Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 17 > Approach to Proteinuria, Pyelonephritis & Renal Neoplasia > Flashcards

Approach to Proteinuria, Pyelonephritis & Renal Neoplasia Flashcards

1
Q

what do protein losing nephropathies cause

A

in dogs

weight loss, lethargy, poor appetite

severe urinary protein loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when would you suspect pyelonephritis

A

with a positive urine culture has systemic signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what renal neoplasia do cats get

A

lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what renal neoplasia do dogs get

A

carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is proteinuria

A

increase in amount of protein in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the physiological causes of proteinuria (4)

A
  1. strenous exercise
  2. seizure
  3. fever
  4. stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the pre renal causes of proteinuria

A

abnormal concentration of protein presented to kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are renal causes of proteinuria

A

defective renal function or inflammation of renal tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are post-renal causes of proteinuria

A

inflammation in the ureter, bladder, urethra, prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the presenting signs of proteinuria

A

none usually

its detected on dipstick

or signs of underlying disease, signs due to low serum protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are signs of underlying disease of proteinuria

A

neoplasia

infectious disease

renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the signs of low serum protein in proteinuria

A

weight loss

lethargy

poor appetite

ascites

pitting edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what can cause false positives of proteinuria dipstick

A

alkaline urine

contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what can cause false negatives of proteinuria dipstick

A
  1. acidic urine
  2. bence jones proteinuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

does hematuria affect the protein content in the urine

A

no

unless the urine is discoloured red

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

does pyuria have an affect on urine protein concentration

A

inconsistent effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what will history and clinical exam help you distinguish in proteinuria

A

if it is a physiological cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what will hematology and biochem help you distinguish in proteinuria

A

identify pre renal causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what will history, clinical exam, urinalysis and imaging help you distinguish in proteinuria

A

identify post-renal causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how would you distinguish renal or post renal inflammation as a cause of proteinuria

A

examine urine sediment for inflammatory cells

perform urine culture and sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

why is it important to quantify proteinuria (3)

A
  1. evaluate severity of renal lesions
  2. assess disease progression
  3. assess response to treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how do you quantify proteinuria

A
  1. 24 hour urine protein measurement

gold standard, difficult so not used clinically

  1. urine protein:creatinine ration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how is the UP:C ratio calculated

A

urine protein (mg/dl)/urine creatinine (mg/dl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the purpose of UP:C ratio

A

negates the effect of urine volume and concentration

results correlate well within 24 hour urine protein excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are renal proteinuria causes (4)

A
  1. renal inflammation
  2. glomerular diseases
  3. tubular diseases
  4. chronic renal failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how does renal inflammation cause proteinuria

A

inflammation in the kidney cause protein to leak into the filtrate

ex. pyelonephritis, acute tubular nephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

how does glomerular disease lead to proteinuria

A

due to increased glomerular permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what would the UP:C be in glomerular disease

A

tends to be >2.0 once disease established

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is protein losing nephropathy caused by

A

severe proteinuria due to primary glomerular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are tubular diseases

A

ex. faconi syndrome

relatively rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

how do tubular diseases cause proteinuria

A

due to reduced tubular reabsorption of normally filtered proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what does the UP:C ratio tend to be in tubular disease

A

magnitude of proteinuria usually low

tends to be <2.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

why does proteinuria occur in CRF (2)

A

caused by adaptive changes to nephron loss

  1. hyperfiltration in remaining nephrons secondary to glomerular capillary hypertension –> glomerular protein loss
  2. tubular dysfunction also occurs –> reduced protein intake from ultrafiltrate –> tubular protein loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is the magnitude of proteinuria in CRF

A

usually low (unless the CRF is a consequence of primaru glomerular disease)

35
Q

what are the causes of protein losing nephropathies (3)

