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SAM 2 > Glomerular Disease > Flashcards

Glomerular Disease Flashcards

1
Q

What is proteinuria?

A

Increase in the amount of protein in the urine

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2
Q

What is the UPC value for non-proteinuric?

A

Dogs=

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3
Q

What is the UPC value for borderline proteinuric?

A 
Dogs = 0.2-0.5
Cats = 0.2-0.4
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4
Q

What is the UPC value for proteinuric?

A 
Dogs = >0.5
Cats = >0.4
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5
Q

What are the physiological causes of proteinuria?

A

Strenuous exercise, seizures, fever, stress

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6
Q

What are the pre-renal causes of proteinuria?

A

Abnormal concentration of protein being presented to the kidneys

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7
Q

What are the renal causes of proteinuria?

A

Defective renal function or inflammation of the renal tissue (glomerular or tubular

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8
Q

What are the post-renal causes of proteinura?

A

Inflammation or infection in the ureter, bladder, urethra, or prostate

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9
Q

How is proteinuria first detected?

A

On a urine dipstick

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10
Q

Is the urine dipstick quantitative or qualitative for proteinuria?

A

Semi-quantitative (not terribly accurate but good for screening)

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11
Q

What can cause false positive results for protein on a urine dipstick?

A

Alkaline urine or contamination

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12
Q

What can cause false negative results for protein on a urine dipstick?

A

Acidic urine or bence-jones proteinuria

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13
Q

T/F: Hematuria and pyuria have inconsistent effect on urine albumin concentration

A

True

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14
Q

What proteins are detected with the urine dipstick?

A

Most sensitive to albumin

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15
Q

What are some ways to identify physiological causes of proteinuria?

A

History and clinical examination

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16
Q

What are some ways to identify pre-renal causes of proteinuria?

A

Hematology and biochemistry

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17
Q

What are some ways to identify post-renal causes of proteinuria?

A

History, clinical exam, urinalysis, imaging

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18
Q

What are some ways to identify renal or post-renal inflammatory causes of proteinuria?

A
  • Examine urine sediment

- Perform urine culture and sensitivity

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19
Q

What are some conditions that can cause renal or post renal inflammation?

A

Hyperadrenocorticism or exogenous steroid administration

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20
Q

Does minor contamination usually create enough sediment to indicate post renal inflammation?

A

No

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21
Q

Why do we want to quantify proteinuria?

A
  • Evaluate severity of renal lesions
  • Help identify location
  • Assess disease progression
  • Assess response to treatment
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22
Q

What is the gold standard to quantify proteinuria?

A

24hr protein measurement

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23
Q

Why do we usually not use the gold standard to measure proteinuria?

A

Because it requires specialized equipment that most hospitals don’t have

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24
Q

What is usually used to quantify proteinuria?

A

Urine protein:creatinine ratio

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25
Q

What does UPC negate?

A

The effect of urine volume and concentration

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26
Q

Does UPC correlate well to 24hr urine protein excretion?

A

Yes

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27
Q

What should UPC be interpreted in conjunction with?

A

Urine sediment findings

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28
Q

What may renal proteinuria be caused by?

A

Defective renal function or inflammation of the renal parenchyma

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29
Q

How is pyelonephritis ruled out?

A

Ultrasound

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30
Q

What can help confirm acute tubular necrosis?

A

Casts in the urine sediment

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31
Q

What are the options for renal poteinuria if inflammation in excluded?

A
  1. Glomerular disease
  2. Tubular disease
  3. CKD
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32
Q

Why does glomerular disease lead to proteinuria?

A

Increased glomerular permeability allowing for greater protein leakage

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33
Q

At what UPC should amyloidosis be considered?

A

> 8

34
Q

Why does tubular disease lead to proteinuria?

A

Decreased tubular protein reabsorption

35
Q

What is the UPC ratio usually in dogs and cats with tubular disease?

A
36
Q

Why does CKD lead to proteinuria?

A

Adaptive changes within the nephron

Hyperfiltration causing hypertension, glomerular protein loss, tubular dysfunction causing reduced uptake

37
Q

When can CKD cause profound proteinuria (over what it usually does)?

A

When CKD is caused by a primary glomerular pathology (dos espeically)

38
Q

What pathology tends to cause the most significant proteinuria?

A

Glomerular protein loss

Protein losing nephropathy (PLN)

39
Q

What is glomerulonephritis?

A

A group of conditions where immune complexes are deposited in the glomeruli

40
Q

Is glomerulonephritis more common in cats or dogs?

A

Dogs

41
Q

What conditions cause glomerulonephritis by chronic antigenic stimulation?

A

Inflammation, infection, or neoplasia

42
Q

T/F: Many cases of glomerulonephritis are idiopathic.

A

True- 50% of cases

43
Q

What familial nephropathy of the basement membrane effects Samoyeds?

A

X-linked hereditary PLN

44
Q

What breed of dog is effected by Alport syndrome?

