Internal Medicine: Glomerulopathies

Question 1

What are the three renal filtration barriers?

Answer 1

• Fenestrated endothelial cell
• Silt diaphragm
• Podocyte

Size and charge selective barrier

Question 2

1. What is a glomerulopathy?
2. What is the hallmark?
3. Is it more common in dogs or cats?

Answer 2

1. Diseases affecting the glomeruli
2. Proteinuria
3. Less common in cats

Question 3

What are the different causes of glormerulpathies?

Answer 3

Acquired or famillial

Acquired can be infective or inflammatory (commonly type III hypersensitivity)- any chronic inflammatory condition of the kidney

Question 4

What are examples of infective causes of glomerulopathy?

Answer 4

Leptospira
Leishmania
Borrelia burgdorferi
Bartonella
Babesia
Erlichia
Anaplasma
Toxoplasma
FIP
FIV
Sepsis
Pyometra

Question 5

What are examples of inflammatory causes of glomerulopathy?

Answer 5

Severe pancreatitis
SIRS
Systemic lupus chronic inflammation
Hyperglobulinaemia
Hyperadrenocorticisms

Question 6

What species have a hereditary predisposition to an amyloid causing glomerulopathy?

Answer 6

Beagle, English foxhound, Shar-Pei

Question 7

When should glomerulopathy be suspected?

Answer 7

• Elevated UPCR >2
• Investigating renal disease
• Hypoalbuminaemia and/or hypercholesterolemia
• Hypertension of unkown origin
• Thrombolic events
• High risk breeds

Question 8

What is the gold standard for glomerulopathy diagnosis?

Answer 8

Renal biopsy

Samples have to be managed in specific way and examined by light microscopy

Question 9

When renal biopsy is not possible how is glomerulopathy diagnosed?

Answer 9

• 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

Question 10

1. What is amyloidosis?
2. How does it affect UPC?
3. How can it commonly affect shar-peis?
4. How is it treated?

Answer 10

1. Formation and deposit of amyloid plaques- in glomeruli
2. Very high- 9 average
3. Shar-pei fever- hyperthermia, swollen joints
4. Colchicine and/or DMSO- no evidence

Question 11

Before treatment for glomerulopathy what needs to be done?

What magnitude of protein uria can suggest what origin?

Answer 11

1. Confirm persistent proteinuria
2. Confirm renal origin- pre/post
3. Quantify with UPCR

over 2 glomerulopathy
<2 tubulointerstitial

Question 12

What can cause pre-renal protein uria?

What can cause post-renal protein uria?

Answer 12

Pre-renal
* Fever
* Systemic inflammation
* Haemoglobinemia
* Myoglobinaemia
* Bence-jones proteinuria

Post-renal
* UTI
* Nephrolithiasis
* Tumours

Question 13

What UPC indicates treatement of glomerulopathy?

Answer 13

over 0.5 dogs
over 0.4 cats

Question 14

What is the standard treatment for proteinuria?

Answer 14

RAAS blockade
* ACE inhibitors- benazepril
* Angiotensin receptor blockers- telimisartan

Cause vasodilation of efferent arterioles- reduction in GFR- reduction proteinuria

Question 14

What is the standard treatment for proteinuria?

Answer 14

RAAS blockade
* ACE inhibitors- benazepril
* Angiotensin receptor blockers- telimisartan

Cause vasodilation of efferent arterioles- reduction in GFR- reduction proteinuria

Question 15

If the animal is not responding well to treatment of proteinuria what can be done?

Answer 15

Immunosuppressive medication can be prescribed

May affect possibility of diagnosis in the future

Question 16

What anti-complication treatment is indicated for glomerulopathies?

Answer 16

• Thromboembolism preventment
• Azotaemia
• Systemic hypertension
• Diet
• Oedema

Question 17

How is thromboembolism prevented for glomerulopathies?

Answer 17

Thromboprophylaxis treatment

Main cause of death is thromboembolism

Antiplatlets- clopidogrel
Anti-coagulant- apixaban or rivaroxaban

Question 18

1. How is azotaemia treated for glomerulopathies?
2. How is systemic hypertension treated?
3. What diet is reccomended?

Answer 18

1. IRIS reccomendations
2. > 160 mmhg dog- benazepril then amlodipine, cat- amlodipine or telmisartan
3. Renal food recommended- animal must eat if not use normal food

Question 19

How is an oedema complication treated for glomerulopathies?

Answer 19

Diuretics
Furosemide: pulmonary oedema/ hyperK
Spironolactone: pleural or abdomina effusion

Question 20

What is the prognosis for glomerulopathies?

Answer 20

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