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Small Animal Med. I > Glomerular Disease - Green > Flashcards

Glomerular Disease - Green Flashcards

1
Q

What are your 2 primary rule outs for Proteinuria?

How do you DX?

A
  • Glomerulonephritis OR Glomerular amyloidosis
  • DX = renal biopsy & send off for histopath
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2
Q

What is the hallmark for Glomerular Dz?

A

Marked proteinuria w/ an inactive sediment

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3
Q

What area most commonly causes Proteinuria?

A

Lower Urinary Tract

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4
Q

What is the classical definition of Nephrotic Syndrome?

A
  1. Proteinuria
  2. Hypoalbuminemia
  3. Hypercholesterolemia
  4. Edema &/o ascites
  • Ascites will be a transudate
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5
Q

What is the most frequent cause of death in patients with Nephrotic Syndrome?

Why?

A
  • Thromboembolism
    • often in the Pulmonary a.
    • 15-25% of dogs w/ Nephrotic syndrome
  • P loses Anti-Thrombin III ⇒ hypercoagulable state
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6
Q

How does the Glomerulus filter the blood?

A
  • Charge
    • ( - ) repels negatively charged proteins
  • Size
    • Type 4 collagen
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7
Q

What is the underlying injury in most cases of Glomerularnephritis?

A

Immunologic Injury

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8
Q

What are the 2 ways that the Immune System can damage the Glomerulus?

A
  1. Circulating→ immune complex deposition → disorts Glomerular shape
  2. In Situ → Anti-GBM Ag → attacks the basement membrane
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9
Q

What is the etiology of Immune Complex Glomerular Nephritis in Dogs & Cats?

A

Idiopathic!

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10
Q

Which 3 dogs get Membranoproliferative GN?

(familial)

A
  • Soft-coated Wheaten terriers
  • Bernese Mtn. Dogs
  • Brittany Spaniels
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11
Q

Which 4 Dogs get Basement Membrane Dz?

(Familial)

A
  • English Cocker spaniels
  • Samoyeds
  • Dobies
  • Bull terriers
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12
Q

List 6 things that are related to Glomerular Dz.

A
  1. CRF → most common
  2. Underlying Infectious/Inflammatory/Neoplastic dz.
  3. Proteinuria
  4. Nephrotic syndrome
  5. Thromboembolism
  6. Sudden blindness
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13
Q

What is the characteristic of Amyloidosis?

A

EXTRAcellular deposition of Beta-pleated sheets

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14
Q

Which stain can confirm Amyloidosis on biopsied tissue?

A

Congo Red stain

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15
Q

Which protein is most often responsible for Amyloidosis?

A

Reactive (AA) Amyloid

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16
Q

What is the most common form of amyloid deposition seen in Vet med?

A

Systemic deposition

17
Q

The C/S of Amyloidosis are often due to _______ & ________.

A
  • Kidney involement
  • Renal failure
18
Q

What breeds are an exception to the amyloid tissue tropism “rule”?

Where does the amyloid like to go in these animals?

A

Shar pei, Siamese & Oriental shorthair cat → targets the liver → + liver rupture & hemoabdomen

19
Q

Where are the amyloid deposits distributed in the kidneys of CANINE patients?

A

Glomerulus

(CAVEAT: Shar peis = Medulla)

20
Q

Where are amyloid deposits distributed in the kidneys of FELINE patients?

A

Medulla

(all cats)

21
Q

Which form of Amyloidosis will test positive on a renal biopsy & have proteinuria?

A

Glomerullar Amyloidosis

22
Q

What is a sign of Amyloidosis in Shar peis?

A

“Shar Pei Fever”

Recurrent, acute, self-limiting fever + tibiotarsal swelling

23
Q

How will a Shar pei typically present with Amyloidosis?

A
  • Signs consistent w/ CRF
  • “Shar pei fever”
  • Isosthenuria W/O proteinuria
24
Q

What will the BW/UA look like in an Abyssinian w/ Amyloidosis?

A
  • NON-regenerative anemia
  • Azotemia
  • Hyperphosphatemia
  • Metabolic acidosis
  • Isothenuria
  • + Proteinuria
25
Q

Which dz would you rather your patient have, Glomerular Nephritis or Amyloidosis?

Why?

A

Glomerular Nephritis

(Amyloidosis = relentless progression!!! GN patients can stay stable for a long time)

26
Q

You need to evulate for proteinuria and have an active sediment, what test WILL NOT work?

A

UPC!!!!!

(UPC w/ an active sediment is useless!)

27
Q

List the 2 Fundic lesions comonlly associated with Hypertension.

A
  • Retinal hemorrhage
  • Retinal detachment
28
Q

What is the most sensitive test to detect proteinuria?

A

Microalbuminuria

(> 1 mg/dL to <30 mg/dL)

29
Q

What is Microalbuminuria a good indicator of?

What does it NOT tell you?

A
  • Early indicator of vascular endothelial damage
  • Prognosis → unclear if seemingly normal dogs w/ microalbuminuria are @ an increased risk of developing progressive renal dz.
30
Q

What is the only reliable way to differentiate btwn GN & Amyloidosis?

A

Renal Biopsy

31
Q

What is the best way to assess GN?

A
  • IHC
  • IF + electron microscopy
32
Q

What is the most important drug you can give to help TX Glomerular Dz?

Second choice?

A
  • An ACE inhibitor (Enalapril) →will help w/ the hypertension & proteinuria
  • Ca2+ channel blocker (Amlodipine)
33
Q

How do ACE inhibitors help with GN?

A

Works on the EFFERNT arterioles & decreases glomerular capillary hydrostatic pressure

(& proteinuria) by decreasing POST-glomerular arteriolar resistance

34
Q

What do can you RX to dogs with GN to help prevent thromboembolisms?

A

Low dose aspirin therapy

(inhibits platelet aggregation)

35
Q

What is the best protocol for PLN?

A
  • Decrease protein in the diet
  • ACE inhibitor
  • Low dose aspirin
36
Q

What supplement can we give our GN patients that may suppress glomerular inflammation & coagulation?

A

Fish Oil

(Omega-3 polyunsaturated fatty acids)

37
Q

If your Glomerular Dz patient starts to suffer from Hypoalbuminemia what should you NOT do?

A

Increase their dietary protein → only compounds the problem!

38
Q

Concentrations of what 2 things are INVERSELY correlated w/ serum albumin concentrations?

A
  • [Plasma cholesterol]
  • [Triglyceride]
39
Q

What percentage of dogs w/ glomerular dz suffer from hypertension?

What does this mean for you as a clinician?

A
  • 50-80%
  • Measure BP in ALL dogs & cats w/ glomerular dz!

Small Animal Med. I (18 decks)

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