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CAEM Pt. 2 > Renal: Glomerular Disease & UTI's > Flashcards

Renal: Glomerular Disease & UTI's Flashcards

1
Q

General cause of glomerular disease

A

Damage to the glomerular filtration barrier and loss of selective permeability

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2
Q

Three primary causes of glomerular disease

A

1) Glomerulonephritis from circulating Ag-Ab complexes (associated with inflammatory, immune-mediated, drugs, endocrinopathies, and neoplastic disease)
2) Amyloidosis - usually secondary to tissue injury or chronic inflammation
3) Familial glomerulonephropathies - genetic defects in type IV collagen = abnormal glomerular basement membranes

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3
Q

Cause of secondary glomerular disease

A

Tubular disease that leads to loss of nephrons

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4
Q

What is the hallmark of glomerular disease?

A

Persistent renal proteinuria -requires localization (pre, renal, post), persistence (> 3 times for 2 wks apart), and magnitude (UPC > 2.0)

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5
Q

Clinical signs of glomerular disease

A
  • Non-specific = lethargy, anorexia
  • Signs of inflammatory, immune-mediated, or neoplastic disease
    + Fluid retention = ascites, peripheral edema
    + Thromboembolic disease = neuro signs, loss of limb function, dyspnea
    + Hypertension = retinal hemorrhage or detachment, CNS signs
    + Azotemia = PU/PD, anorexia, vomiting, oral ulcers
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6
Q

UPC findings of glomerular disease

A

UPC > 2.0

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7
Q

Is abnormal USG specific to glomerular disease?

A

NO - can be varied depending on the degree of renal damage

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8
Q

Clin path findings of glomerular disease

A
  • UPC > 2.0
  • Varying USG’s
  • Casts on urine sediment
  • Hypoalbuminemia
  • Hypercholesterolemia
  • Azotemia
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9
Q

Four components of nephrotic syndrome

A

1) Hypoproteinemia
2) Hypercholesterolemia
3) Proteinuria
4) Evidence of fluid retention (ascites, edema)

*Incomplete nephrotic syndrome (w/o fluid retention) is more common

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10
Q

Diagnostic work-up for glomerular disease

A
  • History and PE (retinal, recal exams)
  • BP measurement
  • CBC
  • Chem
  • U/A + sediment
  • UPC
  • Urine culture and sensitivity
  • Infectious disease screening = lyme, heartworm, Ehrlichia, Leishmania
  • Cats = FeLV and FIV
  • Rule out other treatable infections, inflammatory conditions, immune-mediated conditions, neoplastic, or endocrine disorders

UPC > 3.0 = thoracic rads or abdominal U/S (look for infection or neoplasia), more comprehensive infectious disease screening

+/- Renal biopsy

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11
Q

True or false - the underlying cause of glomerular disease is usually a common etiology and is found

A

FALSE

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12
Q

Indications for renal biopsy (4)

A

1) If treatment of concurrent disease fails to significantly decrease proteinuria or makes it worse
2) If standard-of-care treatment doesn’t improve or worsens proteinuria
3) If concurrent disease is not found and UPC > 3.5 (non-azotemic)
4) Need histologic classfication to guide tx and predict prognosis

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13
Q

What are the contraindications for renal biopsy (3)?

A

1) IRIS CKD stage 4 (Cr > 5) = end stage
2) Medical contraindications = coagulopathy, hydronephrosis, uncontrolled hypertension, severe anemia, etc.
3) If the results won’t change treatment or prognosis

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14
Q

General therapy of glomerular disease (regardless of etiology) (4)

A
  • Treat any primary conditions
    1) Inhibit RAAS = ACE-inhibitor, angiotensin II-R blocker, aldosterone-R blocker
    2) Renal diet
    3) Anti-thrombotics, Ex: low-dose aspirin or clopidogrel (Plavixx)
    4) Anti-hypertensive medication - ACE-inhibitor or amlodipine
  • Caution with fluid therapy, prone to fluid retention
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15
Q

Immunosuppressives used with active immune pathology in glomerular disease, with biopsy (3)

A

1) Mycophenolate - drug of choice (GI side effect)
2) Glucocorticoids - short term for fulminant cases (not for sole tx)
3) Azathioprine

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16
Q

Do we use immunosuppressives in animals that we don’t have renal biopsy info for?

A

Yes - if they’re being treated and creatinine > 3, progressively azotemic, or severe hypoproteinemia (< 2)

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17
Q

Do we use immunosuppressives with amyloidosis caused glomerular disease?

A

No

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18
Q

What two medications do we use to treat amyloidosis?

A

1) Colchicine - anti-inflammatory and anti-fibrotic

2) DMSO - free radical scavenger

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19
Q

What two things do we want to compare when monitoring glomerular disease?

A

Creatinine along with UPC = may indicate progression of disease

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20
Q

Prognosis of glomeronephritis and amyloidosis

A

1) Glomerulonephritis = variable, worse if nephrotic or worsening azotemia
2) Amyloidosis = poor

21
Q

What needs to occur in a urinary tract infection?

A

The adherence, multiplication, and persistence of VIRULENT microbes within the urinary tract

22
Q

Where do the majority of urinary tract pathogens come from?

