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Clinical Reproduction & Urology > Proteinuria > Flashcards

Proteinuria Flashcards

1
Q

glomerulus is a modified…

A

capillary bed

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2
Q

ultrafiltrate of the plasma is formed in

A

the glomerulus

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3
Q

filtration barrier in the glomerulus is composed of what layers?

A
  • fenestrated endothelium
  • glomerular basement membrane
  • visceral epithelial cells (podocytes)
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4
Q

the glomerular basement membrane determines…

A

the size of molecule that can cross

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5
Q

podocytes are linked w/

A

tight jxns

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6
Q

slits diaphragms are…

A

specialised cell jxn btw podocyte bridging the filtration slits

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7
Q

What is the upper limit of filtration molecules that pass thru the podocytes is

A

70K Dalton

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8
Q

What filtrate is too big to pass thru the podocytes

A

Albumin excluded

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9
Q

Podocyte foot processes & slit diaphragms are rich in

A

negatively charged glycoproteins

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10
Q

glomerulopathies lead to alterations of

A

filtration in the membrane

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11
Q

nephropathies arising w/ involvement of the glomeruli are the initial injury that leads to…

A

glomerulopathies

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12
Q

3 main categories of glomerulopathies

A
  • immune complex glomerulonephritis
  • primary glomerulosclerosis
  • amyloidosis
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13
Q

glomerulopathies in dogs is most common in what age?

A

middle-aged to older dogs

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14
Q

what signs are seen in glomerulopathies in middle-aged to older dogs

A
  • microalbuminuria
  • proteinuria (nephrotic syndrome)
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15
Q

canine glomerulopathies can occur in various…

A

breeds

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16
Q

secondary glomerular diseases are commonly caused by

A

Young: infectious, inflammatory
Old: Neoplasia

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17
Q

what signs are compatible w/ CKD that also occur in canine glomerulopathies

A

anorexia, PU/PD, V, halitosis

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18
Q

Fluid retention in glomerulopathies will appear as…

A

ascites, peripheral oedema

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19
Q

glomerulopathies will create thromboembolisms - how?

A

severe loss of ALB -> lose antithrombin -> tips balance of haemostatic state to procoagulation state -> create thromboemboli

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20
Q

target organ damages in glomerulopathies is secondary to…

A

hypertension

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21
Q

Signs of glomerulopathies may relate to…

A

underlying infectious, inflammatory, or neoplastic conditions

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22
Q

non-specific signs of glomerular dz

A

weight loss, lethargy

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23
Q

What are some signs of glomerulopathies picked up on physical exam?

A
  • ascites or peripheral oedema (lack of oncotic pressure -> nephrotic syndrome)
  • kidney variable is size/shape
  • proteinuria
  • non-specific evidence of dz
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24
Q

Proteinuria is considered…

A

a neg prognostic indicator in cats/dogs

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25
Q

non-azotaemic cats w/ proteinuria will develop

A

azotaemia w/i 12 mos

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26
Q

proteinuria assoc’d w/

A
  • interstitial fibrosis
  • tubular degeneration & atrophy (direct toxicity)
  • proteinaceous cases -> tubular obstruction
  • decreased perfusion of tubulo-interstitium & cell necrosis
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27
Q

3 key elements of clinical assessment of proteinuria

A
  • persistence
  • localisation
  • magnitude
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28
Q

lab tests for urine protein

A
  • urine dipstick
  • sulfosalicylic turbidimetric test (SSA)
  • UPC
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29
Q

non-proteinuric UPC values in dogs/cats

A

dogs: <0.2
cats: <0.2

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30
Q

borderline proteinuric UPC values in dogs/cats

A

dogs: 0.2-0.5
cats: 0.2-0.4

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31
Q

proteinuric UPC values in dogs/cats

A

dogs: >0.5
cats: >0.4

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32
Q

potential causes of pre-renal proteinuria in dogs/cats

A
  • haemoglobinuria from intravascular haemolysis
  • myoglobinuria from rhabdomyolysis
  • immunoglobulin light chains from multiple myeloma or lymphoma
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33
Q

potential functional/physiological causes of proteinuria in dogs/cats

A
  • strenuous exercise
  • fever
  • seizure
  • exposure to extreme heat/cold
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34
Q
A
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35
Q
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36
Q
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37
Q
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38
Q
A
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39
Q

glomerular renal causes of proteinuria in dogs/cats

A

any cause of glomerular injury or dysfxn (membranoproliferative glomerulonephritis, membranous nephropathy, glomerulosclerosis, amyloidosis)

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39
Q

tubular renal causes of proteinuria in dogs/cats

A

any cause of glomerular injury or dysfxn (membranoproliferative glomerulonephritis, membranous nephropathy, glomerulosclerosis, amyloidosis)

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40
Q

interstitial renal causes of proteinuria in dogs/cats

A

Interstitial nephritis

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40
Q

post-renal causes of proteinuria of dogs/cats

A
  • UTI
  • urolithiasis
  • transitional cell carcinoma
  • vaginitis
40
Q

glomerular dz in dogs will have a UPC of…

A

glomerular dz

40
Q

if UPC in a dog is <2.0 it could have…

A

glomerular OR tubular dz

41
Q

UPC >2.0 in dogs leads to

A

protein leaking in the urine

42
Q

Hypoalbuminaemia is a sign of

A

glomerular lesions

43
Q

isosthenuria is a variable finding in

A

dogs w/ glomerular dz

44
Q

azotaemia + intact concentrating ability (isosthenuria) =

A

glomerular lesions

45
Q

isosthenuria could be present with what types of casts in urine?

