Kutyák és macskák proteinuriája Irodalmi összefoglaló I. rész

Abstract

Summary In the first part of their review the authors summarize the pathophysiology, diagnostic workup and prognosis of diseases with proteinuria in companion animals. For the detection of urinary proteins the easiest and quickest methods are urinary dipstick and sulfosalicylic acid tests, although they lack specificity and sensitivity. The most accurate way to express the magnitude of proteinuria is to define the urinary protein to creatinine ratio (UPC). Measuring urinary albumin concentration can provide additional information in early stages of nephropathies. There are several physiologic and pathologic mechanisms leading to proteinuria. Pathologic proteinuria is defined by elevated UPC levels with inactive sediment on three different occasions at least 2 or more weeks apart. We can classify proteinuria into 3 categories according to its origin: pre-renal, renal, and post renal. Renal proteinuria can be further divided into glomerular, tubular, and interstitial (parenchymal) diseases. Diagnostic workup usually consists of thorough history and physical examination, complete blood count and chemistry panel, routine urine test with sediment examination, culture and UPC, blood pressure measurement and abdominal ultrasound. Kidney biopsies are essential for the correct differentiation between immune complex-mediated glomerulonephritis, non-immune complex glomerulopathies and amyloidosis, i.e. between the most severe forms of protein losing nephropathies. Biopsy specimens should be examined with the combination of light microscopy (viewed with several histochemical stains), immunofluorescence and transmission electron microscopy. Persistent and excessive proteinuria is associated with fast progression and high mortality rate. The poorest survival is observed in those proteinuric cases that lead to the development of nephrotic syndrome.