A

Enteric bacteria that ascend from the distal urogenital gract

23
Q

True or false - the presence of bacteruria means the patient has a UTI

A

FALSE - could be contaminants during collection (mid stream collection) or after collection

24
Q

True or false - you should always treat the patient if you find bacteruria

A

FALSE

25
Q

Do we always treat asymptomatic bacteruria?

A

> > Controversial
+ Presence of non-virulent strains may outcompete virulent strains
- Bacteria colonizing the bladder could lead to pyelonephritis if no treated

26
Q

What does a patient, suspected of having a UTI, who is showing systemic signs indicate?

A
  • Likely not a simple UTI of the bladder or urethra

* Infection of the prostate or kidney

27
Q

An animal is showing lower urinary tract infection signs, what are other possible diagnoses? (3)

A
  • Feline idiopathic cystitis
  • Urolithiasis
  • Neoplasia
  • Etc.
28
Q

Clinical signs of lower urinary tract infections (bladder, urethra)

A 
\+ Pollakiuria = small and frequent amounts
\+ Stranguria
\+ Dysuria = painful
\+ Inappropriate elimination
\+ Small, painful bladder
\+ Pain on caudal abdominal palpation
\+ Hematuria, esp at the end of micturition
\+ Cloudy urine with color
29
Q

Clinical signs of a renal infection

A 
\+ No signs
\+ Lumbar pain
\+ Hematuria
\+ Azotemia
\+ PU/PD
***Systemic inflammatory response = fever, lethargy, weight loss
\+ Slightly enlarged kidneys
30
Q

Clinical signs of prostatic infection

A 
\+ Pain on rectal palpation
\+ Enlarged prostate
\+ Hematuria
\+ Fever
\+ Tenesmus
\+ Recurrent UTI's
31
Q

Diagnostic tests for UTI’s (4)

A

1) Urine collection, ideally via cystocentesis
2) Urinalysis = urine dipstick for presence of hematuria/proteinuria, urine sediment for bacteriuria, pyuria, hematuria, and USG
3) Urine culture
4) Sensitivity culture

32
Q

Does urine pH help us diagnose UTI’s?

A

Non-specific, but a pH > 7.5 may indicate the presence of urease-producing bacteria

33
Q

What should you do before you send out urine for culture?

A

Look under a microscope to determine if there are bacteria or WBC’s in the urine sediment

34
Q

How long does it take for urine cultures to grow?

A

18-24 hours

35
Q

What does Kirby-Bauer sensitivity testing measure?

A

The concentration of antibiotics achievable in serum/tissue, NOT urine, and it’s ability to neutralize urine culture bacteria

36
Q

What does the measurement based off of serum/tissue concentration in urine C&S mean for UTI’s?

A

Some organisms that appear resistant may actually be susceptible to the higher concentrations that are achievable in the urine

37
Q

Comparison of the MIC and MUC for treatment of UTI’s

A
  • MIC = lowest concentration of antibiotic that would be effective for treating an infection
  • MUC = mean urinary concentration achieved after drug admin
    » Compare = ideal antibiotic is an MUC that is 4x the MIC to be effective
38
Q

Role of chronic kidney disease, urine concentrating ability, and MUC

A

Those with CKD can’t adequately concentrate their urine = may not be able to achieve the reported MUC

39
Q

What must we consider when treating prostatic and renal infections with the MIC?

A

Must use doses based off of plasma concentrations, not MUC

40
Q

What is an uncomplicated UTI?

A

Simple UTI = bladder infection that occurs no greater than once every 6 months in an otherwise healthy dog, with normal urinary tract anatomy and function

*Easy to eradicate

41
Q

What is a complicated UTI?

A

An infection that occurs because the animal has a breach in the normal defenses or the infection has spread to a tissue where infection is difficult to eradicate (kidney, prostate)

42
Q

Why are females at higher risk for UTI than males? (3)

A
  • Urethral opening is close to the anus = high potential for fecal contamination
  • Shorter in length = shorter distance for bacteria to travel
  • Commonly incontinent = weaker sphincter defense mechanism, pooling of urine
43
Q

What role do glycosaminoglycans play in UTI’s?

A
  • Normal = prevent bacterial adherence to the underlying urothelium
  • Trauma to the urothelium caused by uroliths, urethral catheterization, and some drugs may disrupt the GAG layer = increase the risk for UTI’s
44
Q

What diagnostic tests may be helpful in identifying a complicated UTI? (3)

A
  • CBC
  • Chem panel
  • Diagnostic imaging = rads, abdominal U/S, cystoscopy
45
Q

How do we treat uncomplicated UTI’s?

A

Start treating with empirical antibiotics (ampicillin derivatives) usually suffices, for 10-14 days

46
Q

How quickly should you see resolution of clinical signs, if you are properly treating a UTI?

A

24-48 hours

47
Q

How do we treat complicated UTI’s?

A

1) Treat empirically before C&S results come back
2) Treat specifically based on C&S results for 4-6 weeks
3) Re-culture 5-7 days after discontinuing therapy to ensure the infection had cleared

48
Q

What bacterial and fungal pathogen should be suspected if the animal doesn’t respond to traditional UTI therapy?

A

Mycoplasma and Candida

CAEM Pt. 2 (27 decks)

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