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A - Medicine Urology > Proteinuria and protein losing nephropathies > Flashcards

Proteinuria and protein losing nephropathies Flashcards

1
Q

What is proteinuria?

A

Excessive protein in the urine

Proteinuria = hyperproteinuria

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2
Q

What is albuminuria?

A

Excessive albumin in the urine

Albuminuria = Hyperalbuminuria

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3
Q

What is overt proteinuria?

A

Dipstick detectable excessive protein in the urine

Generally Over 0.3g/L

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4
Q

What is microalbuminuria?

A

Mildly excessive albumin the urine
It is higher than normal, but still below limit of detection of most conventional urine dipsticks
0.01 - 0.3 g/L

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5
Q

What are some causes of false positives and negatives when using urine dispticks?

A

False Positives

  • Antiseptic contamination
  • Damp reagent strips
  • Very alkaline or very concentrated urine

False negatives
-Not sensitive for detection of proteins other than albumin

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6
Q

What urine protein:creatinine ratio is normal and abnormal?

UP:UC

A 
Normal 
-Dogs and cats under 0.2
Definitely abnormal 
Dogs over 0.5
Cats over 0.4
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7
Q

Why is using the UP:UC more accurate?

A

Because it takes away the amount the animal is drinking out of the equation

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8
Q

What are the 3 categories of proteinuria?

A

Preglomerular
Glomerular
Postglomerular

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9
Q

What are 5 differential diagnosis for preglomerular proteinuria?

A 
Multiple myeloma
Leukaemias 
B-cell lymphoma
Haemolytic crisis
Rhabdomyolysis
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10
Q

What are 5 differential diagnosis for glomerular proteinuria?

A

Glomerulonephritis**
Hereditary nephropathies
Amyloidosis
Other glomerulopathies

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11
Q

What are 6 differential diagnosis for tubular proteinuria?

A 
Drug toxicities
-NSAID, aminoglycosides
Pyelonephritis
Heavy metal poisoning
Acute tubular necrosis
Fanconi syndrom
Vesicuoureteral reflux
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12
Q

What are the categories for differential diagnosis of post renal proteinuria?

A

Lower urinary tract disease
-Infection, inflammation, calculi, neoplasia

Genital inflammation/infection

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13
Q

Once a patient has tested positive for proteinuria by dipstick, using free catch or catheter, what should you do next?

A

Repeat it by cystocentesis

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14
Q

If a patient has tested positive to proteinuria by cystocentesis using a dipstick, what should you then do?

A

Look at the sediment

-If active or inactive

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15
Q

What is an active urine sediment, and what should you look at next?

A

Has lots of cells and other sediment in it

-Look at lower urinary tract or tubular disease

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16
Q

What is an inactive urine sediment, and what should you look at next?

A

Not many cells or anything that interesting in it

-Look at serum chemistry and UP:UC

17
Q

The more severe the UP:UC is, what is more likely the cause?

A 
Mild under 2.0
-Mild glomerular, tubular, functional
Moderate 2.0-5.0
-Glomerular, tubular
Severe over 5.0
-Glomerular
18
Q

Why is it important to diagnose glomerulonephritis?

A

To try and stop it progressing to renal failure , nephrotic syndrome and other adverse outcomes

19
Q

If you find preglomerular proteinuria, what should you look for?

A

Dysporteinaemia

-Abnormal protein in blood

20
Q

If you find glomerular proteinuria, what should you then look for?

A 
Hypoalbuminaemia
Hypercholestrolaemia
High UP:UC 
Oedema
Inactive urine sediment
21
Q

Explain how a bacterial infection such as an incisor tooth root abscess could lead to polyarthritis, a UP:UC of 15, but an inactive urine sediment and concentrated urine still?

A 
Bacteria present
Start to die
They go into circulation 
Immune system responds
Forms Ab-Ag complexes 
These lodge into joints and the basement membrane of the kidneys
22
Q

Describe the pathophysiology of nephrotic syndrome?

A 
Starts with proteinuria
This leads to hypoalbuminaemia
Drop in blood oncotic pressure
Body tries to increase pressure 
Get hypercholestrolaemia 
Peripheral oedema/ascites
-But may not see it 
Lipiduria - uncommon
23
Q

How can you definitively diagnose glomerulonephritis?

A

Evidence of glomerular proteinuria

Renal biopsy

24
Q

Is it always important to get a definitive diagnosis?

A

No
Sometimes only need to have a rough idea
Especially true if you can only definitively diagnose by an invasive test like a biopsy
Only diagnose if it will change how they will be treated

25
Q

Describe treatment of glomerulonephritis?

A 
Want to attempt to identify and eradicate any underlying cause 
ACE inhibitor*
High quality protein restricted food
Anti-platelet therapy 
-E.g. low dose aspirin 
\+/- other antihypertensive drugs 
Omega-3 fatty acids
-Anti-inflammatory 
\+/- Immunosuppressant therapy 
-E.g. Azathioprine
\+/- anti-edema therapy if required
-Frusemid, NOT prednisolone
26
Q

Why when treating glomerulonephritis you should give an ACE inhibitor?

A

Post-glomerular arteriole is controlled by smooth muscle
The tighter it is, the higher the glomerular pressure and more protein is likely to leak out
ACE inhibitor relaxes this smooth muscle, which means that less protein leaks out and you get an increase in creatinine

27
Q

What is the main cause of renal amyloidosis?

A

Idiopathic

28
Q

What 2 breeds is renal amyloidosis a familial disease?

A

Chinese Shar-pei
Abysinnian cats

-In the renal medulla more than the glomeruli (upset architecture)

29
Q

How do you treat renal amyloidosis?

A

Same as for glomerulonephritis

  • Except maybe
  • DMSO S/C x3/week
  • Colchicine -makes them sick
30
Q

What are the 4 major complications of glomerular proteinuria?

A

Renal failure
Hypercoagulable state
Thromboembolism
Systemic arterial hypertension

31
Q

Do you get PU/PD from glomerular proteinuria?

A

NO

-You are loosing albumin and damaging renal tubules

32
Q

How does glomerular proteinuria lead to a hypercoagulable state?

A

Leaks small protein and antithrombin III

-Becomes out of balance

33
Q

What is the most likely place a thromboembolism will form as a result of glomerular proteinuria?

A

Pulmonary

A - Medicine Urology (5 decks)

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