Proteinuria Flashcards
Function of the glomerulus
Functions as a filter and forms the ultrafiltrate
Charge of the glyoproteins on the basement membrane of the glomerulus?
Negative
The basement membrane of the glomerulus limits proteins of what size?
65,000 Da
From a general standpoint, what does proteinuria indicate (3 points)?
- glomeruluar permeability
- tubular-interstitial dysfunction
- disease/condition in the body
General Dfdx for proteinuria
Kidney Disease Hyperadrenocorticism Neoplasia Immune Mediated Infectious Disease
3 Sequelae of proteinuria
Progression of kidney disease
Possible thromboembolic events
Hypertension
3 general assessments of proteinuria
Localization
Persistence
Magnitude
Cause of pre-renal proteinuria
abnormal proteins in the plasma (myoglobin, hemoglobin, immunoglobin light chanis)
-must assess plasma protein concentration
Categories of renal proteinuria
Functional and Pathological
Functional renal proteinuria
Transient - due to exercise, stress, etc.
Pathological renal proteinuria
Structure abnormalities
Two possible locations for lesions in cases of post-renal proteinuria
urinary (bladder, urethra, etc.)
extraurinary (genital tract)
How do you exclude extra-renal causes of proteinuria?
Do cystocentesis
How to monitor proteinuria over time?
Serial values (day to day) OR collect 3 samples over 2 weeks
Limitations of the urine dipstick
Only semi-quantitative, can get false results with alkaline urine, sediment is active, contact with the strip is too long
What is an abnormal value for UPC?
> 0.3
What is the significance of microalbuminuria?
a manifestation of endothelial cell injury; present prior to elevated urine protein
When should one monitor the UPC?
- When a patient is non-azotemic with steady microalbuminemia
- non azotemic with a UPC greater than >.5
When should one perform kidney diagnostics to determine cause?
- non azotemic with RISING microalbuminemia
2. Non-azotemic with a UPC greater than 1
When should one therapeutically intervene?
Dogs with CKD and UPC of >.5
Cats with CKD and UPC > .4
Non-azotemic patients with a UPC greater than 2
What do ACE inhibitors do?
Decreases arterial resistance, preferential efferent arteriole dilation, decreases aldosterone secretion
What does Angiotensin II receptor blockers do?
Inhibits the RAS pathway at the level of Angiotensin II
Drugs to treat proteinuria?
ACE inhibitors, angiotensin II blockers, Omega 3 fatty acids (reduces platelet activity), Clopidigrel, amilodipine (systemic hypertension)
Why do clotting abnormalities occur with CKD?
antithrombin is lost in the urine
