Proteinuria Flashcards
(97 cards)
1
Q
glomerulus is a modified…
A
capillary bed
2
Q
ultrafiltrate of the plasma is formed in
A
the glomerulus
3
Q
filtration barrier in the glomerulus is composed of what layers?
A
- fenestrated endothelium
- glomerular basement membrane
- visceral epithelial cells (podocytes)
4
Q
the glomerular basement membrane determines…
A
the size of molecule that can cross
5
Q
podocytes are linked w/
A
tight jxns
6
Q
slits diaphragms are…
A
specialised cell jxn btw podocyte bridging the filtration slits
7
Q
What is the upper limit of filtration molecules that pass thru the podocytes is
A
70K Dalton
8
Q
What filtrate is too big to pass thru the podocytes
A
Albumin excluded
9
Q
Podocyte foot processes & slit diaphragms are rich in
A
negatively charged glycoproteins
10
Q
glomerulopathies lead to alterations of
A
filtration in the membrane
11
Q
nephropathies arising w/ involvement of the glomeruli are the initial injury that leads to…
A
glomerulopathies
12
Q
3 main categories of glomerulopathies
A
- immune complex glomerulonephritis
- primary glomerulosclerosis
- amyloidosis
13
Q
glomerulopathies in dogs is most common in what age?
A
middle-aged to older dogs
14
Q
what signs are seen in glomerulopathies in middle-aged to older dogs
A
- microalbuminuria
- proteinuria (nephrotic syndrome)
15
Q
canine glomerulopathies can occur in various…
A
breeds
16
Q
secondary glomerular diseases are commonly caused by
A
Young: infectious, inflammatory
Old: Neoplasia
17
Q
what signs are compatible w/ CKD that also occur in canine glomerulopathies
A
anorexia, PU/PD, V, halitosis
18
Q
Fluid retention in glomerulopathies will appear as…
A
ascites, peripheral oedema
19
Q
glomerulopathies will create thromboembolisms - how?
A
severe loss of ALB -> lose antithrombin -> tips balance of haemostatic state to procoagulation state -> create thromboemboli
20
Q
target organ damages in glomerulopathies is secondary to…
A
hypertension
21
Q
Signs of glomerulopathies may relate to…
A
underlying infectious, inflammatory, or neoplastic conditions
22
Q
non-specific signs of glomerular dz
A
weight loss, lethargy
23
Q
What are some signs of glomerulopathies picked up on physical exam?
A
- ascites or peripheral oedema (lack of oncotic pressure -> nephrotic syndrome)
- kidney variable is size/shape
- proteinuria
- non-specific evidence of dz
24
Q
Proteinuria is considered…
A
a neg prognostic indicator in cats/dogs
25
non-azotaemic cats w/ proteinuria will develop
azotaemia w/i 12 mos
26
proteinuria assoc'd w/
* interstitial fibrosis
* tubular degeneration & atrophy (direct toxicity)
* proteinaceous cases -> tubular obstruction
* decreased perfusion of tubulo-interstitium & cell necrosis
27
3 key elements of clinical assessment of proteinuria
* persistence
* localisation
* magnitude
28
lab tests for urine protein
* urine dipstick
* sulfosalicylic turbidimetric test (SSA)
* UPC
29
non-proteinuric UPC values in dogs/cats
dogs: <0.2
cats: <0.2
30
borderline proteinuric UPC values in dogs/cats
dogs: 0.2-0.5
cats: 0.2-0.4
31
proteinuric UPC values in dogs/cats
dogs: >0.5
cats: >0.4
32
potential causes of pre-renal proteinuria in dogs/cats
* haemoglobinuria from intravascular haemolysis
* myoglobinuria from rhabdomyolysis
* immunoglobulin light chains from multiple myeloma or lymphoma
33
potential functional/physiological causes of proteinuria in dogs/cats
* strenuous exercise
* fever
* seizure
* exposure to extreme heat/cold
34
glomerular renal causes of proteinuria in dogs/cats
any cause of glomerular injury or dysfxn (membranoproliferative glomerulonephritis, membranous nephropathy, glomerulosclerosis, amyloidosis)
34
tubular renal causes of proteinuria in dogs/cats
any cause of glomerular injury or dysfxn (membranoproliferative glomerulonephritis, membranous nephropathy, glomerulosclerosis, amyloidosis)
35
interstitial renal causes of proteinuria in dogs/cats
Interstitial nephritis
35
post-renal causes of proteinuria of dogs/cats
* UTI
* urolithiasis
* transitional cell carcinoma
* vaginitis
35
glomerular dz in dogs will have a UPC of...
glomerular dz
35
if UPC in a dog is <2.0 it could have...
glomerular OR tubular dz
36
UPC >2.0 in dogs leads to
protein leaking in the urine
37
Hypoalbuminaemia is a sign of
glomerular lesions
38
isosthenuria is a variable finding in
dogs w/ glomerular dz
39
azotaemia + intact concentrating ability (isosthenuria) =
glomerular lesions
40
isosthenuria could be present with what types of casts in urine?
hyaline casts
41
Cylinduria is common in...
dogs w/ glomerular dz
42
proteinuria promotes precipitation of...
