stand protein and try their best to reabsorb it, but the resulting interstitial protein incites inflammation
(T/F) The presence of proteinuria on the dipstick is diagnostic for glomerulonephritis
False
(T/F) Almost all patients with PLN are azotemic at diagnosis
False
(T/F) Omega 3 fatty acids supplementation is renoprotective in dogs
True
Angiotensin-converting enzyme inhibitors block the conversion of Angiotensin ____ to Angiotensin _____
I, II
Angiotensin receptor antagonists (blockers) block the action of Angiotensin ____
II
What are some ACE inhibitors that block the conversion of angiotensin I to angiotensin II?
Enalapril
Benazepril
Angiotensin receptor antagonists, like ___________, block the action of angiotensin II.
Telmisartan
- as effective as benazepril in controlling proteinuria in cats
- it is an effective anti-hypertensive in cats
Aldosterone antagonists, like __________, block the action of aldosterone. They are used predominantly as diuretics.
Spironolactone
_____________ causes sodium reabsorption and potassium excretion
Aldosterone
When thinking of hypertension, what are the target organs at most risk for damage?
eyes, brain, heart and kidneys.
Is a calcium channel blocker, and is frequently combined with RAAS inhibitor drugs
Amlodipine (for controlling hypertension)
Immunosuppressive drug for ICGN, which has the fewest side effects and seems effective
Mycophenolate mofetil
Antithrombin III (natural anticoagulant) is the same size as __________
albumin
