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small animal medicine > disease of the glomerulus > Flashcards

disease of the glomerulus Flashcards

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1
Q

list 2 glomerular disease of domestic animals

A
  • glomerulonephritis
  • glomerular amyiloidosis
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2
Q

hallmark for glomerular disease

A

proteinuria

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3
Q

most common causes of proteinuria

A

lower urinary tract

upper urinary tract sometimes

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4
Q

determinant of proteinuria

A
  • molecular weight
  • size​
  • charge of protein
  • filtration barrier
  • fixed negative charge
  • tubular resoption/catabolism
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5
Q

filtration barrier in kidney for proteins

A
  • endothelium
  • basement membrane 9negative charge)
  • epithelial cells
    *
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6
Q

Classical definition of nephrotic syndrome

A
  • Proteinuria
  • Hypoalbuminemia
  • Hypercholesterolemia
  • Edema and/or ascites
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7
Q

function of the mesanchymal cells

A
  • produce mesangial matrix

Are phagocytic and may clear filtration residues

Contain microfilament

 Respond to vasoactive substances (e.g.angiotensin II) and alter surface area of glomerulus available for
filtration

  • May play role in mediating glomerular injury
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8
Q

discuss the characteristics of the glomerulus

A
  • Is both a size and charge selective barrier
  • (-) charges in endothelium, GBM and podocytes
  • Type IV collagen in GBM contributes to size

selectivity

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9
Q

what is the number 1 cause of glomerulonephritis

A

immune mediated injuries

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10
Q

causes of immune complex GN in Dogs

A
  • Pyometra
  • Heartworm disease
  • Systemic lupus erythematosus
  • Canine adenovirus-1
  • Chronic infections
  • Endocarditis, ehrlichiosis, borreliosis, leishmaniasis, etc.
  • Neoplasia (e.g. lymphoma)
  • Most cases are idiopathic !!!
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11
Q

Causes of Immune Complex GN in Cats

A
  • Feline leukemia virus (FeLV)
  • Feline infectious peritonitis (FIP)
  • Chronic progressive polyarthritis (Mycoplasma gatae)
  • Neoplasia (e.g. lymphoma)
  • Most cases are idiopathic !!!
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12
Q

discuss the signalment for Membranoproliferative GN in familial Familial Glomerular Diseases

A

 Soft-coated Wheaten terriers (often associated with PLE)
 Bernese Mountain dogs (often associated with borreliosis)
 CIII deficiency in Brittany Spaniels

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13
Q

discuss the signalment for Basement membrane disorders in Familial Glomerular Diseases

A

 Autosomal recessive in English Cocker spaniels
 X-linked dominant in Samoyeds
 Suspected in Doberman pinschers and Bull terriers

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14
Q

Diverse group of diseases
characterized by
extracellular deposition
of protein subunits that
form -pleated sheets

A

amyloidosis

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15
Q

discuss the classification of amyloidosis based on Distribution of deposits

A

 Systemic (most common in veterinary medicine**)
 Localized (pancreatic islet cells of cats - islet amyloid polypeptide)

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16
Q

discuss classification of amyloidosis based on Nature of responsible protein

A

Reactive (AA)
 Immunoglobulin-associated (AL)
 Transthyretin (ATTR)
 2-microglobulin (A2M)
 Islet amyloid polypeptide (AIAPP)
 Many others

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17
Q

2 main classification groups for amyloidosis

A
  •  Distribution of deposits
  •  Nature of responsible protein
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18
Q

discuss Reactive Systemic Amyloidosis

A
  • associated with chronic infectious and non infectious inflamatory diseases
  • associated with neoplasia
  • most common causes in dogs and cats:idiopathic or familial
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19
Q

most causes of reactive systemic amyloidosis in dogs and cats

A

idiopathic or

familial

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20
Q

dogs most affected by reactive systemic amyloidosis

A

Shar pei
Beagle
English foxhound

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21
Q

cats mostly affected by reactive systemic amyloidosis

A

Abyssinian
Siamese
Oriental shorthair

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22
Q

Tissue Tropisms of Amyloid Proteins

A

 Tissue distribution of amyloid deposits in dogs and
cats can be widespread but clinical signs are due to
kidney involvement and renal failure

