Glomerular Disease Flashcards
What causes proteinuria?
Physiological: strenuous exercise, fever, stress
Pre-renal: abnormal concentrations of proteins being presented to the kidneys (multiple myeloma: Bence-Jones proteins)
Renal: defective renal fxn or inflammation of renal tissue (glomerular or tubular)
Post-renal: inflammation in the ureter, bladder, urethra or prostate
How is proteinuria first detected?
On the urine dipstick!
What protein are dipsticks most sensitive to?
Albumin
If you suspect multiple myeloma but the dipstick comes back as normal, should you rule out MM?
No! Bence jones proteins which are monoclonal protein produced by plasma cells and usually occurs w MM and don’t get picked up on dipstick
What is the gold standard method to quantifying proteinuria?
24 hour urine protein measurement but it’s difficult to do so not used clinically
How do we quantify proteinuria?
Urine protein: creatinine ratio
If sediment is negative, what UPC ratios in cats and dogs are considered non proteinuric, borderline proteinuric and proteinuric?
Dogs Cats
0.5 >0.4 Proteinuric
What are the ways renal proteinuria can occur?
Defective renal fxn: 1. Glomerular pathology 2. Tubular pathology Inflammation of renal parenchyma: 1. Pyelonephritis 2. Acute tubular necrosis
How does glomerular disease occur?
Due to INCREASED glomerular permeability
Leads to greater protein loss (UPC ratio >2.0)
If UPC ratio >8 consider amyloidosis
How does tubular disease occur?
Due to DECREASED tubular protein reabsorption
UPC ratio usually
Why does CKD result in proteinuria?
Due to adaptive changes within the nephron
Causes low level proteinuria
T/F CKD can be caused by primary glomerular pathology (especially dogs) . . . causing a significant proteinuria.
True!
What is the most significant proteinuria?
Protein Losing Nephropathy (PLN)
Term used for condition causing severe proteinuria due to primary glomerular dz
What are glomerulonephritis?
Group of conditions where immune complexes are deposited in the glomeruli. More common in dogs than cats.
What causes glomerulonephritis?
- Chronic antigenic stimulation: inflammation (immune mediated dz, chronic inflammatory dz); infectious (endocarditis, leishmania, erlichia); neoplasia
- Idiopathic 50%
- Familial Nephropathy basement membrane: X linked hereditary PLN of Samoyeds or Alport syndrome of English Cocker Spaniels (type IV collagen dz)
- Glomerulonephritis may be d/t immune complex deposition in glomerulus
- Immune complex glomerulonephritis (ICGN)
- Amyloid deposits in glomeruli: Familial in Shar pei, Beagle, Abyssinian and Siamese
How do we screen for neoplasia?
Thoracic radiographs and abdominal ultrasound
How many times should we test for BP?
five times!
Regarding blood pressure, what organs would show of evidence of end organ damage?
Kidneys, brain, eyes, heart. Especially eyes!
How do we measure hyper coagulability?
Thromboelastography
What are the clinical signs of glomerulonephritis?
Early Signs: - may have no clinical abnormalities -loss of body condition -lethargy, anorexia Later: nephrotic syndrome Very Late: uremic syndrome
What characterizes nephrotic syndrome?
kidney dz characterized by edema and loss of protein from the plasma into the urine d/t increased glomerular permeability
- abdominal and pleural fluid
- subcu pitting edema
- acute onset blindness (hypertensive retinopathy)
- thromboembolic dz
When are kidney biopsies contraindicated?
IRIS stage IV or coagulopathies
What are common findings in nephrotic syndrome?
- proteinuria
- hypoALB
- ascites/edema
- hypercholesterolemia
- often have systemic hypertension and hyper coagulability
How do we tx glomerulonephritis?
Immunosuppressive therapy
- provided proteinuria has been confirmed to be glomerular in origin
- provided a biopsy confirms ICGN (immune complex glom nephritis)
