FA3 Urinary > Lecture 4 > Flashcards

Lecture 4 Flashcards

(52 cards)

Study These Flashcards
1
Q

What are the characteristics of net filtration pressure in the kidneys?

A

-net pressure is 10 mmHg
-driven by glomerular hydrostatic pressure
-opposed by Bowman’s capsule pressure and glomerular oncotic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the characteristics of the podocytes?

A

-cells that line the ureters
-have slit diagrams between the foot processes to allow for filtering of small particles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the three layers through which particles are filtered through in the kidneys?

A

-glomerular blood vessel endothelium
-basement membrane
-podocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the determinants behind which particles are filtered?

A

-size; particles less than 60-70 kDa filter
-charge; positive particles filter best
-capillary pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens when tubular cells filter substances they are not meant to filter?

A

cell injury and decreased function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does proteinuria worsen kidney disease?

A

-proteinuria leads to oxidative stress and chemokine/cytokine production
-kidneys experience tubulointerstitial inflammation and fibrosis and tubular cell atrophy
-progression leads to changes in glomerular filtration barrier and alterations in reabsorption capacity of renal tubular cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does increased protein and UPC relate to CKD?

A

-causes a progression of azotemia
-increases patient’s risk of uremia
-shorter survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the characteristics of dipstick testing for protein?

A

-primarily measures albumin
-can have false negatives with Bence Jones proteins
-can have false positives with alkaline urine or too long of contact times

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is proteinuria confirmed after dipstick testing?

A

-urine protein to creatinine ratio (UPC)
-3 or more occasions documented 2 weeks apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why is protein measured against creatinine for confirmation?

A

creatinine is consistently excreted by the kidneys at about the same rate; provides a good standard to measure against

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are considerations to take into account when measuring UPCs?

A

-want urine to be free of pyuria and color change
-voided samples can be reliable if there is no pyuria/post-renal proteinuria
-UPC is higher in hospital vs at home due to stress
-there is normal day-to-day variation
-pooled or averaged samples are preferred when proteinuria is high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the ranges for UPC results?

A

Dogs:
-less than 0.2: non-proteinuric
-0.2 to 0.5: borderline proteinuric
-greater than 0.5: proteinuric

Cats:
-less than 0.2: non-proteinuric
-0.2 to 0.4: borderline proteinuric
-greater than 0.4: proteinuric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the values for significant differences in UPC?

A

-change of 40% at high UPC values (near 12)
-change of 80% at low UPC values (near 0.5)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can cause pre-renal proteinuria?

A

-increased low molecular weight proteins filtering through normal glomerulus
-systemic hypertension
-systemic inflammation
-hyperadrenocorticism
-cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the characteristics of physiologic proteinuria?

A

-altered physiology in response to transient stressor
-mild, transient proteinuria
-can occur with strenuous exercise, fever, or seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the characteristics of post-renal proteinuria?

A

-inflammatory exudate from lower urinary/repro. tracts
-can occur with infection, neoplasia, or urolithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is renal proteinuria?

A

abnormal renal handling of normal plasma proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the subcategories of renal proteinuria?

A

-physiologic
-glomerular
-tubular
-interstitial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the characteristics of glomerular proteinuria?

A

-worst type
-altered selectivity of glomerular basement membrane; all MWs of proteins can get through
-any magnitude UPC; typically > or = 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the differential diagnoses in patients with glomerular proteinuria?

A

-membranoproliferative glomerulonephritis
-membranous glomerulopathy
-glomerulosclerosis
-amyloidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the characteristics of tubular proteinuria?

Study These Flashcards
A

-impaired tubular recovery of plasma proteins normally found in filtrate
-lower magnitude UPC
-UPC < 2, often <1

22
Q

What are some of the differential diagnoses in patients with tubular proteinuria?

Study These Flashcards
A

-CKD
-acute tubular necrosis
-Fanconi’s syndrome

23
Q

What are the characteristics of interstitial proteinuria?

Study These Flashcards
A

-exudation of proteins from interstitium
-difficult to clinically distinguish from tubular proteinuria
-occurs with interstitial nephritis

24
Q

What is the SDS PAGE test?

Study These Flashcards
A

gel electrophoresis test that allows for identification of the exact proteins in the urine by molecular weight

