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RUSVM SAM 2 > Glomerular Disease > Flashcards

Glomerular Disease Flashcards

1
Q

What are possible causes of proteinuria?

A

Physiological - strenuous exercise, seizures, fever, and stress

Pre-renal - abnormal concentrations of proteins been presented to the kidneys (MM)

Renal - defective renal function or inflammation of renal tissue

Post-renal - inflammation of the ureter, bladder, urethra, or prostate

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2
Q

How can you diagnose proteinuria?

A

Urine dipstick

  • semi-quantitative
  • more sensitive to albumin
  • affected by urine concentration
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3
Q

What can cause a false positive for proteinuria on a urine dipstick?

A

Alkaline urine

Contamination

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4
Q

What can cause false negatives for proteinuria on a urine dipstick?

A 
Acid urine 
Bence jones (multiple myeloma)
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5
Q

What diagnostics do you do to determine cause of proteinuria?

A

Physiological cause: history and clinical exam

pre-renal : hematology and biochem

Post-renal: history, exam, UA, imaging

Renal/post renal inflammation

  • examine sediment for inflammatory cells
  • perform culture and sensitivity
  • hyperadrenocortisim or exogenous steroids
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6
Q

Why do you want to quantify proteinuria?

A

Evaluate severity of renal lesions

Potential to help guess location

Assess disease progression

Assess response to treatment

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7
Q

What methods can you use to quantify proteinuria ?

A

24hr urine protein measurement (Gold standard)

Urine protein:creatinine ratio (UPC)
-negates effect of urine volume and concentration

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8
Q

What are the causes of renal proteinuria ?

A

Defective renal function

  • > glomerular pathology
  • > tubular pathology

Inflammation of renal parenchyma

  • > pyelonephritis
  • > active tubular necrosis
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9
Q

If your UPC ratio >2.0, what do you expect as the cause?

A

Glomerular disease

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10
Q

If UPC ratio > 8, what do you expect the cause to be?

A

Amyloidosis

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11
Q

If UPC ratio is <2.0 what do you expect the cause of proteinuria to be ?

A

Tubular disease

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12
Q

T/F: chronic kidney disease can result in a proteinuria?

A

True

-due to adaptive changes in the nephron (hyper-filtration of remaining nephrons, glomerular protein loss, tubular dysfunction)

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13
Q

T/F: chronic kidney disease can be caused by a primary glomerular pathology

A

True

Causes significant proteinuria

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14
Q

What is the term used for the condition casing severe proteinuria due to primary glomerular disease?

A

Protein losing nephropathy

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15
Q

What is glomerulonephritis ?

A

Group of conditions where immune-complexes are deposited in the glomeruli

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16
Q

What are causes of glomerulonephritis ??

A

Chronic antigen stimulation (immune mediated, infectious, neoplastic)

Familial nephropathy basement membrane -> xlinked PLN of samoyeds or cocker spaniels

Immune complex glomerulonephritis

Non-immune complex GN

Amyloid deposits -> sharpei, beagle, Abyssinian, and Siamese

17
Q

Case of glomerulonephritis, how do you diagnose cause?

A

Consider history/signalment

Travel history/infectious disease

Drugs (TKI)

Clinical exam and systolic BP

MDB

  • CBC and biochem
  • UA, culture/sens, UPC

Radiographs/US for neoplasia

18
Q

You want to determine blood pressure in your patient with glomerulonephritis. How can you do this?

A

Look for end-organ damage (kidney, brain, eyes, and heart)

Indirect

  • oscillometric
  • Doppler

Remember white coat effect —> do an average of 5 readings

19
Q

What causes hyperocagulabilty seen with glomerulonephritis?

A

Thrombocytosis
Increased platelet adhesion and aggregation
Loss of antithrombin
Altered fibrinolysis
Relative increase in large clotting factors

20
Q

How can you measure hypercoagulablility?

A

Can measure D dimers (degredation products of fibrin)

Thromboelastography

  • number of platelets
  • decreased antithrombin
  • increased fibrin
  • increased d dimers
21
Q

Clinical signs of glomerulonephritis ?

A

Early

  • may have no clinical abnormalities
  • loss of body condition
  • lethargy, anorexia

Late (loss of protein and edema)

  • abdominal and pleural effusion
  • subcutaneous pitting edema
  • acute onset of blindness
  • thromboembolic disease

Very late
-uremic syndrome

22
Q

When would you do a kidney biopsy?

A

Persistent subclinical proteinuria detected

Immune-complex glomerulonephritis or amyloidosis is suspected

CONTRAINDICATED in IRIS stave IV disease or coagulopathies

23
Q

What is nephrotic syndrome?

A

Group of findings that include:

Proteinuria
Hypoalbuminemia
Ascities/edema
Hypercholesterolemia

Often have systemic hypertension and hypercoagulability

24
Q

What is the treatment for glomerulonephritis ?

A

Immunosuppressive therapy
-provided proteinuria has been confirmed to be glomerular in origin
-provided a biopsy confirms ICGN (unless contraindicated -
> IRIS stage IV or other mitigating factors)

25
Q

When is immunosuppressive therapy for glomerulonephritis contraindicated ?

A

Pancreatitis
Bone marrow suppression
Diabetes mellitus

26
Q

What is the first choice immunosuppressive therapy for glomerulonephritis ?

A

Mycophenolate mofetil -> inhibit DNA

Glucocorticoids -> as additional therapy

Alternatives ->cyclosporine, chlorambucil, azathioprine, cyclophosphamide

27
Q

How can you treat hypertension associated with glomerulonephritis ?

A

ACEi
ARB - aldosterone receptor blocker (telmisartan)
Calcium channel blocker (amlodipine)

28
Q

How can you treat proteinuria associated with PLN?

A

ACEi

  • > reduced intraglomerular BP
  • > contraindicated in IRIS stage IV
  • > monitor CREA

ARB
-> more complete blockade

Renal diets

  • > supplemented with EPA and DHA (omega 3 fatty acids)
  • > high quality protein and moderately restricted
  • Na restricted
29
Q

How do ACEi decrease proteinuria?

A

Decrease efferent arterial resistance —> decrease pressure

Reduce loss of glomerular heparin sulfate (protein in BM of glomerulus)

Decrease size of glomerular endothelial pore

Improve lipoprotein metabolism

Slow mesangial growth and proliferation

Inhibit bradykinin degradation

30
Q

What can you use to treat the hypercoagulability associated with PLN?

A

Aspirin (low dose)
Clopidogrel

Manage uremia

RUSVM SAM 2 (44 decks)

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