 Exception: Severe liver involvement in Shar pei dog,
Siamese cat, and Oriental shorthair cat can lead to
liver rupture and hemoabdomen

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23
Q

in which animals is Medullary > Glomerular distribution of amyloidosis due to reactive systemic amyloidois

A
  • cat including abyssian
  • cow
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24
Q

in which animals is Glomerular > Medullary Distribution of Deposits within Kidney

A

humans

dogs (except shapei)

horses

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25
DISCUSS LEVELS OF PROTEINURIA IN **GLOMERULAR** AMYLODIOSIS
Expect proteinuria; positive biopsy results
26
what should u expect with medullary Amyloid Distribution in the Kidney
Expect minimal proteinuria; negative biopsy results
27
what do we use to o presumptively identify medullary amyloid deposits at necropsy
Lugol’s iodine
28
discuss SIGNALMENT OF Amyloidosis in Shar Pei Dogs
Mean age - 4 yrs Males & females Black & fawn Familial relationship
29
cs of amyloidosis in shapei
* Signs usually consistent with CRF * **May have history of recurrent acute self-limiting fever and tibiotarsal joint swelling (“Sharpei fever”)** * Severe liver involvement may cause icterus or hemoabdomen due to liver rupture
30
discuss the lesions in Amyloidosis in Shar Pei Dogs **Glomerular involvement**
* proteiunuria * hypercholesterolemia * hypoproteinemia
31
discuss the cs of Medullary involvement (more common) in Amyloidosis in Shar Pei Dogs
Isosthenuria without proteinuria with medullary involvement
32
Clinical findings of Amyloidosis in Abyssinian Cats
 Poor haircoat Weight loss  Lethargy  Polyuria/polydipsia  Dehydration  Small irregular kidneys
33
laboratory findings of Amyloidosis in Abyssinian Cats
* Nonregenerative anemia * Azotemia * Hyperphosphatemia * Metabolic acidosis * Isosthenuria * Variable proteinuria
34
which kidney celss plays a role inmediating glomerular injuries
mesanchymal cells
35
how does prognosis for survival from amyloid differ from GN
amyloid-relentlessprogression is the rule
36
the best stain for amyloid
congo red
37
signalment for glomerular dz
middle aged- to older no gender predilection-cats with gn are mostly male any breed bt remember familial syndromes
38
6 possible presentations of glomerular dz TQ
_signs related to crf most common_ signs related to underlying infectious,inflamatory,neoplastic disorders. proteinuria may be an incidental finding signs related to "nephrotic syndrome' _signs related to thromboembolism--loss of antethrombin_ sudden blindness due to hypertention and retinal detarchment n.b remember that hypertension is related to glomerular dz
39
discuss physical findings of glomerular dz
* related to CRF(most common) * poor haircoat and body condition * dehydration * small irregular kidneys * related to underlying infectious,inflamatory or neoplastic dz * ascites or edema * retinal detarchment,vascular tortuosity,retinal detachment
40
u see a dog with retinal detarchment .which kidney dz do u suspect
* fundic lesion due to hypertention secondary to glomerular dz * retinal hemorrhages * intra-retinal retinal transdudate * retinal edema
41
discuss urinalysis of glomerular dz
proteinuria is the hallmark hyaline and granular casts lipid droplets isosthenuria(most animals with glomerular dz dnt hav it)
42
biochemistry finding s of glomerular dz
* _Laboratory abnormalities of CRF_ Azotemia Hyperphosphatemia Metabolic acidosis * _Hypoalbuminemia (other differentials?)_ Up to 75% of dogs with amyloidosis Up to 60% of dogs with GN * _Hypercholesterolemia (other differentials?)_ Up to 90% of dogs with amyloidosis Up to 60% of dogs with GN
43
does increase in urin protein creatine ratio(upc) mean u hav glomerular dz
not necessarily cannot differentiate protein coming from upper or lower urinary system
44
upc ratio of less than .5 is?
normal
45
upc of .5 to1.0 is
questionable upc of greater than 1 is
46
upc ratio of greater than 5
nephrotic range
47
how is upc ration unreliable
* magnitude of upc ratio correlates with severity of glomerular dz in non azotemic patients * _unreliable in presence of pyuria or severe hematuria_ * decrease in upc ratio in azotemic patients with declining GFR is not a sign of improvement
