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small animal medicine > disease of the glomerulus > Flashcards

disease of the glomerulus Flashcards

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
Q

DISCUSS LEVELS OF PROTEINURIA IN GLOMERULAR AMYLODIOSIS

A

Expect proteinuria; positive biopsy results

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26
Q

what should u expect with medullary Amyloid Distribution in the Kidney

A

Expect minimal proteinuria; negative biopsy results

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27
Q

what do we use to o presumptively identify
medullary amyloid deposits at necropsy

A

Lugol’s iodine

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28
Q

discuss SIGNALMENT OF Amyloidosis in Shar Pei Dogs

A

Mean age - 4 yrs
Males & females
Black & fawn
Familial relationship

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29
Q

cs of amyloidosis in shapei

A
  • 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
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30
Q

discuss the lesions in Amyloidosis in Shar Pei Dogs
Glomerular involvement

A
  • proteiunuria
  • hypercholesterolemia
  • hypoproteinemia
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31
Q

discuss the cs of Medullary involvement (more common) in Amyloidosis in Shar Pei Dogs

A

Isosthenuria without proteinuria with medullary
involvement

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32
Q

Clinical findings of Amyloidosis in Abyssinian Cats

A

 Poor haircoat
Weight loss
 Lethargy
 Polyuria/polydipsia
 Dehydration
 Small irregular kidneys

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33
Q

laboratory findings of Amyloidosis in Abyssinian Cats

A
  • Nonregenerative anemia
  • Azotemia
  • Hyperphosphatemia
  • Metabolic acidosis
  • Isosthenuria
  • Variable proteinuria
34
Q

which kidney celss plays a role inmediating glomerular injuries

A

mesanchymal cells

35
Q

how does prognosis for survival from amyloid differ from GN

A

amyloid-relentlessprogression is the rule

36
Q

the best stain for amyloid

A

congo red

37
Q

signalment for glomerular dz

A

middle aged- to older

no gender predilection-cats with gn are mostly male

any breed bt remember familial syndromes

38
Q

6 possible presentations of glomerular dz

TQ

A

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
Q

discuss physical findings of glomerular dz

A
  • 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
Q

u see a dog with retinal detarchment .which kidney dz do u suspect

A
  • fundic lesion due to hypertention secondary to glomerular dz
    • retinal hemorrhages
    • intra-retinal retinal transdudate
    • retinal edema
41
Q

discuss urinalysis of glomerular dz

A

proteinuria is the hallmark

hyaline and granular casts

lipid droplets

isosthenuria(most animals with glomerular dz dnt hav it)

42
Q

biochemistry finding s of glomerular dz

A
  • 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
Q

does increase in urin protein creatine ratio(upc) mean u hav glomerular dz

A

not necessarily

cannot differentiate protein coming from upper or lower urinary system

44
Q

upc ratio of less than .5 is?

A

normal

45
Q

upc of .5 to1.0 is

A

questionable

upc of greater than 1 is

46
Q

upc ratio of greater than 5

A

nephrotic range

47
Q

how is upc ration unreliable

A
  • 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
Q

tq

A

if there are wbc in a Q, then dnt pick upc ratio

49
Q

on average,the highest upc ratio are seen in

A

glomerular amyloidosis

50
Q

presence of an amount of protein in urine greater than normal but below detection limit of conventional dipstick

A
  • microalbuminuria
  • it will detect proteinuria b4 it can be detected in dipstick
    • if anything less than 10 then your dipstick will be -ve
      *
51
Q

established risk factor for progression of renal dz in human patients

A

type 1 and type 2 diabetes

essential hypertension

52
Q

other factors that can lead to proteinuria

A

corticosteroids

microalbunemia increases with age

53
Q

discuss what -ve/+ve microalbunemia means

A

-ve great–glomerular barriwer working well

+ve -worrisome

breakdown of glomerular barrier fxn

increase in number of holes or size of holes

54
Q

things to do if your test is postive for microalbuminuria

A

r/o systemic hypertension

r/o endocrinopathy

r/o occult neoplasia

r/o occult infections

55
Q

what is the most common cause of proteinuria

A

lower urinary tract

56
Q

what is the most sensitive test to detect proteinuria

A

microalbumininuria

57
Q

the only test to differetiate Gn and amyloidosis

A

renal biopsy

58
Q

Gn is best assessed by

A

immunohistochemistry

immunofluroscence

electron microscopy

remember that if proteinuria is in the renal medula u might miss it

59
Q

how to tx glomerular dz

A

identify and tx any underlying predisposing inflamatory or neoplastic dz

tx crf if present

60
Q

if u have a patient with proteinuria and hypertension,which drug should be your drug of choice?

A

ACE inhibitor

61
Q

explain how ace inhibitors reduce hypertention in glomerular dz

A

they decrease glomerular capillary hydrostatic p and proteinuria

62
Q

side effects of ace inhibitors

A

potentially can aggrevate azotemia

63
Q

which drugs can u use to tx thromboembolism in glomerular dz

A

aspirin

64
Q

specific tx for GN

A

no

immunosuppresants hav not been proven that they work

fatty acids can be used coz they are antiinflamatory

65
Q

specifiic tx for amyloidosis

A

no specific tx has been shown to be beneficial

consideration:colchicine

66
Q

discuss how colchicine works

A

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
Q

complications in glomerular dz

A

hypoalbunemia

na retention

thromboembolism

hyperlipidermia

hypertension

68
Q

discuss hypoproteinemia as a complication of glomerular dz

A
  • 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
Q

discuss nephroembolism

A

nephrotic syndrome is a hypercoagulble state

thromboembolism events may be main reason for presentation

70
Q

why do u get hypercoagulability in nephrotic syndrome

A

loss of antithrombin 111

71
Q

discuss hyperlipidermia in nephrotic syndrome

A
  • 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
Q

discuss mechanisms of hypertension

A
  • primary intrarenalmechanism for Na retention(early)
  • activation of RAS(later)
  • hypertension occurs in 50-80% of dogs with glomerular dz
    *
73
Q

targets for hypertension

A

eyes

kidney

kidney

74
Q

which test should u perform in dogs with glomerular dz

A

blood p

control of bp can slow progression of renal dz

75
Q

tx for hypertension in nephrotic syndrome

A

enalpride

may reduce proteinuria in addition to reducing bp

monitor BUN and SCr

may slow progression of renal dz

76
Q

best tx option of GN

A

ACE

77
Q

reason why dogs with renal amyloidosis and GN die

A

progressive CKDto failure

78
Q

prognosis of amyloidosi

A

poor

79
Q

reasons why dogs with renal amyloidosis and gn die

A

progressive ckd to failure

80
Q

prognosis for gn

A

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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