Glomerulopathies

Question 1

What is the hallmark of glomerulopathy?

Answer 1

• Proteinuria (>2)
  -less common in cats

Question 2

What are inflammatory causes of glomerulopathy?

Answer 2

*Severe Pancreatitis
* SIRS or other severe chronic inflammation
* Systemic Lupus Erythematous (SLE)
* Hyperglobulinemia (Multiple myeloma/ B cell lymphoma)
* Hyperadrenocorticism

Question 3

What are infective causes of glomerulopathy?

Answer 3

• Leptospira spp.
• Leishmania spp.
• Borrelia burgdorferi
• Bartonella spp.
• Babesia spp.
• Erlichia spp.
• Anaplasma spp.
• Toxoplasma spp.
• FIP
• FeLV/FIV
• Pyelonephritis
• Sepsis
• Pyometra

Question 4

What are hereditary glomerulopathies?

Answer 4

• Focal proliferative glomerulopathy - Abyssinian cats
• Amyloidosis - Beagles, english foxhounds, shar-pei
• Mesangiocapillary glomerulonephritis - bernese mountain dog
• Hereditary nephritis - bull terrier, cocker spaniel, dalmatian, samoyed
• Glomerulosclerosis, cystic glomerular atrophy - doberman, corgis

Question 5

What is seen in sharpei’s? CS?

Answer 5

• Amyloidosis - rapidly progressive
• Preceeded by episodes of shar-pei fever, self-limiting hyperthermia, swollen joints

Question 6

When would you suspect glomerulopathy?

Answer 6

• Unexpected proteinuria on urinalysis
• Investigating renal disease
• Hypertension of unknow origin
• Hypoalbuminemia and/or hypercholesterolemia
• Thromboembolic events
• Breed at risk

Question 7

What should be done if proteinuria is positive?
When would you treat dog/cat?

Answer 7

• Quantify by Urine Protein Creatinine Ratio
• Rule out pre/post renal proteinuria
• Treat =
  -Dog UPCR >0.5
  -Cat UPCR >0.4

Question 8

What is gold standard for glomerulopathy?

Answer 8

• Renal biopsy

Question 9

What is treatment of proteinuria?

Answer 9

• RAAS blockade = ACE inhibitors, angiotensin receptor blockers

Question 10

What are patients with glomerulopathies at high risk of getting? Tx?

Answer 10

• Thromboembolism
• Tx = clopidogrel (antiplatelet)
  -Apixaban / rivaroxaban (anti-coagulant)

Question 11

What are complications of glomerulopathies + their treatment?

Answer 11

• Azotaemia
• Systemic hypertension -treat if BP >170mmHG - Tx =
  -dog = benazepril then amlodipine
  -cat = amlodipine or telmisartan
• Oedema - renal sodium retention - Tx =
  -furosemide for pulmonary oedema / hyperK
  -Spironolactone for pleural / abdominal effusion