Glomerular Disease - Green

Question 1

What are your 2 primary rule outs for Proteinuria?

How do you DX?

Answer 1

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

Question 2

What is the hallmark for Glomerular Dz?

Answer 2

Marked proteinuria w/ an inactive sediment

Question 3

What area most commonly causes Proteinuria?

Answer 3

Lower Urinary Tract

Question 4

What is the classical definition of Nephrotic Syndrome?

Answer 4

1. Proteinuria
2. Hypoalbuminemia
3. Hypercholesterolemia
4. Edema &/o ascites

• Ascites will be a transudate

Question 5

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

Why?

Answer 5

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

Question 6

How does the Glomerulus filter the blood?

Answer 6

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

Question 7

What is the underlying injury in most cases of Glomerularnephritis?

Answer 7

Immunologic Injury

Question 8

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

Answer 8

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

Question 9

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

Answer 9

Idiopathic!

Question 10

Which 3 dogs get Membranoproliferative GN?

(familial)

Answer 10

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

Question 11

Which 4 Dogs get Basement Membrane Dz?

(Familial)

Answer 11

• English Cocker spaniels
• Samoyeds
• Dobies
• Bull terriers

Question 12

List 6 things that are related to Glomerular Dz.

Answer 12

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

Question 13

What is the characteristic of Amyloidosis?

Answer 13

EXTRAcellular deposition of Beta-pleated sheets

Question 14

Which stain can confirm Amyloidosis on biopsied tissue?

Answer 14

Congo Red stain

Question 15

Which protein is most often responsible for Amyloidosis?

Answer 15

Reactive (AA) Amyloid

Question 16

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

Answer 16

Systemic deposition

Question 17

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

Answer 17

• Kidney involement
• Renal failure

Question 18

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

Where does the amyloid like to go in these animals?

Answer 18

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

Question 19

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

Answer 19

Glomerulus

(CAVEAT: Shar peis = Medulla)

Question 20

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

Answer 20

Medulla

(all cats)

Question 21

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

Answer 21

Glomerullar Amyloidosis

Question 22

What is a sign of Amyloidosis in Shar peis?

Answer 22

“Shar Pei Fever”

Recurrent, acute, self-limiting fever + tibiotarsal swelling

Question 23

How will a Shar pei typically present with Amyloidosis?

Answer 23

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

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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

Question 26

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

Answer 26

**UPC!!!!!** ## Footnote (UPC w/ an active sediment is useless!)

Question 27

List the 2 Fundic lesions comonlly associated with **Hyper**tension.

Answer 27

* Retinal hemorrhage * Retinal detachment

Question 28

What is the most sensitive test to detect proteinuria?

Answer 28

Microalbuminuria | (\> 1 mg/dL to \<30 mg/dL)

Question 29

What is Microalbuminuria a good indicator of? What does it NOT tell you?

Answer 29

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

Question 30

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

Answer 30

Renal Biopsy

Question 31

What is the best way to assess **GN**?

Answer 31

* IHC * IF + electron microscopy

Question 32

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

Answer 32

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

Question 33

How do ACE inhibitors help with GN?

Answer 33

Works on the EFFERNT arterioles & decreases glomerular capillary hydrostatic pressure (& proteinuria) by decreasing POST-glomerular arteriolar resistance

Question 34

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

Answer 34

Low dose aspirin therapy | (inhibits platelet aggregation)

Question 35

**What is the best protocol for PLN?**

Answer 35

* **Decrease protein in the diet** * **ACE inhibitor** * **Low dose aspirin**

Question 36

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

Answer 36

Fish Oil | (Omega-3 polyunsaturated fatty acids)

Question 37

If your Glomerular Dz patient starts to suffer from *Hypo*albuminemia what should you NOT do?

Answer 37

Increase their dietary protein → only compounds the problem!

Question 38

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

Answer 38

* [Plasma cholesterol] * [Triglyceride]

Question 39

What percentage of dogs w/ glomerular dz suffer from **hyper**tension? What does this mean for you as a clinician?

Answer 39

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