Proteinuria Flashcards
How do we diagnose Proteinuria?
Dip stick test of urine
Sulphosalicyclic acid test
Protein creatinine ratio
Protein Electrophoresis
What are the advantages and disadvantages to using a Dip Stick Measurement?
Cheap & Convenient
BUT only useful for detecting severe proteinuria
How useful is measuring the Protein Creatinine Ratio in diagnosing Proteinuria?
Very practical & widely available
BUT high day to day variability so ideally measure several times and then pool the samples
What UPC ration indicates non proteinuric and proteinuric?
<0.2 non proteinuric
>0.4 is proteinuric
In Proteinuria, where is the protein coming from?
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
What kind of proteins will we find in the Urine of a patient with Pre Renal Proteinuria? (3)
immunoglobulin, haemoglobin, myoglobin
Broadly speaking, what can cause Post Glomerular proteinuria? (3)
Haemorrhage, Inflammation/ Infection, Neoplasia
What is the key difference in Proteinuria Urinalysis results in an animal with Primary Glomerular Disease and Proximal Tubular Dysfunction?
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
What causes Protein Losing Nephropathy?
Glomerular Disease
Low blood albumin alone suggests …
Low albumin & globulin suggests…
low albumin- liver failure, hypoadrenocorticisim, protein losing nephropathy
low albumin & globulin- protein losing enteropathy, haemorrhage
Which dog breeds are most at risk of Protein Losing Nephropathy?
Wheaten Terriers and Airedale Terriers
1/3 of animals that with PLN, further develop…
Nephrotic Syndrome
What would the bloodwork of Nephrotic Syndrome look like?
proteinuria
hypoalbuminemia
hyperlipidaemia (increased cholesterol)
Why is Thromboembolism a symptom of PLN?
Loss of anti-thrombin which is an inhibitor of the anti clotting cascade- lost in the urine
How can we diagnose Glomerular Disease?
Cannot be diagnosed except through a biopsy
Give an example of a dog breed that is prone to familiar glomerulopathies and what disease it is prone to?
English Cocker Spaniels- prone to hereditary nephritis which is a defect of type IV collagen in the basement membrane which causes leakage
What else may cause Proteinuria that aren’t pre renal/ post renal disorders? (6)
think disease, medication etc.
Leishmania
Heartworm
Lyme Disease
Steroids
Sulphonamides cause proteinuria particularly in Dobermans
Tyrosine Kinase Inhibitors
When is a Renal Biopsy contraindicated?
In cases of suspected Haemorrhage or Renal Injury
and when patient can’t afford it (because it do be expensive)
How is a renal biopsy performed?
ultrasound guided- taken from cortical tissue and then fixed in Formalin with a stain
What are the two types of Immune Complex Glomerulonephritis that a renal biopsy may detect?
Membranoproliferative glomerulonephritis (MPGN)- dogs (more common)
Membranous Glomerulonephritis- dogs and cats (rare in cats but effects males usually)
Amyloidosis can cause Proteinuria but what is the exception to this rule?
If amyloids are deposited in the medulla the animal will not be proteinuric but will present with renal failure
Animals with Proteinuria have a worse prognosis when?
if the animal is also azotemic
