Glomerulonephropathies (Specht) Flashcards Preview

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Flashcards in Glomerulonephropathies (Specht) Deck (14):
1

Nephrotic syndrome

boards

  • characterized by
    • proteinuria
    • hypoalbuminemia
    • hypercholesterolemia
    • edema
    • +/- azotemia

2

Amyloidosis

  • can cause PLN
  • breed dispositions
    • abbysinian cats
    • sharpei dogs
  • Hallmark
    • polarization of the protein

3

ACVIM  consensus

big things that came out of it

  • When and how to assess
  • Categories / classifications
    • persisten renal proteinuria
      • localization
      • persistence
      • magnitude
  • Clinical response recommendations

4

Detecting urine protein

  • U/A
    • dipstick: colorimetric test
  • SSA test
    • semi-quantitative
    • more sensitive/specific
  • POC microabluminuria test
    • sensitive
    • do we care?!
  • Quantitative assays
    • eliminate other variables

5

Interpretation of proteinuria

 

 

  • Step 1: Localization
    • Pre-glomerular
      • tests
        • med Hx and PE
        • Chem/CBC
        • Blood pressure
    • Post-glomerular
      • tests
        • Med Hx and PE
        • UA
        • Urine culture
        • imaging
      • easy to R/O 
  • Step 2: check for persistence: will need multiple samples
  • Step 3: assess magnitute: UPC

6

Things that inc UPC

  • Active sediment
  • systemic hypertension
  • fever
  • high protein diet: raw foods
  • exercise

7

Things that DON'T change UPC

  • microscopic hematuria
  • Collection method
    • may be lower if collected at home
  • Time of the day
  • Fed vs fasted

8

Diagnostic investigation proteinuria

  • Tier 1
    • Hx & PE
    • Chem, CBC, UA, UPC, Urine Culture
    • regionally common infectious agents
  • Tiers II and III
    • imaging
    • additional infectious dz screening
    • renal bx

9

Kidney bx

  • H&E not helpful
  • may help with immune mediated disease tx
    • will tx with immunosuppression

10

Proteinuric kidney dz

Standard therapy

  • RAAS inhibition
    • ace inhibitors I think
  • Diet:
    • low protein
  • thrombophrophylaxis:
    • at risk for clotting because of protein loss
      • anti-thrombin same size as albumin so also lost
        • functions to inhibit clotting
    • platelet inhibition: aspirin
  • anti-hypertensives...?

11

side effects of ace inhibitors

  • lower glomerular filtration pressure, BP, and GFR
    • trade-off of lower GFR for less protein through glomerulus
  • retention of potassium
    • monitor for hyperkalemia

12

Immunosuppressant tx

  • avoid in dogs w/ suspected familial dz or amyloidosis
  • consider when dogs on standard tx have
    • Cr > 3.0 mg/dL, progressive azotemia
    • severe hypoalbuminemia
  • Close/careful monitoring
  • don't use without a bx unless patient progressing on standard therapy

13

If serology positive

  • treat for the agents you find
  • if they don't get better then consider
    • standard therapy
    • biopsy
    • immunosuppressive tx

14

Conclusions

  • Proteinuria has become imp in staging/tx CKD
  • localization, persistence, magnitude
  • guidelines for treatment are available
    • IRIS