Proteinuria

Question 1

How do we diagnose Proteinuria?

Answer 1

Dip stick test of urine
Sulphosalicyclic acid test
Protein creatinine ratio
Protein Electrophoresis

Question 2

What are the advantages and disadvantages to using a Dip Stick Measurement?

Answer 2

Cheap & Convenient
BUT only useful for detecting severe proteinuria

Question 3

How useful is measuring the Protein Creatinine Ratio in diagnosing Proteinuria?

Answer 3

Very practical & widely available
BUT high day to day variability so ideally measure several times and then pool the samples

Question 4

What UPC ration indicates non proteinuric and proteinuric?

Answer 4

<0.2 non proteinuric
>0.4 is proteinuric

Question 5

In Proteinuria, where is the protein coming from?

Answer 5

Can be pre glomerular- low molecular weight proteins slipping through glomerular filter
Can be post glomerular- addition of protein to the urine after it has been formed

Question 6

What kind of proteins will we find in the Urine of a patient with Pre Renal Proteinuria? (3)

Answer 6

immunoglobulin, haemoglobin, myoglobin

Question 7

Broadly speaking, what can cause Post Glomerular proteinuria? (3)

Answer 7

Haemorrhage, Inflammation/ Infection, Neoplasia

Question 8

What is the key difference in Proteinuria Urinalysis results in an animal with Primary Glomerular Disease and Proximal Tubular Dysfunction?

Answer 8

Glomerular Disease will have plasma protein & albumin due to the loss of size barriers
Tubular dysfunction will have just albumin in the urine as it is a small molecule that is usually reabsorbed at the PCT

Question 9

What causes Protein Losing Nephropathy?

Answer 9

Glomerular Disease

Question 10

Low blood albumin alone suggests …

Low albumin & globulin suggests…

Answer 10

low albumin- liver failure, hypoadrenocorticisim, protein losing nephropathy
low albumin & globulin- protein losing enteropathy, haemorrhage

Question 11

Which dog breeds are most at risk of Protein Losing Nephropathy?

Answer 11

Wheaten Terriers and Airedale Terriers

Question 12

1/3 of animals that with PLN, further develop…

Answer 12

Nephrotic Syndrome

Question 13

What would the bloodwork of Nephrotic Syndrome look like?

Answer 13

proteinuria
hypoalbuminemia
hyperlipidaemia (increased cholesterol)

Question 14

Why is Thromboembolism a symptom of PLN?

Answer 14

Loss of anti-thrombin which is an inhibitor of the anti clotting cascade- lost in the urine

Question 15

How can we diagnose Glomerular Disease?

Answer 15

Cannot be diagnosed except through a biopsy

Question 16

Give an example of a dog breed that is prone to familiar glomerulopathies and what disease it is prone to?

Answer 16

English Cocker Spaniels- prone to hereditary nephritis which is a defect of type IV collagen in the basement membrane which causes leakage

Question 17

What else may cause Proteinuria that aren’t pre renal/ post renal disorders? (6)

think disease, medication etc.

Answer 17

Leishmania
Heartworm
Lyme Disease
Steroids
Sulphonamides cause proteinuria particularly in Dobermans
Tyrosine Kinase Inhibitors

Question 18

When is a Renal Biopsy contraindicated?

Answer 18

In cases of suspected Haemorrhage or Renal Injury
and when patient can’t afford it (because it do be expensive)

Question 19

How is a renal biopsy performed?

Answer 19

ultrasound guided- taken from cortical tissue and then fixed in Formalin with a stain

Question 20

What are the two types of Immune Complex Glomerulonephritis that a renal biopsy may detect?

Answer 20

Membranoproliferative glomerulonephritis (MPGN)- dogs (more common)
Membranous Glomerulonephritis- dogs and cats (rare in cats but effects males usually)

Question 21

Amyloidosis can cause Proteinuria but what is the exception to this rule?

Answer 21

If amyloids are deposited in the medulla the animal will not be proteinuric but will present with renal failure

Question 22

Animals with Proteinuria have a worse prognosis when?

Answer 22

if the animal is also azotemic