Internal Medicine: Glomerulopathies Flashcards
What are the three renal filtration barriers?
- Fenestrated endothelial cell
- Silt diaphragm
- Podocyte
Size and charge selective barrier
- What is a glomerulopathy?
- What is the hallmark?
- Is it more common in dogs or cats?
- Diseases affecting the glomeruli
- Proteinuria
- Less common in cats
What are the different causes of glormerulpathies?
Acquired or famillial
Acquired can be infective or inflammatory (commonly type III hypersensitivity)- any chronic inflammatory condition of the kidney
What are examples of infective causes of glomerulopathy?
Leptospira
Leishmania
Borrelia burgdorferi
Bartonella
Babesia
Erlichia
Anaplasma
Toxoplasma
FIP
FIV
Sepsis
Pyometra
What are examples of inflammatory causes of glomerulopathy?
Severe pancreatitis
SIRS
Systemic lupus chronic inflammation
Hyperglobulinaemia
Hyperadrenocorticisms
What species have a hereditary predisposition to an amyloid causing glomerulopathy?
Beagle, English foxhound, Shar-Pei
When should glomerulopathy be suspected?
- Elevated UPCR >2
- Investigating renal disease
- Hypoalbuminaemia and/or hypercholesterolemia
- Hypertension of unkown origin
- Thrombolic events
- High risk breeds
What is the gold standard for glomerulopathy diagnosis?
Renal biopsy
Samples have to be managed in specific way and examined by light microscopy
When renal biopsy is not possible how is glomerulopathy diagnosed?
- Confirm the Proteinuria
- Can be easily detected with a dipstick
- Quantify with UPCR
Can be pre-renal, renal or post-renal
Important to evaluate the persistence: proteinuria should be repeatable on at least 3 samples, 2 weeks apart
- What is amyloidosis?
- How does it affect UPC?
- How can it commonly affect shar-peis?
- How is it treated?
- Formation and deposit of amyloid plaques- in glomeruli
- Very high- 9 average
- Shar-pei fever- hyperthermia, swollen joints
- Colchicine and/or DMSO- no evidence
Before treatment for glomerulopathy what needs to be done?
What magnitude of protein uria can suggest what origin?
- Confirm persistent proteinuria
- Confirm renal origin- pre/post
- Quantify with UPCR
over 2 glomerulopathy
<2 tubulointerstitial
What can cause pre-renal protein uria?
What can cause post-renal protein uria?
Pre-renal
* Fever
* Systemic inflammation
* Haemoglobinemia
* Myoglobinaemia
* Bence-jones proteinuria
Post-renal
* UTI
* Nephrolithiasis
* Tumours
What UPC indicates treatement of glomerulopathy?
over 0.5 dogs
over 0.4 cats
What is the standard treatment for proteinuria?
RAAS blockade
* ACE inhibitors- benazepril
* Angiotensin receptor blockers- telimisartan
Cause vasodilation of efferent arterioles- reduction in GFR- reduction proteinuria
What is the standard treatment for proteinuria?
RAAS blockade
* ACE inhibitors- benazepril
* Angiotensin receptor blockers- telimisartan
Cause vasodilation of efferent arterioles- reduction in GFR- reduction proteinuria
If the animal is not responding well to treatment of proteinuria what can be done?
Immunosuppressive medication can be prescribed
May affect possibility of diagnosis in the future
What anti-complication treatment is indicated for glomerulopathies?
- Thromboembolism preventment
- Azotaemia
- Systemic hypertension
- Diet
- Oedema
How is thromboembolism prevented for glomerulopathies?
Thromboprophylaxis treatment
Main cause of death is thromboembolism
Antiplatlets- clopidogrel
Anti-coagulant- apixaban or rivaroxaban
- How is azotaemia treated for glomerulopathies?
- How is systemic hypertension treated?
- What diet is reccomended?
- IRIS reccomendations
- > 160 mmhg dog- benazepril then amlodipine, cat- amlodipine or telmisartan
- Renal food recommended- animal must eat if not use normal food
How is an oedema complication treated for glomerulopathies?
Diuretics
Furosemide: pulmonary oedema/ hyperK
Spironolactone: pleural or abdomina effusion
What is the prognosis for glomerulopathies?
Huge variation
* Azotaemia, nephrotic syndrome, amyloidosis and other co-morbs affect
In animals with mild/no azotaemia and no other co-morbidities 6 months- 2 years