A

hyaline casts

46
Q

Cylinduria is common in…

A

dogs w/ glomerular dz

47
Q

proteinuria promotes precipitation of…

A

Thamm-Horsfall mucoprotein in the tubular lumen forming a hyaline cast

48
Q

renal haematuria is rare in…

49
Q

hypoproteinaemia is secondary to

A

hypoalbuminaemia dvlpmt in dogs

50
Q

Azotaemia, hyperphosphataemia, metabolic acidosis can be signs of…

51
Q

non-regenerative anaemia, thrombocytosis, and hyperfibrinogenaemia can also be part of what condition?

A

proteinuria

52
Q

nephrotic syndrome is a sign of progression of

A

proteinuria

53
Q

signs of nephrotic syndrome

A
  • hypoalbuminaemia
  • proteinuria
  • hypercholesterolaemia
  • peripheral oedema/ascites
54
Q

diagnostic imaging is part of…

55
Q

progonosis & txt for each of the 3 categories of proteinuria is

A

very different

56
Q

Contraindications for renal Bx

A
  • end-stage CKD (will not change prognosis)
  • coagulopathy
  • hypertension
57
Q

how common is amyloidosis?

A

15% reported cases
56% dogs w/ nephrotic syndrome

58
Q

you cannot cure…

A

amyloidosis; supportive txt only

59
Q

clinical features of amyloidosis

A
  • more common in older dogs
  • beagle & E. foxhound
60
Q

renal amyloidosis in Shar-peis dvlps at

A

younger age & is more common in females

61
Q

Amyloid A demonstrates signs of

A

chronic inflammation & persistent elevation in SAA; kidney/liver

62
Q

Txt of Shar-Pei amyloidosis

A
  • little to no evidence
  • Colchicine rec’d to prevent progression of dz (but has severe GI signs in dogs)
63
Q

Prognosis for animals w/ amyloidosis

64
Q

MST for animals w/ amyloidosis

A

2-20 mos, 1 yr survival (8%)

65
Q

Glomerulosclerosis

A

aging & remodelling of glomeruli normally but earlier in life & progresses faster

66
Q

Inhibition of RAAS to control proteinuria due to

A

changing haemodynamics at glomeruli to decrease pressure of capillaries & protein-leakage

67
Q

haemodynamic forces influence the

A

transglomerular mvmt of proteins

68
Q

altering renal haemodynamics (aka decreasing hydrostatic pressure) means

A

reducing proteinuria (protein leaving BVs)

69
Q

RAAS targeting agents

A

antihypertensive agents (ACEi) or angiotensin receptor blockers (ARB)

70
Q

RAAS inhibition is the standard of care in pets w/

A

renal proteinuria w/ 0.2 (d)/0.4 (c) UPC

71
Q

ACEi lowers

A

efferent arteriole resistance

72
Q

ACEi cause what changes in the kidneys leading to efferent arteriole resistance?

A
  • decrease glomerular capillary hydrostatic pressure
  • decrease size of glomerular endothelial pores
73
Q

What do angiotensin receptor blockers do?

A

block angiotensin II receptor 1

74
Q

ARBs cause what in cats?

A

proteinuria & renal dz

75
Q

Telmisartan is what kind of drug? what does it treat?

A

ARB
1st line of choice for hypertensive, proteinuric cats

76
Q

Losartan is what kind of drug? what species does it treat?

77
Q

Combined therapy can be used to inhibit RAAS how?

A

ACEi + ARB

78
Q

Ideal therapeutic target with medications for treating proteinuria/glomerulonephritis

A

UPC <0.5-1.0 w/o worsening renal fxn

79
Q

if the target UPC is not achieved, what does this mean for medication dosing?

A
  • dosage can be increased q 4-6 wks
  • if the max dosage is reached in 1 drug, then add another agent or change medications entirely
79
Q

Alternate target for drug therapy for dogs

A

> 50% reduction in UPC

80
Q

Hyperkalaemia is a common side effect of…

A

RAAS inhibition, more so in dogs than cats

81
Q

What kind of diets can help manage hyperkalaemia?

A
  • renal diet b/c supplemented in K+
  • low protein/low fat (hydrolysed protein) diet
82
Q

pseudohyperkalaemia can occur secondary to…

A

thrombocytosis in dogs

83
Q

if hyperkalaemia occurs and is greater than 5.5 mEq/L, what effects must be monitored

A

Cardiotoxic effects

84
Q

what organ is the target organ for systemic hypertension?

85
Q

A uraemic crisis consists of…

A

sustained hypertension which is caused by increased magnitude to proteinuria & decreased GFR

86
Q

A RAAS inhibitor is a weak

A

anti-hypertensive agent

87
Q

RAAS inhibitors lead to a reduction in

A

blood pressure by 10-15%

88
Q

If BP > 160 mmHg, dosing for a RAAS inhibitor should be

A

increased until the max dose is reached, then Ca channel blocker added

89
Q

What Ca channel blocker is used when managing hypertension?

A

Amlodipine

90
Q

In dogs, amlodipine will activate what system?

91
Q

When managing hypertension, what are the therapeutic goals?

A

120 mmHg <BP <160 mmHg

92
Q

For a proteinuria patient, what is the dietary management goal?

A

to modify the polyunsaturated fatty acid ratio & protein content

93
Q

For stage I & II dogs, dietary management should consist of…

A

low fat diet & omega-3s

94
Q

50-60% of proteinuric dogs have…

A

immune complex mediated glomerulonephritis

95
Q

Prednisolone increases…

A

proteinuria

96
Q

when might you consider a Bx?

A
  • animal w/ persistent glomerular proteinuria
  • to confirm active immune mediated glomerulonephritis
97
Q

Contraindications for renal biopsy

A

severe azotaemia
hypertension
coagulation disorder
pyelonephritis
hydronephrosis
anaemia

Clinical Reproduction & Urology (29 decks)

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