PLN Flashcards
Albumin has an overall _____ charge
Negative
AGTII, Thromboxane, and ET-1 are all _______ substances
Vasoconstrictive
4 key features of nephrotic syndrome:
Hypoproteinemia (decreased TP)
Proteinuria
Hypercholesterolemia
Ascites
PLN should be on your radar if proteinuria has been present for how long?
At least 2 weeks
If UPC is >2, patient likely has:
Glomerular disease
If UPC is <2, patient might have:
Glomerular or tubular disease
UPC >0.5 with an inactive sediment is characteristic of:
Glomerular disease
Normal UPC in a dog is ______
< 0.5
Normal UPC in cats is:
< 0.4
(Ideally, less than 0.2)
4 differentials for hypoalbuminemia?
PLN
PLE
Liver failure
Blood loss
Defining feature of PLN on a chem profile is ______
Hypercholesterolemia
5 differentials for Hypercholesterolemia?
PLN
Recent meal
Lipid disorder
Cushing’s
Hypothyroidism
Contraindications for renal biopsy?
Severe, chronic azotemia
Moderate- severe Hypertension
Severe uremia
Severe chronic azotemia is a contraindication for renal biopsy for 2 key reasons:
Chronic, Severe azotemia = you’re likely just going to find irreversible fibrosis
Azotemia causes platelet dysfunction; patient is at increased risk of bleeding!!
What is severe uremia a contraindication for renal biopsy?
Risk of bleeding!
Uremia causes platelet dysfunction, patient can’t clot as well!
Where do you want to biopsy from for kidney biopsy?
Renal cortex!
This is where glomeruli live
Omega-3 fatty acids are ______ protective in dogs
Renal
Can also help with suppressing inflammation
3 drug classes that block RAAS:
ACE inhibits, angiotensin receptor blockers, aldosterone antagonists
Effect of AGII on the kidneys =
Works on proximal tubule to increase sodium reabsorption
Effect of AGII on blood vessels =
Vasoconstriction!
Increases systemic pressure, increases tissue perfusion!
Effect of AGII on the adrenals =
Release of aldosterone
Aldosterone makes distal tubule reabsorb Na+ and secrete K+
RAAS is stimulated when ____ ___ _____
Flow is low!
If flow is low, to RAAS we go!
(To maintain our systemic BP yo)
AGII constricts the _______ arteriole more than the _______ arteriole
EFFERENT
Afferent
Block AGII = decrease vasoconstriction = _________
Decreases glomerular blood pressure
Decrease the force that is pushing protein through the glomerular barrier!
3 side effects of ACE inhibitors:
Hyperkalemia
Hypotension
Azotemia
How can ACE inhibitors cause Azotemia?
If you decrease BP enough, you can decrease GFR to levels that result in azotemia
Ace inhibitors overcome efferent arteriole constriction!
You started a patient on enalapril one week ago. You recheck a chem and BP a week later
Creatinine has increased by 35%, what should you do?
> 20% increase = decrease dose or discontinue med
How low does albumin need to be for plasma to leak out and cause ascites?
VERY LOW <2 mg/dL
Good drug for mild-moderate hypertension?
ACE Inhibitors
Good drug for SEVERE hypertension?
Amlodipine
Severe hypertension = ______
Hypertensive = ________
Normotensive = _________
> 180 mm Hg
140-180 mm Hg
<140 mm hG
Inherited forms of PLN will not respond to Immunosuppressive drugs. True or false?
TRUE
Why can’t we use steroids to treat PLN?
steroids cause proteinuria in dogs
What are common side effects of mycophenolate?
Diarrhea, GI upset
If you’re losing albumin in your urine, you’re also losing:
Antithrombin III
(Same size as albumin)
Loss of ATIII is bad because
Now patient is at risk of clotting!
What drug can be used to combat loss of antithrombin III?
Plavix!
(Clopidogrel)
It prevents platelet clumping and clot formation
_____ is the term used to describe apoptosis that occurs due to detachment from the basement membrane
Anoikis
