Flashcards in Renal - Glomerular and Tubular Diseases Deck (46)
Where are the 2 sites of possible renal protein loss?
The glomerulus and proximal renal tubule
What are the three layers of the glomerulus?
Capillary endothelium, glomerular basement membrane, and visceral epithelium (podocytes)
What size molecules and cells does the glomerulus exlude?
proteins > 67 kDa from the ultrafiltrate
What can unchecked proteinuria lead to?
Hypoalbuminemia, thromboembolism, and decreased nephron lifespan
At what age of onset do dogs get proteinuria?
Middle/old age. If the patient is younger, consider a familial glomerular disorder
Is proteinuria more common in dogs or cats?
dogs - it is rare in cats
What clinical signs are associated with mild gomerular disease?
What clinical signs are associated with late proteinuria?
edema/effusion, thromboembolism, and organ damage
What will you find on CBC in a patient with proteinuria?
You may have anemia
What may you find on a chemistry in patients with proteinuria?
Hypoalbuminemia, +/- signs of decreased renal function (+/- azotemia, +/- hyperphosphatemia), and +/- metabolic acidosis
Will USG be affected by proteinuria?
Unlikely - the concentration ability is often intact
What may you find on urine sediment in a patient with proteinuria?
What is the most common fist step to diagnosing proteinuria?
What is the most quantitative test for proteinuria?
UPC ratio - it will correlate with daily protein loss
What is the approach to proteinuric patients?
Confirm if the proteinuria is persistent or transient. Once persistency is confirmed then screen for underlying disease. Finally do a renal biopsy
What are the causes of transient proteinuria?
Fever, physical exertion, and seizure
What criteria does there need to be for proteinuria to be considered persistent?
It needs to be confirmed in 3-4 instances over 2-3 weeks
What screening tests can be done for underlying disease/cause of proteinuria?
PE (fundic exam!), CBC/Chem/UA, blood pressure, urine culture, imaging, vector-borne disease testing, and endocrine testing
What is the purpose of a renal biopsy in proteinuric patients?
To allow for definitive histopathological diagnosis
What are the indications for renal biopsies?
Lack of response to standard therapy, UPC >3.5, and if you are considdering immunosuppresion
What are the contra-indications for renal biopsies?
Underlying disease identified/treated, uncontrolled hypertension, coagulopathy, and end-stage CKD (stage 4)
What are the differentials for glomerular disease?
Membranoproliferative glomerulonephritis (MGPN), membranous nephropathy, proliferative glomerulonephritis, immunoglobulin A nephropathy, amyloidosis, glomerulosclerosis, other non-IC glomerulopathies, non-IC glomerulopathies, and tubular diseases
What accounts for 50% of cases of canine glomerular disease?
ICGN - immune-complex glomerulonephritis
What is ICGN more likely to respond to?
How is glomerular disease managed?
Monitoring and treatment of underlying disorder, reduction and proteinuria, management of decreased renal function and other consequences, +/- immunosuppression
How can proteinuria be reduced nutritionally?
Decrease dietary protein (25-50%) and omega-3 fatty acid supplementation
How can proteinuria be reduced pharmaceutically?
Modulation of RAAS pathway with ace inhibitors or angiotensin receptor blockers
How is hypercoagulability managed in proteinuric patients?
The use of platelet inhibitors - Clopidogrel and Aspirin
What drug is used to manage hypertesion in proteinuric patients?