A
  1. developmental abnormalities in basement membrane (rare)
  2. amyloid deposits in glomerulus
  3. glomerulonephritis due to immune-complex deposition in glomerulus
36
Q

what breeds does developmental abnormalities in the basement membrane

A

english springer spaniels and bull terriers

defects in type IV collagen

37
Q

what breeds have a genetic predispositions of amyloid deposits

A

Shar pei, beagle, abyssinian and siamese

38
Q

what is glomerulonephritis

A

groups of conditions in which immune complexes are deposited in the glomeruli

39
Q

what are the causes of glomerulonephritis (2)

A
  1. chronic antigenic stimulation
  2. often unknown (idiopathic)
40
Q

what are the causes of chronic antigenic stimulation in glomerulonephritis (3)

A
  1. inflammatory (immune-mediated diseases, chronic inflammatory diseases)
  2. infectious (endocarditis, lyme disease, leishmaniasis)
  3. neoplasia
41
Q

is glomerulonephritis more common in cats or dogs

A

more common in dogs

42
Q

what are the early clinical signs of PLN (3)

A
  1. may be no clinical signs
  2. loss of body condition
  3. lethargy, anorexia
43
Q

what are the later clinical signs of PLN (4)

A
  1. abdominal/pleural effusions
  2. subcutaneous piting edema
  3. acute onset blindness (hypertensive retinopathy)
  4. thromboembolic disease (pulmonary thromboembolism)
44
Q

what are the very late signs of PLN

A

uremic syndrome (due to CRF)

45
Q

what would the hematology/biochem signs be of PLN (3)

A
  1. low albumin
  2. normal or mildly increased globulin
  3. possibly increased cholesterol
46
Q

if the animal is low albumin what should you do when investigating a PLN (2)

A
  1. urine sample (to look for proteinuria)
  2. bile acid stimulation test (rule out concurrent liver disease)
47
Q

what are the findings of nephrotic syndrome (4)

A
  1. proteinuria
  2. hypoalbuminemia
  3. ascites/edema
  4. hypercholesterolemia

may also have

systemic hypertension

hypercoagulability

48
Q

how would you perform a renal biopsy

A
  1. tru cut with ultrasound guidance
  2. via key hole technique
  3. laparoscopically
  4. at laparotomy
49
Q

what is hypercoagulability caused by (5)

A
  1. mild thrombocytosis
  2. increased platelet adhesion and aggregation
  3. loss of antithrombin (works with heparin, plays role in modulating thrombin and fibrin production)
  4. altered fibrinolysis
  5. relative increase in large clotting factors
50
Q

what can hypercoagulability

A

can lead to thromboemboli (lungs/brain)

51
Q

how do you treat PLN (6)

A
  1. identifty and eliminate underlying disease (infections, skin disease, neoplasia)
  2. treat hypertension (ACE inhibitor, amlodipine, ARBs)
  3. treat proteinuria
  4. treat hypercoagulability
  5. manage uremia if present
  6. consider immunosuppression
52
Q

how do you treat proteinuria in a PLN (3)

A
  1. renal diet
  2. ACE inhibitors
  3. +/- angiotensin receptor blockers
53
Q

how do you treat hypercoagulability

A

low dose aspirin or clopidogrel

54
Q

what should you not do to treat a PLN

A
  1. drain abdominal effusion unless difficulty breathing
  2. treat with diuretics unless difficulty breathing (can cause dehydration and renal decompensation)
55
Q

what does the prognosis of PLN depend on (3)

A
  1. underlying cause (often unknown)
  2. severe dysfunction
  3. response to therapy
56
Q

what is pyelonephritis

A

interstitial inflammation of the kidney associated with bacterial infection

57
Q

what are the causes of pyelonephritis

A
  1. ascending infection (usually)
  2. hematogenous spread (less common)
58
Q

what could predispose to pyelonephritis

A
  1. immunosuppression may predispose
  2. chronic renal failure
59
Q

what are the acute signs of pyelonephritis (8)

A
  1. mild renomegaly
  2. renal pain
  3. fever
  4. anorexia
  5. dehydration
  6. weight loss
  7. PUPD
  8. vomiting
60
Q

what are the chronic signs of pyelonephritis (2)

A
  1. normal or small kidneys (due to fibrosis)
  2. pain and fever not usually present
61
Q

how is pyelonephritis diagnosed

A

can be difficult to distinguish from bacterial cystitis

62
Q

what laboratory changes would you see with pyelonephritis (8)

