Serology positive glomerular disease Flashcards
What infections are associated with glomerular disease?
Although any infection can be causally associated with glomerular diseases, infections with Borrelia burgdorferi and Leishmania in dogs are especially problematic because of the seemingly common association of these infections with proteinuric conditions
HOWEVER many pets become serology positive without glomerular disease.
Others: A. phagocytophilum, A platys, E. canis, Bartonella, various babesia spp. Brucella canis, Hepatazoon americanum, leptospirosis, Mycoplasma, rikettsia
how can you increase your ability to tell if an organism is related to the glomerular disease, aside from serology?
Renal histopathology
if lesions characteristic for the disease are identified in the biopsy, but this too cannot prove a cause–effect relationship unless agent‐specific antigens associated with active immune deposits in glomerular lesions are proven to be from the infectious agent
Currently this testing is not available clinically
What should you do for the Management of Glomerular Disease in Dogs with Serologic Positive Test Results for an Infectious Agent without the Results of a Renal Biopsy or before Obtaining Results of a Renal Biopsy
assume that there is a role for the infectious agent in the origin of glomerular injury until proven otherwise.
How should you manage clinically stable dogs without azotemia, progressive increases in serum creatinine or UPC, or clinical consequences associated with their proteinuria?
managed initially only with specific anti‐infective treatment against the suspected infectious agent plus Standard Treatment for glomerular disease.
What should you do for seropositive dogs that are azotemic (IRIS CKD Stage II or greater), or have progressive nonazotemic (IRIS AKI Grade I) to azotemic (IRIS AKI Grade II or greater) increases in serum creatinine, or have evidence of rapidly progressive glomerular disease based on clinical and/or laboratory assessments?
(1) A thorough search for possible geographic‐specific coinfections (eg, for Babesia microti‐like infection in Spain).
(2) A renal biopsy evaluated by a nephropathologist using appropriate light, immunofluorescent, and electron microscopic imagingc to support potential intervention with immunosuppressive treatment.
(3) In the absence of a renal biopsy, immunosuppressive treatment should be considered to manage potential immune causes of the glomerular injury.
What dhould be done if the results of renal biopsy document an active immune component to the glomerular disease?
appropriate immunosuppressive treatment is indicated.
At this stage, the glomerular disease should be considered as having an immune‐mediated component, and not infectious alone, and it is not likely to respond merely to anti‐infective treatment and irradiation of the infection if severe or progressive.
