Glomerular Disease

Question 1

What can be caused by immune disease processes or non-immune disease?

Answer 1

Protein-Losing Nephropathy

Question 2

What is the space between the podocytes called?

Answer 2

Slit pore*

• they restrict movement based on size and charge

Question 3

The following substances are listed from smallest to largest. What is the smallest substance that is not filtered substantially?

Sodium
Creatinine
Albumin
Immunoglobulin G (IgG)

Answer 3

Albumin

Question 4

What is a protein induced by inflammation that deposits in the kidney?

Answer 4

Amyloid

Question 5

Can amyloid already in the kidney be removed?

Answer 5

No

Question 6

What is the hallmark of PLN?

Answer 6

Proteinuria

Question 7

What do many patients with PLN have?

Answer 7

Low albumin
High cholesterol
Hypertension (due to stimulation of RAAS)

Question 8

What are other causes you need to rule out for proteinuria?

Answer 8

UTI
Stones

Question 9

PLN can be caused by immune disease processes or non-immune causes.
- What are the immune causes?

Answer 9

Glomerulonephritis, and they can be further classified based on morphology

Question 10

PLN can be caused by immune disease processes or non-immune causes.
- What are the non-immune causes?

Answer 10

1. Glomerulopathies, which are glomerular diseases that don’t have the inflammation of a glomerulonephritis
2. Amyloidosis

Question 11

(T/F) Glomerular disease is more common in Cats

Answer 11

False

Question 12

What are the breeds that have a high enough incidence of hereditary nephropathy?

Answer 12

• Bernese mountain dog
• Bull terrier
• English cocker spaniel
• Dalmatian
• Doberman pinscher
• Greyhound
• Newfoundland
• Rottweiler
• Soft-coated wheaten terrier

Question 13

PLN starts as a disease of the glomerulus, which can then cause damage to the ___________ and ____________

Answer 13

tubules, interstitium

Question 14

What type of sheets does amyloid form?

Answer 14

beta-pleated sheets

Question 15

What two breed species get amyloidosis?

Answer 15

Shar Pei dogs & Abyssinian cats

Question 16

A syndrome of recurrent fevers and hock swelling as young dogs. Renal failure and proteinuria don’t appear until middle age

Answer 16

Shar Pei Fever

Question 17

Amyloid can occur secondary to ______________ or from ______________

Answer 17

Chronic inflammation, Familial problems

Question 18

Which patient will benefit the most from drugs to inhibit RAAS?
Dog w/ AKI
Cat w/ CKD
Dog w/ PLN

Answer 18

Dog w/ PLN

Question 19

The nephrotic syndrome consists of 4 components:

Answer 19

Hypoproteinemia
Proteinuria
Hypercholesterolemia
Ascites or Edema (tends to be the last feature to develop)

Question 20

(T/F) Azotemia is required to be present for a dog to have nephrotic syndrome

Answer 20

False

Question 21

If the glomerulus is leaky, why does the creatine go up?

Answer 21

The entire nephrons become lost (proteinuria causes fibrosis
of the interstitium) and the global renal function declines, leading to azotemia - an increased creatinine

Question 22

Glomerular disease ultimately leads to:

Answer 22

Tubulointerstitial damage
Nephron loss from glomerulosclerosis

Question 23

In a Urinalysis, what is a characteristic of glomerular disease?

Answer 23

Proteinuria (UPC >0.5) with an inactive sediment

Question 24

Persistent proteinuria due to systemic problems, like fever or myoglobinemia is classified as:

Answer 24

Pre-renal

Question 25

In a Dipstick, a trace of 1+ protein in concentrated urine may be normal but is rarely normal with ___________

Answer 25

isothenuria

Question 26

In dogs and cats, what does alkaline urine usually mean?

Answer 26

urinary tract infection

Question 27

(T/F) Most cases of PLN have High platelet numbers

Answer 27

True

Question 28

(T/F) Platelet numbers can be low if the PLN is caused by vectorborne infectious

Answer 28

True

Question 29

What would be considered mandatory testing for all proteinuric dogs?

Answer 29

- 4DX test or similar - Other infectious disease testing may be warranted also

Question 30

(T/F) We usually do not biopsy if chronic severe azotemia is present, because of the expectation of finding irreversible fibrosis.

Answer 30

True

Question 31

What is the role tubule plays in the pathogenesis of glomerular disease?

Answer 31

Tubules can't stand protein and try their best to reabsorb it, but the resulting interstitial protein incites inflammation

Question 32

(T/F) The presence of proteinuria on the dipstick is diagnostic for glomerulonephritis

Answer 32

False

Question 33

(T/F) Almost all patients with PLN are azotemic at diagnosis

Answer 33

False

Question 34

(T/F) Omega 3 fatty acids supplementation is renoprotective in dogs

Answer 34

True

Question 35

Angiotensin-converting enzyme inhibitors block the conversion of Angiotensin ____ to Angiotensin _____

Answer 35

I, II

Question 36

Angiotensin receptor antagonists (blockers) block the action of Angiotensin ____

Answer 36

II

Question 37

What are some ACE inhibitors that block the conversion of angiotensin I to angiotensin II?

Answer 37

Enalapril Benazepril

Question 38

Angiotensin receptor antagonists, like ___________, block the action of angiotensin II.

Answer 38

Telmisartan - as effective as benazepril in controlling proteinuria in cats - it is an effective anti-hypertensive in cats

Question 39

Aldosterone antagonists, like __________, block the action of aldosterone. They are used predominantly as diuretics.

Answer 39

Spironolactone

Question 40

_____________ causes sodium reabsorption and potassium excretion

Answer 40

Aldosterone

Question 41

When thinking of hypertension, what are the target organs at most risk for damage?

Answer 41

eyes, brain, heart and kidneys.

Question 42

Is a calcium channel blocker, and is frequently combined with RAAS inhibitor drugs

Answer 42

Amlodipine (for controlling hypertension)

Question 43

Immunosuppressive drug for ICGN, which has the fewest side effects and seems effective

Answer 43

Mycophenolate mofetil

Question 44

Antithrombin III (natural anticoagulant) is the same size as __________

Answer 44

albumin