Thamm-Horsfall mucoprotein in the tubular lumen forming a hyaline cast
43
renal haematuria is rare in...
dogs
44
hypoproteinaemia is secondary to
hypoalbuminaemia dvlpmt in dogs
45
Azotaemia, hyperphosphataemia, metabolic acidosis can be signs of...
CKD
46
non-regenerative anaemia, thrombocytosis, and hyperfibrinogenaemia can also be part of what condition?
proteinuria
47
nephrotic syndrome is a sign of progression of
proteinuria
48
signs of nephrotic syndrome
* hypoalbuminaemia
* proteinuria
* hypercholesterolaemia
* peripheral oedema/ascites
49
diagnostic imaging is part of...
staging
50
progonosis & txt for each of the 3 categories of proteinuria is
very different
51
Contraindications for renal Bx
* end-stage CKD (will not change prognosis)
* coagulopathy
* hypertension
52
how common is amyloidosis?
15% reported cases
56% dogs w/ nephrotic syndrome
53
you cannot cure...
amyloidosis; supportive txt only
54
clinical features of amyloidosis
* more common in older dogs
* beagle & E. foxhound
55
renal amyloidosis in Shar-peis dvlps at
younger age & is more common in females
56
Amyloid A demonstrates signs of
chronic inflammation & persistent elevation in SAA; kidney/liver
57
Txt of Shar-Pei amyloidosis
* little to no evidence
* Colchicine rec'd to prevent progression of dz (but has severe GI signs in dogs)
58
Prognosis for animals w/ amyloidosis
Poor
59
MST for animals w/ amyloidosis
2-20 mos, 1 yr survival (8%)
60
Glomerulosclerosis
aging & remodelling of glomeruli normally but earlier in life & progresses faster
61
Inhibition of RAAS to control proteinuria due to
changing haemodynamics at glomeruli to decrease pressure of capillaries & protein-leakage
62
haemodynamic forces influence the
transglomerular mvmt of proteins
63
altering renal haemodynamics (aka decreasing hydrostatic pressure) means
reducing proteinuria (protein leaving BVs)
64
RAAS targeting agents
antihypertensive agents (ACEi) or angiotensin receptor blockers (ARB)
65
RAAS inhibition is the standard of care in pets w/
renal proteinuria w/ 0.2 (d)/0.4 (c) UPC
66
ACEi lowers
efferent arteriole resistance
67
ACEi cause what changes in the kidneys leading to efferent arteriole resistance?
* decrease glomerular capillary hydrostatic pressure
* decrease size of glomerular endothelial pores
68
What do angiotensin receptor blockers do?
block angiotensin II receptor 1
69
ARBs cause what in cats?
proteinuria & renal dz
70
Telmisartan is what kind of drug? what does it treat?
ARB
1st line of choice for hypertensive, proteinuric cats
71
Losartan is what kind of drug? what species does it treat?
* ARB
* dogs
72
Combined therapy can be used to inhibit RAAS how?
ACEi + ARB
73
Ideal therapeutic target with medications for treating proteinuria/glomerulonephritis
UPC <0.5-1.0 w/o worsening renal fxn
74
if the target UPC is not achieved, what does this mean for medication dosing?
* dosage can be increased q 4-6 wks
* if the max dosage is reached in 1 drug, then add another agent or change medications entirely
74
Alternate target for drug therapy for dogs
>50% reduction in UPC
75
Hyperkalaemia is a common side effect of...
RAAS inhibition, more so in dogs than cats
76
What kind of diets can help manage hyperkalaemia?
* renal diet b/c supplemented in K+
* low protein/low fat (hydrolysed protein) diet
77
pseudohyperkalaemia can occur secondary to...
thrombocytosis in dogs
78
if hyperkalaemia occurs and is greater than 5.5 mEq/L, what effects must be monitored
Cardiotoxic effects
79
what organ is the target organ for systemic hypertension?
kidney
80
A uraemic crisis consists of...
sustained hypertension which is caused by increased magnitude to proteinuria & decreased GFR
81
A RAAS inhibitor is a weak
anti-hypertensive agent
82
RAAS inhibitors lead to a reduction in
blood pressure by 10-15%
83
If BP > 160 mmHg, dosing for a RAAS inhibitor should be
increased until the max dose is reached, then Ca channel blocker added
84
What Ca channel blocker is used when managing hypertension?
Amlodipine
85
In dogs, amlodipine will activate what system?
RAAS
86
When managing hypertension, what are the therapeutic goals?
120 mmHg
87
For a proteinuria patient, what is the dietary management goal?
to modify the polyunsaturated fatty acid ratio & protein content
88
For stage I & II dogs, dietary management should consist of...
low fat diet & omega-3s
89
50-60% of proteinuric dogs have...
immune complex mediated glomerulonephritis
90
Prednisolone increases...
proteinuria
91
when might you consider a Bx?
* animal w/ persistent glomerular proteinuria
* to confirm active immune mediated glomerulonephritis
92
Contraindications for renal biopsy
severe azotaemia
hypertension
coagulation disorder
pyelonephritis
hydronephrosis
anaemia