A
  1. hematuria
  2. pyruria
  3. sub optimal urine concentrating ability
  4. WBC casts (not always)
  5. positive urine culture (not always)
  6. neutrophilic leukocytosis (not always)
  7. ultrasound: mild hydronephrosis without uretral dilation
  8. azotemia (only if progressed to CRF)
63
Q

what clues would indicate that its more than just bacterial in pyelonephritis (4)

A
  1. leukocytosis present (unlikely with bacterial cystitis)
  2. presence of dilute urine
  3. presnce of ultrasound chnages in kidney
  4. recurrence of infection after short course of antibiotics for bacterial cystitis (pyelonephritis 4-6 weeks treatment)
64
Q

how do you treat pyelonephritis

A

antibiotics for 4-6 weeks

choose based on culture and sensitivity

65
Q

what antibiotics could you use in treating pyelonephritis while you wait for culture and sensitivity

A

amoxycillin clavulanate (not intact males)

potentiated sulphonamides

66
Q

what are other causes of renal pain (7)

A
  1. pyelonephritis
  2. renal calculi
  3. acute nephrosis
  4. hydronephrosis (early)
  5. renal trauma
  6. abscesses
  7. neoplasia (rarely painful)
67
Q

what can be difficult to distinguish from renal pain

A

spinal pain or other causes of abdominal pain (ex. pancreatitis, peritonitis)

68
Q

what are primary renal neoplasia (4)

A
  1. renal adenocarcinoma
  2. renal lymphoma
  3. renal sarcoma
  4. nephroblastoma (very rare)
69
Q

what are metastatic renal neoplasias

A

hemangiosarcomas

70
Q

what are presenting signs of renal neoplasia 7

A
  1. weight loss
  2. inappetance
  3. hematuria
  4. abdominal distention/abdominal mass
  5. PUPD
  6. uremia (rare)
  7. paraneoplastic syndromes (rare)
71
Q

what are clinical signs of renal carcinomas (4)

A
  1. few clinical signs in early stages
  2. hematuria and weight loss
  3. unilateral (usually) renomegaly
  4. rarely causes renal azotemia
72
Q

what paraneoplastic syndromes can cause renal carcinomas (2)

A
  1. polycythemia
  2. hypertrophic osteopathy
73
Q

what causes polycythemia in renal carcinomas

A

due to erythropoietin production by tumour or

due to renal hypoxia

can cause neurological signs

74
Q

what is hypertrophic osteopathy in renal carcinomas

A

soft tissue swelling of long bones

progresses to periosteal reaction/periosteal new bone formation

75
Q

how do you diagnose renal carcinomas

A
  1. renal ultrasound
  2. ultrasound FNA
76
Q

how do you treat renal carcinomas

A

ensure sufficient function in contralateral kidney

nephrectomy

77
Q

what are the presenting signs of renal lymphomas (4)

A
  1. weight loss
  2. inappetance
  3. PUPD
  4. renomegaly
78
Q

what is renal lymphoma more common in

A

more common in cats than dogs

79
Q

what does renal lymphoma cause

A

renal azotemia

tendency to spread to CNS

80
Q

how do you diagnose renal lymphoma

A
  1. renal ultrasound
  2. FNAs of kidneys
81
Q

how do you treat renal lymphoma (2)

A
  1. multi agent chemotherapy (COP or CHOP)
  2. azotemia may resolve with treatment
82
Q

what are non-neoplastic causes of renomegaly (5)

A
  1. renal inflammation (acute nephrosis, acute pyelonephritis, FIP, leptospirosis)
  2. amyloidosis
  3. hydronephrosis
  4. polycystic kidney disease (PKD)
  5. portosystemic shunts
83
Q

what breed of cats is polycystic kidney disease common in

A

Persian and persian cross cats

autosomal dominant

mutation in PKD-1 gene

84
Q

what dog breeds does PKD also occur in

A
  1. bull terrier
  2. carin terrier
  3. whw terrier

Module 17 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions