Glomerulopathy (Yr4)

Question 1

what is the hallmark of glomerulopathy?

Answer 1

proteinurea

Question 2

how can proteinuria be quantified?

Answer 2

urine protein:creatinine concentration (UPCR)

Question 3

do cases of glomerulpathy of tubulointerstitial disease tend to have a large magnitude proteinuria?

Answer 3

glomerulopathy

Question 4

why will glomerulopathies always eventually present as azotaemic (even if they don’t initially)?

Answer 4

proteinuria causes damage to tubules, leading to loss of nephrons

Question 5

what is the difference between the cause of proteinuria in glomerulopathy and interstitial disease?

Answer 5

glomerulopathy… more protein is filtered as the glomerulus is damaged meaning larger gaps for protein to pass through
tubulointerstitial… reduced re-absorption of protein by the proximal convoluted tubules

Question 6

are cats more commonly seen with glomerulopathies or tubulointerstitial disease?

Answer 6

tubulointerstitial disease (such as CKD)

Question 7

what is the main cause of glomerulopathies?

Answer 7

type III hypersensitivities (circulating immunoglobulins become trapped in the glomeruli and activate complement)

Question 8

what patients are predisposed to amyloidosis?

Answer 8

shar-peis, Abyssinian, siamese

Question 9

how does amyloidosis cause glomerulopathy?

Answer 9

amyloid protein plaques get deposited in the glomeruli, causing leakage of protein and inflammation which further exacerbates disease

Question 10

what is the gold standard for diagnosis of glomerulopathies?

Answer 10

renal biopsy

Question 11

what dogs breeds are associated with amyloidosis?

Answer 11

shar-peis

Question 12

what happens during shar-pei fever complex?

Answer 12

waxing/waning pyrexia and swelling of hocks which resolve without treatment
eventually deposition of protein in the glomerulus causes renal disease

Question 13

what is the treatment typically used for amyloidosis?

Answer 13

colchicine… anti-fibrotic so breaks down amyloid plaques (no evidence to support its use)

Question 14

what is typically the first test used to screen for proteinuria?

Answer 14

dipstick

Question 15

what three things do we need to check for when presented with proteinuria?

Answer 15

location (rule out pre and post renal)
persistence (3 samples two weeks apart)
magnitude (UPCR)

Question 16

what treatments are used for glomerulopathies?

Answer 16

RAAS blockades and steroids
anti-platelet and anti-coagulant therapy

Question 17

what are the options for RAAS blockade therapy?

Answer 17

angiotensin converting enzyme inhibitors (benazepril)
angiotensin receptor blockers (telmisartan)

Question 18

what is an example of an ACE inhibitor?

Answer 18

benazepril

Question 19

what is an example of an angiotensin receptor blocker?

Answer 19

telmisartan

Question 20

what is the mechanism by which RAAS blockade helps to treat glomerulopathies?

Answer 20

causes relaxation of the afferent and efferent arterioles which reduces GFR

Question 21

other than reducing GFR, how does dilation of the afferent/efferent arterioles aid the kidney in glomerulopathies?

Answer 21

means better perfusion to the rest of the nephron

Question 22

what is a negative effect of RAAS blockade for glomerulopathy treatment?

Answer 22

decreased GFR means decreased excretion of creatinine, potassium and phosphate meaning they become more azotaemic (and possibly uraemic)

Question 23

what effect does telmisartan and benazepril have on systemic blood pressure?

Answer 23

decreased

Question 24

how can steroids help in the treatment of glomerulopathies?

Answer 24

most glomerulopathies are as a result of immune complexes, so immunosuppressive therapy can aid treatment (and even be curative)

Question 25

why is anti-platelet and anti-coagulant therapy indicated for glomerulopathies?

Answer 25

they are in a hypercoaguable state partly due to anti-thrombin loss through the kidney

Question 26

what is the anti-platelet therapy used for glomerulopathies?

Answer 26

clopidogrel (superior to aspirin)

Question 27

what anti-coagulant treatment is used for patients with glomerulopathies?

Answer 27

dalteparin (SC injection)
rivaroxaban (oral)

Question 28

what is the treatment of choice for hypertension in glomerulopathy cases?

Answer 28

benazepril (dogs)
amlodipine (cats)

Question 29

what diet should be used in glomerulopathy cases?

Answer 29

high quality, moderately restricted protein diet (same as CKD)
low phosphate of CKD diet also beneficial
(more important that animal eats the diet as weight loss is associated with poor prognosis)

Question 30

what are the three characteristics of nephrotic syndrome?

Answer 30

hypoalbuminaemia (protein losing nephropathy)
peripheral oedema
hypercholesterolaemia (changes in metabolism due to apolipoprotein loss through kidneys)

Question 31

what is the prognosis for nephrotic syndrome?

Answer 31

very grave prognosis

Question 32

what are the two general categories of glomerulopathys?

Answer 32

acquired and familial

Question 33

what presenting signs would lead you to suspect a glomerulopathy?

Answer 33

unexpected proteinuria on urinalysis
hypertension of unknown origin
hypoalbuminaemia/hypercholesterolaemia
thromboembolic events
at risk breeds

Question 34

how can oedema associated with glomerulopathy be treated?

Answer 34

diuretics (furosemide, spironolactone)