Glomerular Disease Flashcards by Fiona Lair

What is proteinuria?

Increase in the amount of protein in the urine

How well did you know this?

Not at all

Perfectly

What is the UPC value for non-proteinuric?

Dogs=

How well did you know this?

Not at all

Perfectly

What is the UPC value for borderline proteinuric?

Dogs = 0.2-0.5
Cats = 0.2-0.4

How well did you know this?

Not at all

Perfectly

What is the UPC value for proteinuric?

Dogs = >0.5
Cats = >0.4

How well did you know this?

Not at all

Perfectly

What are the physiological causes of proteinuria?

Strenuous exercise, seizures, fever, stress

How well did you know this?

Not at all

Perfectly

What are the pre-renal causes of proteinuria?

Abnormal concentration of protein being presented to the kidneys

How well did you know this?

Not at all

Perfectly

What are the renal causes of proteinuria?

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

How well did you know this?

Not at all

Perfectly

What are the post-renal causes of proteinura?

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

How well did you know this?

Not at all

Perfectly

How is proteinuria first detected?

On a urine dipstick

How well did you know this?

Not at all

Perfectly

Is the urine dipstick quantitative or qualitative for proteinuria?

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

How well did you know this?

Not at all

Perfectly

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

Alkaline urine or contamination

How well did you know this?

Not at all

Perfectly

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

Acidic urine or bence-jones proteinuria

How well did you know this?

Not at all

Perfectly

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

True

How well did you know this?

Not at all

Perfectly

What proteins are detected with the urine dipstick?

Most sensitive to albumin

How well did you know this?

Not at all

Perfectly

What are some ways to identify physiological causes of proteinuria?

History and clinical examination

How well did you know this?

Not at all

Perfectly

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

Hematology and biochemistry

How well did you know this?

Not at all

Perfectly

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

History, clinical exam, urinalysis, imaging

How well did you know this?

Not at all

Perfectly

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

Examine urine sediment

- Perform urine culture and sensitivity

How well did you know this?

Not at all

Perfectly

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

Hyperadrenocorticism or exogenous steroid administration

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Why do we want to quantify proteinuria?

Evaluate severity of renal lesions
Help identify location
Assess disease progression
Assess response to treatment

How well did you know this?

Not at all

Perfectly

What is the gold standard to quantify proteinuria?

24hr protein measurement

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

What is usually used to quantify proteinuria?

Urine protein:creatinine ratio

How well did you know this?

Not at all

Perfectly

What does UPC negate?

The effect of urine volume and concentration

Does UPC correlate well to 24hr urine protein excretion?

Yes

What should UPC be interpreted in conjunction with?

Urine sediment findings

What may renal proteinuria be caused by?

Defective renal function or inflammation of the renal parenchyma

How is pyelonephritis ruled out?

Ultrasound

What can help confirm acute tubular necrosis?

Casts in the urine sediment

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

1. Glomerular disease 2. Tubular disease 3. CKD

Why does glomerular disease lead to proteinuria?

Increased glomerular permeability allowing for greater protein leakage

At what UPC should amyloidosis be considered?

Why does tubular disease lead to proteinuria?

Decreased tubular protein reabsorption

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

Why does CKD lead to proteinuria?

Adaptive changes within the nephron Hyperfiltration causing hypertension, glomerular protein loss, tubular dysfunction causing reduced uptake

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

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

What pathology tends to cause the most significant proteinuria?

Glomerular protein loss Protein losing nephropathy (PLN)

What is glomerulonephritis?

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

Is glomerulonephritis more common in cats or dogs?

Dogs

What conditions cause glomerulonephritis by chronic antigenic stimulation?

Inflammation, infection, or neoplasia

T/F: Many cases of glomerulonephritis are idiopathic.

True- 50% of cases

What familial nephropathy of the basement membrane effects Samoyeds?

X-linked hereditary PLN

What breed of dog is effected by Alport syndrome?

English cocker spaniels Type IV collagen disease

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

Shar-pei, beagle, abyssinian, siamese

What chemotherapy drugs can cause glomerulonephritis?

Tyrosine kinase inhibitors

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

Lyme disease

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

4dX test- Borrelia, dirofilaria, ehrlichia, leishmania

How do you screen for neoplastic causes of glomerulonephritis?

Thoracic radiographs or abdominal ultrasound

What is important to check for in glomerulonephritis patients?

Blood pressure and hypercoagulability

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

Doppler

Which BP measuring technique is better for larger dogs?

Oscillometic

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

At least 5

Why are glomerulonephritis patients hypercoagulable?

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

What is the risk of hypercoagulability?

Thomboemboli- often pulmonary and fatal

How do we directly measure hypercoagulability?

Thromboelastography

How do we indirectly measure hypercoagulability?

- Platelet numbers - Decreased antithrombin - Increased fibrin - Increased d-dimers

What are early clinical signs of glomerulonephritis?

May have no abnormalities | Loss of body condition, lethargy, or anorexia

What are the later signs of glomerulonephritis?

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

What are the end stage clinical signs of glomerulonephritis?

Uremic syndrome

When is a kidney biopsy indicated?

- Persistant subclinical proteinuria | - Immune-complex doposition or amyloidosos is suspected

When is a kidney biopsy contraindicated?

IRIS stage IV patients or coagulopathies

What is the importance of IFA assesment?

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

What part of the kidney should be biopsied?

Cortex only

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

- Trucut ultrasound guided - Key-hole sx technique - Laparosocopy - Laparotomy

What are the findings in nephrotic syndrome?

Proteinuria, hypoalbuminemia, ascites/edema, hypercholesterolemia Often have hypertension and hypercoagulability as well

When is immunosupressive therapy indicated for glomerulonephritis?

When biopsy confirms ICGN (confirmed diagnosis)

When is immunosuppresive therapy contraindicated?

Pancreatitis, bone marrow suppresion, diabetes mellitus

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

Yes when you cannot do a biopsy or there is absent pathological disease Must get owner consent and inform them of potential adverse effects

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

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

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

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

Can other immunosuppresive therapies be used?

Yes- cyclosporine, chlorambucil, azathioprine, cyclophosphamide

What therapies can be used to treat proteinuria?

ACE inhibitors, Angeiotensin Receptor Blockers, and renal diets

What should be monitored with ACE inhibitor therapy?

Creatinine levels

What percent increase of creatinine should ACEi be discontinued?

30%

What can renal diets do to help treat proteinuria?

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

How do you treat hypercoagulable patients?

Low dose aspirin or clopidogrel

What should NOT be done in hypercoagulable patients?

Drain effusions or treat with diuretics UNLESS there is difficulty breathing

What does the prognosos of glomerulonephritis depend on?

Underlying cause, severity of dysfunction, response to therapy

T/F: Glomerulonephritis is usually a progressive condition.

True