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There are 6 possible presentations with glomerular disease. Which is the most common?
signs related to chronic renal failure
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)
Why would sudden blindness be related to glomerular disease?
hypertension/retinal hemorrhage and detachment; tortuous vessels
Glomerular disease can be consistent with nephrotic syndrome signs. What are these signs?
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
- sudden blindness
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)
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
Hypercholesterolemia is associated with glomerular disease. What are some other diseases that also present with this?
- nephrotic syndrome
Is urine protein/creatinine ratio quantitative or qualitative? what is normal value?
- normal <0.3 or 0.4
- (questionable up to 1; but definitely abnormal >1)
High UPC values (>10) are often seen with what renal disease?
what renal disease usually has UPC values <10?
interstitial renal disease
what are UPC values like with glomerulonephritis?
variable (normal to >30)
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)
In azotemic patient w/decr. GFR, is decreasing UPC sign of improvement?
what is level protein that has to be present to be detected on urine dip stick? what test can detect below this?
- microalbuminuria >1 <30 (so more sensitive than UPC or dipstick)
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
T/F: microalbuminuria is positive in ~25% of dogs/cats and increases with advancing age.
What can you say for sure if microalbuminuria test is negative?
glomerular barrier is working well
What are some non-renal issues to rule out if microalbuminuria test is positive?
- endocrinopathy (cushings/DM)
- occult neoplasia
- heartworms/occult chronic infections
what is the only reliable way to differentiate between GN and amyloidosis?
renal biopsy (cortex sufficient except in abyssinian/shar pei with medullary amyloidosis)
what tests best assess glomerulonephritis?
immunohistochemistry or immunofluorescence and electron microscopy
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)
What are possible clinical outcome for patients with GN?
- spontaneous remission
- longterm stable proteinuria
- progression to CRF
Should you give steroids to GN patient?
- harmful to dog
- not harmful to cat but don't know if its helpful
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)
Should you give omega 3 fatty acids to GN patient?
yes, can suppress glomerular inflammation and coagulation
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
In summary, what are some complications associated w/Glomerular disease?
- Na retention
- hyperlipidemia (w/elevated cholesterol)
- hypertension ****
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
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)
Plasma cholesterol/TG are inversely correlated to serum concentrations of what?
albumin (so if albumin goes down, cholesterol goes up)
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
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)
What specific monitoring should be done when giving enalapril?
- monitor BUN/Crea
- electrolytes (may get hyperK since blocking Na retention)
In summary, what is the BEST treatment option for glomerulonephritis?
ACE inhibition (enalapril)
What is the most common reason dogs with renal amyloidosis and GN die?
what is prognosis for amyloidosis? GN?
- amyloidosis: poor
- GN: variable bc can spontaneously regress, stable for years, or progress to CRF in time