48
tq
if there are wbc in a Q, then dnt pick upc ratio
49
on average,the highest upc ratio are seen in
glomerular amyloidosis
50
presence of an amount of protein in urine greater than normal but below detection limit of conventional dipstick
* microalbuminuria * it will detect proteinuria b4 it can be detected in dipstick * if anything less than 10 then your dipstick will be -ve *
51
established risk factor for progression of renal dz in human patients
type 1 and type 2 diabetes essential hypertension
52
other factors that can lead to proteinuria
corticosteroids microalbunemia increases with age
53
discuss what -ve/+ve microalbunemia means
-ve great--glomerular barriwer working well +ve -worrisome breakdown of glomerular barrier fxn increase in number of holes or size of holes
54
things to do if your test is postive for microalbuminuria
r/o systemic hypertension r/o endocrinopathy r/o occult neoplasia r/o occult infections
55
what is the most common cause of proteinuria
lower urinary tract
56
what is the most sensitive test to detect proteinuria
microalbumininuria
57
the only test to differetiate Gn and amyloidosis
renal biopsy
58
Gn is best assessed by
immunohistochemistry immunofluroscence electron microscopy remember that if proteinuria is in the renal medula u might miss it
59
how to tx glomerular dz
identify and tx any underlying predisposing inflamatory or neoplastic dz tx crf if present
60
if u have a patient with proteinuria and hypertension,which drug should be your drug of choice?
ACE inhibitor
61
explain how ace inhibitors reduce hypertention in glomerular dz
they decrease glomerular capillary hydrostatic p and proteinuria
62
side effects of ace inhibitors
potentially can aggrevate azotemia
63
which drugs can u use to tx thromboembolism in glomerular dz
aspirin
64
specific tx for GN
no immunosuppresants hav not been proven that they work fatty acids can be used coz they are antiinflamatory
65
specifiic tx for amyloidosis
no specific tx has been shown to be beneficial consideration:colchicine
66
discuss how colchicine works
tx amyloidosis by decreasing serum amyloid A protein (SAA) conce by imparing hepatic secretion prevents developments of amyloidosis in humans with familial mediterianian fever (FMF)
67
complications in glomerular dz
hypoalbunemia na retention thromboembolism hyperlipidermia hypertension
68
discuss hypoproteinemia as a complication of glomerular dz
* low oncootic pressure stimulates hepatic albumin synthesis * increased hepatic albumen synthesis insufficient for degree of hypoalbunemia * increased renal catabolism of filtered proteins * **increasing diatery protein only worsens urinary protein loss**
69
discuss nephroembolism
nephrotic syndrome is a hypercoagulble state thromboembolism events may be main reason for presentation
70
why do u get hypercoagulability in nephrotic syndrome
loss of antithrombin 111
71
discuss hyperlipidermia in nephrotic syndrome
* increased hepatic syntheses and decreased peripheral catabolism of lipoproteinscaused by hypoalbunemia and urinary loss of lipid regulatory factors * plasma cholesterol and triglyceride concentrations inversely correlated with serum albumin conc. * can lead to non specific gi signs and pancreatitis
72
discuss mechanisms of hypertension
* primary intrarenalmechanism for Na retention(early) * activation of RAS(later) * hypertension occurs in 50-80% of dogs with glomerular dz *
73
targets for hypertension
eyes kidney kidney
74
which test should u perform in dogs with glomerular dz
blood p control of bp can slow progression of renal dz
75
tx for hypertension in nephrotic syndrome
enalpride may reduce proteinuria in addition to reducing bp monitor BUN and SCr may slow progression of renal dz
76
best tx option of GN
ACE
77
reason why dogs with renal amyloidosis and GN die
progressive CKDto failure
78
prognosis of amyloidosi
poor
79
reasons why dogs with renal amyloidosis and gn die
progressive ckd to failure
80
prognosis for gn
**variable** spontaneous remission(role of tx) stable course for months to years with ongoing proteinuria progression tocrf over mnths to yrs

small animal medicine (3 decks)

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