25
What are the characteristics of immune-complex glomerulonephritis?
-accounts for around 60% of dogs with glomerular proteinuria -occurs with aberrant/excessive immune response; inflammatory or neoplastic -rare in cats
26
What are the possible immune deposits seen in immune-complex glomerulonephritis?
-subepithelial -subendothelial -intramembranous -mesangial
27
What are non-immune complex diseases that can lead to proteinuria?
-congenital dz -amyloidosis -glomerulosclerosis/scarring -glomerular lipidosis (rare)
28
What is involved in a work up for patients with proteinuria?
-history and physical exam -minimum database -indirect blood pressure -infectious dz screening -thoracic and abdominal imaging -possible endocrine testing -possible renal biopsy *treat any potential underlying conditions found*
29
What are the four major treatment goals in proteinuria cases?
-UPC reduction of at least 50% from baseline -potassium < or = 6.0 mmol/L -systolic blood pressure > or = 120 mmHg -serum creatinine stable or minimally increased
30
What are the serum creatinine increases tolerable levels for each stage of kidney disease?
Stage 1 or 2 CKD: < or = 30% increase from baseline Stage 3 CKD: < or = 10% increase from baseline Stage 4 CKD: no increase tolerated
31
What are the broad management steps for proteinuria?
-treat underlying causes -control hypertension -RAAS inhibition -nutritional modification -thromboprophylaxis -immunosuppression
32
Which organs receive end-organ damage from hypertension and why?
-brain -heart -kidneys -retina/eyes *these organs have one artery in, one vein out: suffer more damage from hypertension
33
What are the systolic blood pressure ranges in hypertension?
-< 140: normotensive, minimal risk of organ damage -140-159: prehypertensive, low risk of organ damage -160-179: hypertensive, moderate risk of organ damage -180+: severely hypertensive, high risk of organ damage
34
What are the goals regarding hypertension treatment?
-reduce BP and minimize risk of ongoing target organ damage -gradual persistent reduction over weeks; more rapid if ocular or neuro. crisis -maintain BP in 120 to 140 range
35
Which drugs are used to combat hypertension in dogs and cats?
MILD TO MODERATE: -ACE inhibitors or angiotensin II receptor blockers in dogs -calcium channel blockers or angiotensin II receptor blockers in cats SEVERE: -calcium channel blockers in dogs and cats
36
When does RAAS become activated?
compensation to reduction in blood pressure
37
What are the steps of the RAAS system?
-hypovolemia triggers kidneys to release renin -renin converts angiotensinogen from the liver into angiotensin I -angiotensin I is converted to angiotensin II in the lungs by ACE-converting enzyme -angiotensin II is a potent vasoconstrictor -angiotensin II also triggers aldosterone release to retain Na and H2O to improve blood volume and pressure
38
What are the adverse effects of chronic RAAS activation in renal patients?
-endothelial dysfunction -tissue fibrosis -cellular remodeling -proteinuria
39
How does angiotensin II function?
constricts the efferent arteriole to increase glomerular capillary pressure
40
How do ACE inhibitors like enalapril and benazepril function?
block ACE-converting enzyme in the lungs to prevent conversion of angiotensin I to angiotensin II
41
How do ARBs like telmisartin function?
-prevent angiotensin II from triggering aldosterone -prevent angiotensin II from acting as a vasoconstrictor
42
What are the characteristics of using telmisartan as a treatment?
-want to ensure patient is euhydrated -typically see improvement within a month -greater effect on UPC compared to ACE inhibitors -adverse events include GI signs, azotemia, and hyperkalemia
43
What should be monitored in patients on telmisartan?
-azotemia -hyperkalemia -blood pressure -UPC every 3-4 weeks
44
What are the characteristics of using ARBs and ACEi together?
-significant reduction in UPC vs each drug alone -lower systolic BP -discontinue if worsened azotemia and/or hyperkalemia -want to recheck blood work and BP any time doses are changed -do not use in hypovolemic/dehydrated animals
45
What are the characteristics of nutritional modification for proteinuria patients?
-want to reduce proteinuria and maintain lean body mass -want to recommend a low protein, high quality diet -low protein diet + RAAS inhibition can have additive effects -want to consider adding Omega 3 fatty acids
46
What are the characteristics of thromboprophylaxis?
-especially want to consider in glomerular proteinuria cases -protein-losing nephropathy can cause pulmonary and aortic thrombi -thought to be due to a loss of antithrombin and increased procoagulant factors -no predictive factors
47
Which drugs are used for thromboprophylaxis?
-anti-platelet drugs like clopidogrel -direct Xa-inhibitors (if dz present) -low molecular weight heparin (if dz present)
48
What are the characteristics of renal biopsy?
-used to determine if immunopathogenesis is occurring -guides decisions around immunosuppression -needs experienced personnel and special sample handling
49
What are the contraindications to renal biopsy?
-advanced CKD -increased risk groups -not helpful in diagnosing main differentials
50
When should immunosuppression be considered without a biopsy?
-glomerular proteinuria -failure of standard therapy -no contraindications -no familial nephropathy -amyloidosis unlikely -creatinine > or = 3.0 mg/dL with progressive azotemia -albumin < or = 2 g/dL
51
What is the protocol for immunosuppression therapy?
-mycophenolate mofetil, cyclosporine, +/- glucocorticoids -discontinue if no change after 3 to 4 months -taper to lowest effective dose if there is a response
52
What is important regarding proteinuria and CKD?
-no correlation to CKD stage; can occur at any stage -want to recognize and intervene early to stabilize CKD, slow progression, and improve survival
FA3 Urinary
flashcards
Decks in class (24)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions