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There are 6 possible presentations with glomerular disease. Which is the most common?
signs related to chronic renal failure
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Why would glomerular disease be related to thromboembolism?
losing antithrombin III via damaged kidneys so more likely to form clots in body --> tx w/aspirin (low dose)
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Why would sudden blindness be related to glomerular disease?
hypertension/retinal hemorrhage and detachment; tortuous vessels
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Glomerular disease can be consistent with nephrotic syndrome signs. What are these signs?
- proteinuria
- hypoalbuminuria
- hypercholesterolemia
- edema/ascites
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So in summary, what are the 6 possible presentations of glomerular disease?
- signs related to CRF (most common)
- signs related to underlying infection, inflamm, neoplasia
- proteinuria as incidental finding
- nephrotic syndrome signs
- thromboembolism
- sudden blindness
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what are UA findings for glomerular disease?
- proteinuria with inactive sediment
- hyaline + granular casts
- lipid droplets
- isosthenuria (possible but not typical; w/lots of damaged nephrons)
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Hypoalbuminemia is seen with glomerular disease. what are two other renal differentials to keep in mind if you see this?
- 75% of dogs with amyloidosis
- 60% dogs w/glomerularnephritis
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Hypercholesterolemia is associated with glomerular disease. What are some other diseases that also present with this?
- nephrotic syndrome
- Cushings
- hyperthyroid
- DM
- amyloidosis/GN
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Is urine protein/creatinine ratio quantitative or qualitative? what is normal value?
- quantitative
- normal <0.3 or 0.4
- (questionable up to 1; but definitely abnormal >1)
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High UPC values (>10) are often seen with what renal disease?
amyloidosis
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what renal disease usually has UPC values <10?
interstitial renal disease
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what are UPC values like with glomerulonephritis?
variable (normal to >30)
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In non-azotemic patients, does magnitude of UPC correlate with severity of disease?
yes (but unreliable in presence of pyuria/severe hematuria bc has to be INACTIVE sediment)
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In azotemic patient w/decr. GFR, is decreasing UPC sign of improvement?
no
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what is level protein that has to be present to be detected on urine dip stick? what test can detect below this?
- 10-30mg/dl
- microalbuminuria >1 <30 (so more sensitive than UPC or dipstick)
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Microalbuminuria is an indicator of vascular endothelial damage but why is prognostic value still uncertain?
- more studies/info needed for animals w/positive values --> not sure if + test correlates with future disease development
- but if test is NEG then you can Rule Out endothelial damage
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T/F: microalbuminuria is positive in ~25% of dogs/cats and increases with advancing age.
True
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What can you say for sure if microalbuminuria test is negative?
glomerular barrier is working well
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What are some non-renal issues to rule out if microalbuminuria test is positive?
- hypertension
- endocrinopathy (cushings/DM)
- occult neoplasia
- heartworms/occult chronic infections
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what is the only reliable way to differentiate between GN and amyloidosis?
renal biopsy (cortex sufficient except in abyssinian/shar pei with medullary amyloidosis)
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what tests best assess glomerulonephritis?
immunohistochemistry or immunofluorescence and electron microscopy
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What is main treatment protocol for glomerular disease related to hypertension?
- give enalapril (angiotensin converting enzyme inhibitor to dilate efferent tubule -->decr. glomerular pressure/proteinuria)
- and consider amlodipine (Ca channel blocker for reducing hypertension)
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What are possible clinical outcome for patients with GN?
- spontaneous remission
- longterm stable proteinuria
- progression to CRF
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Should you give steroids to GN patient?
- harmful to dog
- not harmful to cat but don't know if its helpful
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Should you give Azathioprine (used for renal transplant & rheumatoid arthritis patients) to GN patient?
- may be helpful in dog
- toxic to cats (causes BM suppression)
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Should you give omega 3 fatty acids to GN patient?
yes, can suppress glomerular inflammation and coagulation
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there is no specific therapy shown to be beneficial for amyloidosis, but colchicine can be considered. What are possible beneficial effects?
decreases serum amyloid A protein by impairing hepatic secretion; can give to shar-pei w/recurrent febrile attacks
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In summary, what are some complications associated w/Glomerular disease?
- hypoalbuminemia
- Na retention
- thromboembolism
- hyperlipidemia (w/elevated cholesterol)
- hypertension ****
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why is it a bad idea to supplement protein in the diet for a patient with low serum protein?
increasing dietary protein will only worsen urinary protein loss
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Why are patients with nephrotic syndrome at risk for thromboembolism? where is most common site?
- increased fibin and decreased antithrombin III
- (fibrin >300 and ATIII <70% = increased risk)
- pulmonary artery (can give meds to try to prevent clots but not to break down existing ones)
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Plasma cholesterol/TG are inversely correlated to serum concentrations of what?
albumin (so if albumin goes down, cholesterol goes up)
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Why does patient with nephrotic syndrome get hyperlipidemia?
- low albumin leads to increased hepatic synthesis of lipids and decreased peripheral catabolism
- also losing regulatory factors in urine
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What is the purpose of giving enalapril (ACE inhibitor) to nephrotic syndrom pt? What med is often combined w/enalapril?
- reduce proteinuria +/- help to reduce hypertension
- may slow progression of renal disease
- give w/amlodipine to lower BP (monitor 1wk after starting)
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What specific monitoring should be done when giving enalapril?
- monitor BUN/Crea
- electrolytes (may get hyperK since blocking Na retention)
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In summary, what is the BEST treatment option for glomerulonephritis?
ACE inhibition (enalapril)
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What is the most common reason dogs with renal amyloidosis and GN die?
thromboembolic events
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what is prognosis for amyloidosis? GN?
- amyloidosis: poor
- GN: variable bc can spontaneously regress, stable for years, or progress to CRF in time
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