Renal: Glomerular Disease & UTI's Flashcards
General cause of glomerular disease
Damage to the glomerular filtration barrier and loss of selective permeability
Three primary causes of glomerular disease
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
Cause of secondary glomerular disease
Tubular disease that leads to loss of nephrons
What is the hallmark of glomerular disease?
Persistent renal proteinuria -requires localization (pre, renal, post), persistence (> 3 times for 2 wks apart), and magnitude (UPC > 2.0)
Clinical signs of glomerular disease
- 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
UPC findings of glomerular disease
UPC > 2.0
Is abnormal USG specific to glomerular disease?
NO - can be varied depending on the degree of renal damage
Clin path findings of glomerular disease
- UPC > 2.0
- Varying USG’s
- Casts on urine sediment
- Hypoalbuminemia
- Hypercholesterolemia
- Azotemia
Four components of nephrotic syndrome
1) Hypoproteinemia
2) Hypercholesterolemia
3) Proteinuria
4) Evidence of fluid retention (ascites, edema)
*Incomplete nephrotic syndrome (w/o fluid retention) is more common
Diagnostic work-up for glomerular disease
- 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
True or false - the underlying cause of glomerular disease is usually a common etiology and is found
FALSE
Indications for renal biopsy (4)
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
What are the contraindications for renal biopsy (3)?
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
General therapy of glomerular disease (regardless of etiology) (4)
- 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
Immunosuppressives used with active immune pathology in glomerular disease, with biopsy (3)
1) Mycophenolate - drug of choice (GI side effect)
2) Glucocorticoids - short term for fulminant cases (not for sole tx)
3) Azathioprine
Do we use immunosuppressives in animals that we don’t have renal biopsy info for?
Yes - if they’re being treated and creatinine > 3, progressively azotemic, or severe hypoproteinemia (< 2)
Do we use immunosuppressives with amyloidosis caused glomerular disease?
No
What two medications do we use to treat amyloidosis?
1) Colchicine - anti-inflammatory and anti-fibrotic
2) DMSO - free radical scavenger
What two things do we want to compare when monitoring glomerular disease?
Creatinine along with UPC = may indicate progression of disease
Prognosis of glomeronephritis and amyloidosis
1) Glomerulonephritis = variable, worse if nephrotic or worsening azotemia
2) Amyloidosis = poor
What needs to occur in a urinary tract infection?
The adherence, multiplication, and persistence of VIRULENT microbes within the urinary tract
Where do the majority of urinary tract pathogens come from?
Enteric bacteria that ascend from the distal urogenital gract
True or false - the presence of bacteruria means the patient has a UTI
FALSE - could be contaminants during collection (mid stream collection) or after collection
True or false - you should always treat the patient if you find bacteruria
FALSE
