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Renal > Proteinuria > Flashcards

Proteinuria Flashcards

1
Q

quantification of proteinuria

A 
dip stick
sulphosalicyic acid test
24h protein loss
protein creatinine ratio
protein electrophoresis
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2
Q

dip stick

A

qualitative
cheap, convenient
false -ves + +ves occur

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3
Q

protein creatinine ratio

A

practical for routine use

widely available

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4
Q

site of origin

A

pre-glomerular
glomerular
tubular
post-globerular

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5
Q

mechanisms of renal proteinurea

A

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

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6
Q

pre-glomerular proteinuria - functional

A

fever

exercise

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7
Q

pre-glomerular proteinuria - overload

A

small proteins
immunoglobulin light chains
haemoglobin
myoglobin

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8
Q

post-glomerular proteinuria - lower urinary tract - causes

A

haemorrhage
infl/infection
neoplasia

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9
Q

effect of UTI

A

variable + hard to predict

UTI should be ruled out before investigating glomerular cause

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10
Q

gross proteinuria - effects

A

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

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11
Q

micro-proteinuria

A

marker of glomerular hypertension
not direct clinical signs
needs investigation

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12
Q

when to suspect PLN

A

hypoalbuminemia
renal failure
clinical signs

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13
Q

glomerular disease

A

gross proteinuria is hallmark
glomerulonephritis
amyloidosis
familial glomerulonephropathies

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14
Q

nephrotic syndrome - effects

A 
hypoalbuminemia
proteinuria
hyperlipidaemia
oedema
azotaemia
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15
Q

nephrotic syndrome - clinical signs

A

muscle wasting
renal failure
hypertension
thromboembolism

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16
Q

nephrotic syndrome - diagnostic plan

A 
CBC/chemistry
imaging
serology
CSF/joint taps
Felf/FIV
specialised tests
17
Q

diagnostic plan in all proteinuric patients

A 
urea/creatinine/usg
albumin/cholesterol
urine culture
blood pressure
fundic exam
clotting function
18
Q

renal biopsy - pro’s

A

characterise the disease

prognostic

19
Q

renal biopsy - con’s

A

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

20
Q

renal biopsy

A

u/s guided or surgical wedge biopsy

cortical tissue

21
Q

glomerulonephritis (GN)

A

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

22
Q

GN - remove inciting cause

A

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

23
Q

immunosuppression

A

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

24
Q

amyloidosis

A

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

25
Q

pathophysiology - reactive systemic amyloidosis

A

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

26
Q

amyloidosis - dogs

A

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

27
Q

amyloidosis - cats

A

mid-old age

breed linked

28
Q

specific therapy - amyloidosis

A

no therapy to dissolve AA amyloid

colchicine - not helpful if in RF, may worsen clinical signs, give if animal at high risk of amyloidosis

29
Q

familial glomerulopathies

A

young dogs
no specific treatments
hereditary nephritis

30
Q

non-specic treatment glomerular disease

A

diet - protein high quality + restricted

ACE inhibition - dogs with idiopathic GN

31
Q

anti-thrombotic therapy

A

aspirin

32
Q

anti-hypertensive therapy

A

ACE inhibition

can give amlodipine if BP high

33
Q

oedema/ascites - treatment

A 
sodium restriction
thoracocentesis
abdominocentesis
plasma transfusion
diuretics - avoid if possible
34
Q

prognosis

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

Renal (13 decks)

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