Protein losing nephropathy (unfinished)

Protein losing nephropathy typically happens when damage occurs to what 3 structures of the urinary system?

• glomerulous

• renal tubules

• interstitium

Protein losing nephropathy leads to what conditions

• albuminuria

• further kidney damage

What are the consequences of protein losing nephropathy typically?

• hypoalbuminemia

• effusions

• hypertension

• hypercoagulability

• muscle loss

• progressive kidney injury

What are the classification of protenuria

• pre renal

• renal

• post renal

Pre renal causes of proteinuria could be what?

• hemoglobin/myoglobin

• immunoglobulin light chains

• hypertension

• steroids

A pre renal proteinuria typically indicates an ______ and need for additional evaluation

underlying condition

Causes for of renal proteinuria are related to what structures

• glomerular

• tubular

• interstitial

Proteinuria caused by glomerular changes are due to what?

damage to endothelium or epithelium

Proteinuria due to tubular changes is caused by what?

Chronic kidney disease

Proteinuria due to interstitial changes is due to what?

• neoplasia

• injury

• infection

• inflammation

Post renal causes of proteinuria are what?

• collection artifact

• lower urinary tract disease

Proteinuria is a problem due to what 3 aspects

• glomerular damage

• proximal tubular damage

• loss of albumin

Loss of albumin can lead to _________

nephrotic syndrome

What are the consequences of protein in the urine

• tubular and interstitial damage and fibrosis

• transformation of tubular epithelium into myofibroblasts

• damage to renal tubules by molecules that bind albumin

The consequences of proteinuria cause damage to the glomerular ________ function

permaselectivity

What is the best detection method for proteinuria

• dipstrip

• urine protein creatinine ratio

An animal with highly ____ and ___________ urine may cause false _______ on a dip strip

• alkaline

• concentrated

• positives

A _______ protein reading on a dip strip increases ________ and ________ in both dogs and cats

• 2+

• specificity

• PPV

A _____ protein reading on a dip strip needs _________ to verify

• 1+

• quantification

urine protein creatinine ratio evaluates level of protein in relation to the ____ of the urine

concentration

UPC is not a ______ test and should only be used if suspicious

screening

A normal UPC is __________

<0.2

UPC is loosely correlated with _______________ with a tubular disease typically being considered _____ grade and amyloidosis or severe glomerular disease being ________

• type of renal disease

• low

• high

Who should we test with a dipstick?

patients with chronic illness

If a patient gets greater than a 1+ protein reading what are the possible next steps?

• consider repeating in 2 weeks

• UPC to quantify

If protein is definitively elevated what are the next steps

• monitor

• investigate

• intervene

What should be monitored in dogs with elevated proteins

• blood pressure

• UPC

when investigating the cause for protein in the urine what should you be doing?

• rule out non renal causes

• measure blood pressure

• evaluate renal function

• look for underlying inflammation

What are the 3 tiers of glomerular disease

1. uncomplicated proteinuria

2. proteinuria and decreased albumin

3. proteinuria and azotemia

What diagnostics should be run with a tier 1 glomerular disease

• CBC

• chem

• UA

• BP

• UC

• UPC

A dog with tier 1 renal glomerular disease is most likely due to what?

• travel or localized infections

• drugs

What diagnostics should be run on a dog with tier 2 glomerular disease

• abdominal ultrasound

• thoracic radiographs

• liver function evaluation

• assess for GI protein loss

• renal biopsy

What diagnostics should be considered for tier 3 glomerular disease

renal biopsy

The only definitive way to determine type of glomerular damage is through what?

renal biopsy