Glomerulonephropathies (Specht)

Question 1

Nephrotic syndrome

boards

Answer 1

• characterized by
  
  • proteinuria
  • hypoalbuminemia
  • hypercholesterolemia
  • edema
  • +/- azotemia

Question 2

Amyloidosis

Answer 2

• can cause PLN
• breed dispositions
  
  • abbysinian cats
  • sharpei dogs
• Hallmark
  
  • polarization of the protein

Question 3

ACVIM consensus

big things that came out of it

Answer 3

• When and how to assess
• Categories / classifications
  
  • persisten renal proteinuria
    
    • localization
    • persistence
    • magnitude
• Clinical response recommendations

Question 4

Detecting urine protein

Answer 4

• U/A
  
  • dipstick: colorimetric test
• SSA test
  
  • semi-quantitative
  • more sensitive/specific
• POC microabluminuria test
  
  • sensitive
  • do we care?!
• Quantitative assays
  
  • eliminate other variables

Question 5

Interpretation of proteinuria

Answer 5

• Step 1: Localization
  
  • Pre-glomerular
    
    • tests
      
      • med Hx and PE
      • Chem/CBC
      • Blood pressure
  • Post-glomerular
    
    • tests
      
      • Med Hx and PE
      • UA
      • Urine culture
      • imaging
    • easy to R/O
• Step 2: check for persistence: will need multiple samples
• Step 3: assess magnitute: UPC

Question 6

Things that inc UPC

Answer 6

• Active sediment
• systemic hypertension
• fever
• high protein diet: raw foods
• exercise

Question 7

Things that DON’T change UPC

Answer 7

• microscopic hematuria
• Collection method
  
  • may be lower if collected at home
• Time of the day
• Fed vs fasted

Question 8

Diagnostic investigation proteinuria

Answer 8

• Tier 1
  
  • Hx & PE
  • Chem, CBC, UA, UPC, Urine Culture
  • regionally common infectious agents
• Tiers II and III
  
  • imaging
  • additional infectious dz screening
  • renal bx

Question 9

Kidney bx

Answer 9

• H&E not helpful
• may help with immune mediated disease tx
  
  • will tx with immunosuppression

Question 10

Proteinuric kidney dz

Standard therapy

Answer 10

• RAAS inhibition
  
  • ace inhibitors I think
• Diet:
  
  • low protein
• thrombophrophylaxis:
  
  • at risk for clotting because of protein loss
    
    • anti-thrombin same size as albumin so also lost
      
      • functions to inhibit clotting
  • platelet inhibition: aspirin
• anti-hypertensives…?

Question 11

side effects of ace inhibitors

Answer 11

• lower glomerular filtration pressure, BP, and GFR
  
  • trade-off of lower GFR for less protein through glomerulus
• retention of potassium
  
  • monitor for hyperkalemia

Question 12

Immunosuppressant tx

Answer 12

• avoid in dogs w/ suspected familial dz or amyloidosis
• consider when dogs on standard tx have
  
  • Cr > 3.0 mg/dL, progressive azotemia
  • severe hypoalbuminemia
• Close/careful monitoring
• don’t use without a bx unless patient progressing on standard therapy

Question 13

If serology positive

Answer 13

• treat for the agents you find
• if they don’t get better then consider
  
  • standard therapy
  • biopsy
  • immunosuppressive tx

Question 14

Conclusions

Answer 14

• Proteinuria has become imp in staging/tx CKD
• localization, persistence, magnitude
• guidelines for treatment are available
  
  • IRIS