Proteinuria

Question 1

Function of the glomerulus

Answer 1

Functions as a filter and forms the ultrafiltrate

Question 2

Charge of the glyoproteins on the basement membrane of the glomerulus?

Answer 2

Negative

Question 3

The basement membrane of the glomerulus limits proteins of what size?

Answer 3

65,000 Da

Question 4

From a general standpoint, what does proteinuria indicate (3 points)?

Answer 4

1. glomeruluar permeability
2. tubular-interstitial dysfunction
3. disease/condition in the body

Question 5

General Dfdx for proteinuria

Answer 5

Kidney Disease
Hyperadrenocorticism
Neoplasia
Immune Mediated 
Infectious Disease

Question 6

3 Sequelae of proteinuria

Answer 6

Progression of kidney disease
Possible thromboembolic events
Hypertension

Question 7

3 general assessments of proteinuria

Answer 7

Localization
Persistence
Magnitude

Question 8

Cause of pre-renal proteinuria

Answer 8

abnormal proteins in the plasma (myoglobin, hemoglobin, immunoglobin light chanis)
-must assess plasma protein concentration

Question 9

Categories of renal proteinuria

Answer 9

Functional and Pathological

Question 10

Functional renal proteinuria

Answer 10

Transient - due to exercise, stress, etc.

Question 11

Pathological renal proteinuria

Answer 11

Structure abnormalities

Question 12

Two possible locations for lesions in cases of post-renal proteinuria

Answer 12

urinary (bladder, urethra, etc.)

extraurinary (genital tract)

Question 13

How do you exclude extra-renal causes of proteinuria?

Answer 13

Do cystocentesis

Question 14

How to monitor proteinuria over time?

Answer 14

Serial values (day to day) OR collect 3 samples over 2 weeks

Question 15

Limitations of the urine dipstick

Answer 15

Only semi-quantitative, can get false results with alkaline urine, sediment is active, contact with the strip is too long

Question 16

What is an abnormal value for UPC?

Answer 16

> 0.3

Question 17

What is the significance of microalbuminuria?

Answer 17

a manifestation of endothelial cell injury; present prior to elevated urine protein

Question 18

When should one monitor the UPC?

Answer 18

1. When a patient is non-azotemic with steady microalbuminemia
2. non azotemic with a UPC greater than >.5

Question 19

When should one perform kidney diagnostics to determine cause?

Answer 19

1. non azotemic with RISING microalbuminemia

2. Non-azotemic with a UPC greater than 1

Question 20

When should one therapeutically intervene?

Answer 20

Dogs with CKD and UPC of >.5
Cats with CKD and UPC > .4
Non-azotemic patients with a UPC greater than 2

Question 21

What do ACE inhibitors do?

Answer 21

Decreases arterial resistance, preferential efferent arteriole dilation, decreases aldosterone secretion

Question 22

What does Angiotensin II receptor blockers do?

Answer 22

Inhibits the RAS pathway at the level of Angiotensin II

Question 23

Drugs to treat proteinuria?

Answer 23

ACE inhibitors, angiotensin II blockers, Omega 3 fatty acids (reduces platelet activity), Clopidigrel, amilodipine (systemic hypertension)

Question 24

Why do clotting abnormalities occur with CKD?

Answer 24

antithrombin is lost in the urine

Question 25

test

Answer 25

cat