Approach to Proteinuria, Pyelonephritis and Renal Neoplasia

Question 1

What are some physiological causes of proteinuria

Answer 1

Strenuous exercise, seizure, fevers, stress

Question 2

What are some Pre-renal causes of proteinuria

Answer 2

Abnormal concentration of protein presented to kidney

Question 3

What are some renal causes of proteinuria

Answer 3

Defective renal function or inflammation of renal tissue

Question 4

What are some post-renal causes of proteinuria

Answer 4

Inflammation in the ureter, bladder, urethra or prostate

Question 5

What is the most common cause of proteinuria

Answer 5

Post Renal Causes. Inflammation in the ureter, bladder, urethra or prostate

Question 6

Name of protein that the dipstick test is most sensitive to

Answer 6

Albumin

Question 7

Haematuria has an effect on urine protein concentration (T/F)

Answer 7

False! Haematuria has little effect on urine protein concentration unless the urine is discoloured red

Question 8

List 4 reasons for renal proteinuria

Answer 8

1. Renal inflammation
2. Glomerular diseases
3. Tubular diseases
4. Chronic renal failure

Question 9

How do we quantify severity of proteinuria

Answer 9

Urine protein:creatinine ratio (UPCR)
24 hour protein measurement

Question 10

What is the normal level of Urine protein:Creatine (UPCR) for dogs and cats

Answer 10

<0.2

Question 11

What are abnormal levels of Urine protein:Creatine (UPCR) for dogs and cats

Answer 11

Dog: >0.5
Cat: >0.4

Question 12

Why does renal inflammation cause a high UPCR

Answer 12

Inflammation in the kidney can cause protein to leak into the filtrate

Question 13

Give an example of types of renal inflammation that causes high UPCR

Answer 13

Pyelonephritis, Acute tubular nephrosis

Question 14

Why does glomerular diseases cause a high UPCR

Answer 14

Due to increased glomerular permeability

Question 15

Glomerular disease is more common in cats than dogs (T/F)

Answer 15

False!

Question 16

What is the UPCR of a patient with glomerular disease

Answer 16

2.0

Question 17

Protein-losing nephropathy

Answer 17

Term used for conditions which cause severe proteinuria due to primary glomerular diseases

Question 18

Why does tubular disease cause a high UPCR

Answer 18

Proteinuria due to reduced tubular reabsorption of normally filtered proteins

Question 19

What dog breed is predisposed to have tubular disease and what is the disease name

Answer 19

Fanconi syndrome (Basenji breed)

Question 20

Why does CKD cause a high UPCR

Answer 20

In CKD, adaptive changes to nephron loss cause hyperfiltration in remaining nephrons, leading to glomerular protein loss. Simultaneously, tubular dysfunction reduces protein uptake, contributing to tubular protein loss and overall proteinuria.

Question 21

What is the magnitude of proteinuria in CKD

Answer 21

Usually low [unless the CKD is a consequence of primary glomerular disease (dogs)]

Question 22

What are three categories of protein losing nephropathies

Answer 22

Developmental abnormalities in basement membrane (rare)
Amyloid deposits in glomerulus
Glomerulonephritis due to immune-complex deposition in glomerulus

Question 23

What breeds are predisposed to Developmental abnormalities in basement membrane causing protein losing nephropathies

Answer 23

Defects in type IV collagen in English Springer spaniels & bull terriers

Question 24

What breeds are predisposed to Amyloid deposits in glomerulus

Answer 24

Shar pei, Beagle, Abyssinian & Siamese

Question 25

What is Glomerulonephritis and Immune Complex Deposition

Answer 25

Cause: Formation of immune complexes in the bloodstream.
Effect: Deposition in glomeruli triggers inflammation and damages filtration membrane.
Consequence: Increased permeability leads to proteinuria and reduced kidney function.

Question 26

Clinical signs for protein losing nephropathies

Answer 26

Early:
May be no clinical signs
Loss of body condition
Lethargy, anorexia

Later:
Abdominal/pleural effusions
Subcutaneous pitting oedema
Acute onset blindness (hypertensive retinopathy)
Thromboembolic disease (eg. pulmonary thromboembolism)

Very late:
Uraemia (due to CKD)

Question 27

What are some haemotology/biochemistry findings expected from a patient with PLN

Answer 27

Low serum albumin
Normal or mildly increased globulin
Possibly increased cholesterol

Question 28

Patients with protein losing nephropathies have a problem with coagulation (T/F)

Answer 28

True! Multifaceted reasons

Question 29

What are some clinical findings of nephrotic syndrome

Answer 29

Proteinuria
Hypoalbuminaemia
Ascites/oedema
Hypercholesterolaemia

Question 30

Drugs used to manage coagulopathies from PLN

Answer 30

Clopidogrel, aspirin, rivaroxaban

Question 31

Drugs used to manage proteinuria from PLN

Answer 31

ACE-I, ARBs, renal specific diets

Question 32

One should always drain abdominal effusion and administer diurects

Answer 32

DO NOT:
Drain abdominal effusion unless difficulty breathing
Treat with diuretics unless difficulty breathing
Due to RAAS system

Question 33

Pyelonephritis

Answer 33

Interstitial inflammation of the kidney associated with bacterial infection

Question 34

Causes of pyelonephritis

Answer 34

Usually ascendingfrom lower urinary tract
May also be haematogenous(in circulation)

Question 35

Risk factors for pyelonephritis

Answer 35

Immunosuppression, structural renal disease, degenerative renal disease

Question 36

Drug to treat pyelonephritis

Answer 36

Fluroquinolones

Question 37

What differentiate pyelonephritis from bacterial cystitis

Answer 37

History: quick recurrence of confirmed bacterial cystitis after antimicrobials
Physical exam: painful retroperitoneal space / kidneys
CBC: + / - neutrophilia
Biochemistry: + / - azotaemia
Abdominal imaging: + / - dilated ureters, enlarged kidneys (renomegaly)