Proteinuria

Question 1

quantification of proteinuria

Answer 1

dip stick
sulphosalicyic acid test
24h protein loss
protein creatinine ratio
protein electrophoresis

Question 2

dip stick

Answer 2

qualitative
cheap, convenient
false -ves + +ves occur

Question 3

protein creatinine ratio

Answer 3

practical for routine use

widely available

Question 4

site of origin

Answer 4

pre-glomerular
glomerular
tubular
post-globerular

Question 5

mechanisms of renal proteinurea

Answer 5

loss of filter size barrier - large proteins get into filtrate
proximal tubular dysfunction - lack of resorption of protein

Question 6

pre-glomerular proteinuria - functional

Answer 6

fever

exercise

Question 7

pre-glomerular proteinuria - overload

Answer 7

small proteins
immunoglobulin light chains
haemoglobin
myoglobin

Question 8

post-glomerular proteinuria - lower urinary tract - causes

Answer 8

haemorrhage
infl/infection
neoplasia

Question 9

effect of UTI

Answer 9

variable + hard to predict

UTI should be ruled out before investigating glomerular cause

Question 10

gross proteinuria - effects

Answer 10

marker of glomerular disease
may lead to nephrotic syndrome
causes protein loosing nephropathy (PLN)
needs treatment

Question 11

micro-proteinuria

Answer 11

marker of glomerular hypertension
not direct clinical signs
needs investigation

Question 12

when to suspect PLN

Answer 12

hypoalbuminemia
renal failure
clinical signs

Question 13

glomerular disease

Answer 13

gross proteinuria is hallmark
glomerulonephritis
amyloidosis
familial glomerulonephropathies

Question 14

nephrotic syndrome - effects

Answer 14

hypoalbuminemia
proteinuria
hyperlipidaemia
oedema
azotaemia

Question 15

nephrotic syndrome - clinical signs

Answer 15

muscle wasting
renal failure
hypertension
thromboembolism

Question 16

nephrotic syndrome - diagnostic plan

Answer 16

CBC/chemistry
imaging
serology
CSF/joint taps
Felf/FIV
specialised tests

Question 17

diagnostic plan in all proteinuric patients

Answer 17

urea/creatinine/usg
albumin/cholesterol
urine culture
blood pressure
fundic exam
clotting function

Question 18

renal biopsy - pro’s

Answer 18

characterise the disease

prognostic

Question 19

renal biopsy - con’s

Answer 19

haemorrhage
renal injury
expense
complications in 13% dogs + 18% cats

Question 20

renal biopsy

Answer 20

u/s guided or surgical wedge biopsy

cortical tissue

Question 21

glomerulonephritis (GN)

Answer 21

immune mediated disorder
deposited pre-formed antigen-antibody complexes
infiltration of infl cells, complement activation, cytokine release etc.

Question 22

GN - remove inciting cause

Answer 22

eliminate antigenic source
often no cause can be identified
removal may not be possible

Question 23

immunosuppression

Answer 23

glucocorticoids?? - use only if is to treat underlying disease/if biopsy confirms immune-mediated disease

Question 24

amyloidosis

Answer 24

extra-cellular deposition of insoluble fibrillar proteins in tissues
compromise organ function

Question 25

pathophysiology - reactive systemic amyloidosis

Answer 25

infl/tissue injury serum amyloid A protein (SAA) - usually converted to other protein which can be broken down but instead converted to insoluble AA amyloid

Question 26

amyloidosis - dogs

Answer 26

mid-old age females more deposition may be non-glomerular

Question 27

amyloidosis - cats

Answer 27

mid-old age | breed linked

Question 28

specific therapy - amyloidosis

Answer 28

no therapy to dissolve AA amyloid | colchicine - not helpful if in RF, may worsen clinical signs, give if animal at high risk of amyloidosis

Question 29

familial glomerulopathies

Answer 29

young dogs no specific treatments hereditary nephritis

Question 30

non-specic treatment glomerular disease

Answer 30

diet - protein high quality + restricted | ACE inhibition - dogs with idiopathic GN

Question 31

anti-thrombotic therapy

Answer 31

aspirin

Question 32

anti-hypertensive therapy

Answer 32

ACE inhibition | can give amlodipine if BP high

Question 33

oedema/ascites - treatment

Answer 33

``` sodium restriction thoracocentesis abdominocentesis plasma transfusion diuretics - avoid if possible ```

Question 34

prognosis

Answer 34

``` variable often progressive remission + recovery occasionally seen worse if azotaemic poor if have nephrotic syndrome ```