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Small Animal Medicine > Renal - Glomerular and Tubular Diseases > Flashcards

Renal - Glomerular and Tubular Diseases Flashcards

1
Q

Where are the 2 sites of possible renal protein loss?

A

The glomerulus and proximal renal tubule

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2
Q

What are the three layers of the glomerulus?

A

Capillary endothelium, glomerular basement membrane, and visceral epithelium (podocytes)

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3
Q

What size molecules and cells does the glomerulus exlude?

A

proteins > 67 kDa from the ultrafiltrate

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4
Q

What can unchecked proteinuria lead to?

A

Hypoalbuminemia, thromboembolism, and decreased nephron lifespan

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5
Q

At what age of onset do dogs get proteinuria?

A

Middle/old age. If the patient is younger, consider a familial glomerular disorder

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6
Q

Is proteinuria more common in dogs or cats?

A

dogs - it is rare in cats

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7
Q

What clinical signs are associated with mild gomerular disease?

A

azotemia

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8
Q

What clinical signs are associated with late proteinuria?

A

edema/effusion, thromboembolism, and organ damage

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9
Q

What will you find on CBC in a patient with proteinuria?

A

You may have anemia

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10
Q

What may you find on a chemistry in patients with proteinuria?

A

Hypoalbuminemia, +/- signs of decreased renal function (+/- azotemia, +/- hyperphosphatemia), and +/- metabolic acidosis

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11
Q

Will USG be affected by proteinuria?

A

Unlikely - the concentration ability is often intact

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12
Q

What may you find on urine sediment in a patient with proteinuria?

A

casts

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13
Q

What is the most common fist step to diagnosing proteinuria?

A

Urine dipstick

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14
Q

What is the most quantitative test for proteinuria?

A

UPC ratio - it will correlate with daily protein loss

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15
Q

What is the approach to proteinuric patients?

A

Confirm if the proteinuria is persistent or transient. Once persistency is confirmed then screen for underlying disease. Finally do a renal biopsy

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16
Q

What are the causes of transient proteinuria?

A

Fever, physical exertion, and seizure

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17
Q

What criteria does there need to be for proteinuria to be considered persistent?

A

It needs to be confirmed in 3-4 instances over 2-3 weeks

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18
Q

What screening tests can be done for underlying disease/cause of proteinuria?

A

PE (fundic exam!), CBC/Chem/UA, blood pressure, urine culture, imaging, vector-borne disease testing, and endocrine testing

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19
Q

What is the purpose of a renal biopsy in proteinuric patients?

A

To allow for definitive histopathological diagnosis

20
Q

What are the indications for renal biopsies?

A

Lack of response to standard therapy, UPC >3.5, and if you are considdering immunosuppresion

21
Q

What are the contra-indications for renal biopsies?

A

Underlying disease identified/treated, uncontrolled hypertension, coagulopathy, and end-stage CKD (stage 4)

22
Q

What are the differentials for glomerular disease?

A

Membranoproliferative glomerulonephritis (MGPN), membranous nephropathy, proliferative glomerulonephritis, immunoglobulin A nephropathy, amyloidosis, glomerulosclerosis, other non-IC glomerulopathies, non-IC glomerulopathies, and tubular diseases

23
Q

What accounts for 50% of cases of canine glomerular disease?

A

ICGN - immune-complex glomerulonephritis

24
Q

What is ICGN more likely to respond to?

A

immunosuppression

25
Q

How is glomerular disease managed?

A

Monitoring and treatment of underlying disorder, reduction and proteinuria, management of decreased renal function and other consequences, +/- immunosuppression

26
Q

How can proteinuria be reduced nutritionally?

A

Decrease dietary protein (25-50%) and omega-3 fatty acid supplementation

27
Q

How can proteinuria be reduced pharmaceutically?

A

Modulation of RAAS pathway with ace inhibitors or angiotensin receptor blockers

28
Q

How is hypercoagulability managed in proteinuric patients?

A

The use of platelet inhibitors - Clopidogrel and Aspirin

29
Q

What drug is used to manage hypertesion in proteinuric patients?

A

Amlodipine

30
Q

Aside from hypercoagulability and hypertension, what other consequences of decreased renal function need to be managed?

A

Phosphorus intake, anemia, metabolic acidosis, and gastrointestinal manifestations

31
Q

When is immunosuppression indicated in proteinuric patients?

A

If there is a lack of response to standard therapy

32
Q

When should proteinuria be monitored?

A

1-2 weeks after a new therapy has been initiated or after initiating a new therapy

33
Q

Since UPC varies day-to-day, how often should samples be collected during monitoring?

A

Samples over 2-4 days

34
Q

What side effects are associated with ACEi and ARBs?

A

Excessive drop in blood pressure and GFR

35
Q

What is nephrotic syndrome?

A

A syndrome associated with 4 concurrent findings

36
Q

What are the 4 concurrent findings associated with nephrotic syndrome?

A

Proteinuria, hypoalbuminemia, hypercholesterolemia, and edema/effusion

37
Q

What is the prognosis of proteinuric patients?

A

It varies - some cases can have long survival with appropriate control of disease

38
Q

What conditions of proteinuria have a poorer prognosis?

A

Amyloidosis, Nephrotic syndrome, and concurrent azotemia

39
Q

Fanconi’s syndrome is associated with an abnormal presence of certain metabolies in urine. What are the?

A

Glucose, amino acids, proteins, phosphate, and bicarbonate

40
Q

What breed is the inherited form of Fanconi’s syndrome most common in?

A

Basenjis

41
Q

What type of gene is the inherited form of Fanconi’s syndrome?

A

autosomal recessive

42
Q

What can cause the acquired form of Fanconi’s syndrome?

A

Medications, labradors with copper hepatopathies, and chicken jerky treats

43
Q

How is fanconi’s syndrome diagnosed?

A

Concurrent normoglycemia with glucosuria, proteinuria, amino aciduria, hypokalemia/phosphatemia, and metabolic acidosis

44
Q

How is Fanconi’s syndrome treated?

A

Discontinuation of trigger (acquired) and supportive care

45
Q

What supportive care can help in Fanconi’s syndrome patients?

A

Correction of electrolyte and acid/base abnormalities, IV/SQ fluid support

46
Q

What is the prognosis of Fanconi’s syndrome?

A

Variable - inherited have a survival time of 5-6 mean survival after diagnosis and aquired can have spontaneous return to normal tubular function is possible

Small Animal Medicine (100 decks)

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