Renal - Glomerular and Tubular Diseases Flashcards Preview

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Flashcards in Renal - Glomerular and Tubular Diseases Deck (46)
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1

Where are the 2 sites of possible renal protein loss?

The glomerulus and proximal renal tubule

2

What are the three layers of the glomerulus?

Capillary endothelium, glomerular basement membrane, and visceral epithelium (podocytes)

3

What size molecules and cells does the glomerulus exlude?

proteins > 67 kDa from the ultrafiltrate

4

What can unchecked proteinuria lead to?

Hypoalbuminemia, thromboembolism, and decreased nephron lifespan

5

At what age of onset do dogs get proteinuria?

Middle/old age. If the patient is younger, consider a familial glomerular disorder

6

Is proteinuria more common in dogs or cats?

dogs - it is rare in cats

7

What clinical signs are associated with mild gomerular disease?

azotemia

8

What clinical signs are associated with late proteinuria?

edema/effusion, thromboembolism, and organ damage

9

What will you find on CBC in a patient with proteinuria?

You may have anemia

10

What may you find on a chemistry in patients with proteinuria?

Hypoalbuminemia, +/- signs of decreased renal function (+/- azotemia, +/- hyperphosphatemia), and +/- metabolic acidosis

11

Will USG be affected by proteinuria?

Unlikely - the concentration ability is often intact

12

What may you find on urine sediment in a patient with proteinuria?

casts

13

What is the most common fist step to diagnosing proteinuria?

Urine dipstick

14

What is the most quantitative test for proteinuria?

UPC ratio - it will correlate with daily protein loss

15

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

16

What are the causes of transient proteinuria?

Fever, physical exertion, and seizure

17

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

18

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

19

What is the purpose of a renal biopsy in proteinuric patients?

To allow for definitive histopathological diagnosis

20

What are the indications for renal biopsies?

Lack of response to standard therapy, UPC >3.5, and if you are considdering immunosuppresion

21

What are the contra-indications for renal biopsies?

Underlying disease identified/treated, uncontrolled hypertension, coagulopathy, and end-stage CKD (stage 4)

22

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

23

What accounts for 50% of cases of canine glomerular disease?

ICGN - immune-complex glomerulonephritis

24

What is ICGN more likely to respond to?

immunosuppression

25

How is glomerular disease managed?

Monitoring and treatment of underlying disorder, reduction and proteinuria, management of decreased renal function and other consequences, +/- immunosuppression

26

How can proteinuria be reduced nutritionally?

Decrease dietary protein (25-50%) and omega-3 fatty acid supplementation

27

How can proteinuria be reduced pharmaceutically?

Modulation of RAAS pathway with ace inhibitors or angiotensin receptor blockers

28

How is hypercoagulability managed in proteinuric patients?

The use of platelet inhibitors - Clopidogrel and Aspirin

29

What drug is used to manage hypertesion in proteinuric patients?

Amlodipine

30

Aside from hypercoagulability and hypertension, what other consequences of decreased renal function need to be managed?

Phosphorus intake, anemia, metabolic acidosis, and gastrointestinal manifestations

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