A

English cocker spaniels

Type IV collagen disease

45
Q

What breeds are effected by amyloid deposits in the glomeruli (amyloidosis)?

A

Shar-pei, beagle, abyssinian, siamese

46
Q

What chemotherapy drugs can cause glomerulonephritis?

A

Tyrosine kinase inhibitors

47
Q

What infectious disease can cause glomerulonephritis that is important to screen for with a proper history?

A

Lyme disease

48
Q

What is an easy in clinic test to rule out several infetious causes of glomerulonephritis?

A

4dX test- Borrelia, dirofilaria, ehrlichia, leishmania

49
Q

How do you screen for neoplastic causes of glomerulonephritis?

A

Thoracic radiographs or abdominal ultrasound

50
Q

What is important to check for in glomerulonephritis patients?

A

Blood pressure and hypercoagulability

51
Q

Which BP measuring technique is better for cats and small dogs?

A

Doppler

52
Q

Which BP measuring technique is better for larger dogs?

A

Oscillometic

53
Q

How many readings should be done in order to ensure a more accurate BP measurement?

A

At least 5

54
Q

Why are glomerulonephritis patients hypercoagulable?

A
  1. Mild thrombocytosis with increased platelet adhesion and aggregation
  2. Loss of antithrombin
  3. Altered fibrinolysis
55
Q

What is the risk of hypercoagulability?

A

Thomboemboli- often pulmonary and fatal

56
Q

How do we directly measure hypercoagulability?

A

Thromboelastography

57
Q

How do we indirectly measure hypercoagulability?

A
  • Platelet numbers
  • Decreased antithrombin
  • Increased fibrin
  • Increased d-dimers
58
Q

What are early clinical signs of glomerulonephritis?

A

May have no abnormalities

Loss of body condition, lethargy, or anorexia

59
Q

What are the later signs of glomerulonephritis?

A

aka Nephrotic syndrome

Abdominal and pleural effusion, subcutaneous pitting edema, acute onset blindness, thromboembolic disease

60
Q

What are the end stage clinical signs of glomerulonephritis?

A

Uremic syndrome

61
Q

When is a kidney biopsy indicated?

A
  • Persistant subclinical proteinuria

- Immune-complex doposition or amyloidosos is suspected

62
Q

When is a kidney biopsy contraindicated?

A

IRIS stage IV patients or coagulopathies

63
Q

What is the importance of IFA assesment?

A

Able to look for GBM remodelling or hypercellularity and synechiae at BM

64
Q

What part of the kidney should be biopsied?

A

Cortex only

65
Q

What techniques can be performed in order to obtain a kidney biopsy?

A
  • Trucut ultrasound guided
  • Key-hole sx technique
  • Laparosocopy
  • Laparotomy
66
Q

What are the findings in nephrotic syndrome?

A

Proteinuria, hypoalbuminemia, ascites/edema, hypercholesterolemia

Often have hypertension and hypercoagulability as well

67
Q

When is immunosupressive therapy indicated for glomerulonephritis?

A

When biopsy confirms ICGN (confirmed diagnosis)

68
Q

When is immunosuppresive therapy contraindicated?

A

Pancreatitis, bone marrow suppresion, diabetes mellitus

69
Q

Can you do a trial of immunosuppressive therapy in glomerulonephritis patients with no confirmed diagnosis?

A

Yes when you cannot do a biopsy or there is absent pathological disease

Must get owner consent and inform them of potential adverse effects

70
Q

What are the advantages/disadvantages of glucocorticoid therapy in glomerulonephritis?

A

Can be used for rapid onset but hace long term adverse effects

71
Q

What are the advantages/disadvantages of mycophenolate therapy in glomerulonephritis?

A

First choice therapy, rapid onset and low rate of adverse reaction

may cause therapy

72
Q

Can other immunosuppresive therapies be used?

A

Yes- cyclosporine, chlorambucil, azathioprine, cyclophosphamide

73
Q

What therapies can be used to treat proteinuria?

A

ACE inhibitors, Angeiotensin Receptor Blockers, and renal diets

74
Q

What should be monitored with ACE inhibitor therapy?

A

Creatinine levels

75
Q

What percent increase of creatinine should ACEi be discontinued?

A

30%

76
Q

What can renal diets do to help treat proteinuria?

A

Anti-inflammatory agents, increase quality of protein and decrease levels, restrict sodium

77
Q

How do you treat hypercoagulable patients?

A

Low dose aspirin or clopidogrel

78
Q

What should NOT be done in hypercoagulable patients?

A

Drain effusions or treat with diuretics UNLESS there is difficulty breathing

79
Q

What does the prognosos of glomerulonephritis depend on?

A

Underlying cause, severity of dysfunction, response to therapy

80
Q

T/F: Glomerulonephritis is usually a progressive condition.

A

True

SAM 2 (21 decks)

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