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Renal > Proteinuria > Flashcards

Proteinuria Flashcards

1
Q

How is proteinuria most commonly quantified?

A

Dipstick

Protein-creatinine ratio

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2
Q

What are the advantages/disadvantages of using a dipstick to quantify proteinuria?

A

+ Cheap
+ Convenient
- Must consider with USG
- Only useful in identifying severe proteinuria

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3
Q

What is the UPC?

A

Urine protein:creatinine ratio

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4
Q

How does the IRIS system categorise different UPCs into levels of proteinuria? What else must be considered?

A

<0.2 (D+C) - Non-proteinuric
0.2 to 0.4 (C)/ 0.5 (D) - Borderline
>0.4(C)/0.5(D) - Proteinurici

Must consider creatinine conc and BP

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5
Q

Define proteinuria. Why are only small levels of protein found in the urine normally?

A

Pathological increase of protein present in the urine.

Large proteins cannot pass through glomerular filter
Glomeruli are negatively charged with repel anionic proteins
Majority of filtered proteins are reabsorbed in PT

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6
Q

The presence of which protein in the urine is always abnormal? And why?

A

Globulin

V large protein and thus glomerular filter must be distrupted

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7
Q

What urinary tract diseases can cause proteinuria and should be ruled out before investigating the kidneys?

A

Infection
Inflammation
Neoplasia
Haemorrhage

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8
Q

Why should you be careful not to over interpret the UPC value?

A

UPCs fluctuate normally

Severe decrease in functioning nephrons -> Fall in UPC

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9
Q

Outline the 4 types of proteinuria and their causes…

A

Pre-glomerular - increased small proteins presented to glomerular filter

Glomerular - increased capillary pressure > proteins forced through barrier

Tubular - decreased resorption of proteins in tubules

Post-glomerular - inflam/haemorrhage/neoplasia contaminates blood/urine with proteins

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10
Q

What can cause glomerular proteinuria?

A

Glomerulonephritis
Amyloidosis
Familial glomerulopathise

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11
Q

Outline the pathophysiology of glomerulonephritis…

A

Circulating ag-ab complexes form or get trapped in the glomerulus > cellular proliferation and thickening of the glomerular basement membrane > Hyalinisation and sclerosis > nephron destruction and renal failure

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12
Q

Outline the pathogenesis of amyloidosis

Which species/breeds are predisposed?

A

Chronic inflammation or neoplasia > serum amyloid A produced > insoluble so desposits in renal tissue > renal failure or NS

Chinese Shar-Pei dog
Abyssinian cat

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13
Q

Can blood in the urine contaminate protein level readings?

A

Yes but contamination must be v severe to alter UPC

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14
Q

What UPC value is considered gross proteinuria which can be caused by primary glomerular disease (PLN)?

A

> 3

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15
Q

What are DDx with:
Low alb alone?
Low alb and glob?

A

Low alb
Liver failure
HypoAC
PLN

Low alb and glob
PLE
Haemorrhage

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16
Q

What are clin signs of PLN?

A 
Proteinuria
Hypoalb, hyperchol
Ascites, pleural effusion
Inappetance, depression, Exercise intolerance
Thromboembolism
Hypertension
Signs of underlying disease
Muscle wasting, wt loss
\+/- azotaemia
17
Q

Why can thromboembolism occur with PLN?

A

Anti-thrombin is lost with albumin

18
Q

What diagnostic test should be carried out in all patients with proteinuria?

A 
Urea, creatinine, USG
Albumin, chol
Urine culture
Blood pressure
Fundic exam
19
Q

How can glomerular disease be distinguished? What should be ruled out before this?

A

Renal biopsy

Familial amyloidosis or glomerulonephropathies

20
Q

Which breeds suffer from hereditary nephritis? What is the defect? How is it prevent?

A

English Cocker Spaniels
Defect in type IV collage of the basement membrane of glomerular filter
Genetic tests

21
Q

What should be a DDx of proteinuria if the dog has travelled to the Med?

A

Leishmania

Lyme’s disease

22
Q

What are possible iatrogenic causes of proteinuria?

A

Steroids
Sulphonamides
Tyrosine kinase inhibitors

23
Q

What dietary changes can slow progression of proteinuria?

A

Mild-mod protein restriction
Good quality protein
Omega-3 fatty acid supplementation
Na restriction

24
Q

Which class of drugs is indicated in all patients with gross proteinuria?

A

ACEi

25
Q

What role do low doses of aspirin play in the proteinuric patient?

A

Reduces risk of thromboembolism

26
Q

Which drug can be added to ACEi therapy to prevent hypertension?

A

Amlodipine

27
Q

How is oedema/ascites treated?

A

Sodium restriction
Thoraco/abdocentesis
Diurectics
Colloids

28
Q

What are the dis/advantages of renal biopsy?

A 
\+ Can treat specific problem
\+ Breed management
\+ Can give accurate prognosis
- Risk of haemhorrage
- Expense
29
Q

Outline the typical signalment of immune-complex glomerulonephritis in the C and D…

A

C
Uncommon
Young adults
M > F

D
Common
Broad ages
M=F

30
Q

What kind of renal disease are immunosuppresors used to treat only?

A

Immune-complex glomerulonephritis

31
Q

How is amyloidosis treated? What can be used to prevent it?

A

No treatment can solubilise amyloid fibrils

Colchicine a plant extract (unproven)

32
Q

How can treatment of proteinuria be monitored?

A

UPC and creatinine concs

33
Q

What is the prognosis of proteinuria? What are negative prognostic factors?

A

Variable though is most often progressive

  • Azotaemia
  • Nephrotic syndrome
34
Q

What is the difference between azotaemia and proteinuria?

A

A - reduced number of functioning nephrons

P - damaged filtration barrier

Renal (12 decks)

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