Kutyák és macskák proteinuriája II. rész: Kutyák és macskák proteinuriájának gyógykezelése - Irodalmi összefoglaló

Abstract

SUMMARY In the second part of their review the authors summarize the therapeutic possibilities of proteinuria. The treatment of proteinuria is indicated if the proteinuria is persistent (the urinary protein/creatinine ratio is > 0,5 in dogs and > 0,4 in cats at three different occasions at least 2 weeks apart with inactive urinary sediment) and we do not find any underlying extrarenal cause or the proteinuria is still present in spite of the adequate treatment of the underlying disease. The medical care consists of standard therapy alone or along with immunosuppressant therapy. The first step of standard therapy is „kidney diet”, which contains high quality but restricted amount of proteins, reduced amount of phosphorus and sodium, and has a decreased omega 6:3 fatty acid ratio. The first-choice drugs are those blocking the renin-angiotensin-aldosterone system (ACE-inhibitors, angiotensin receptor blockers or aldosterone blockers). Anticoagulants, antihypertensive agents, fluid or diuretic therapy can be added if necessary. Histopathologic evaluation of kidney biopsy samples helps us to differentiate between the different types of glomerulopathies. The two main categories are immune complex-mediated glomerulonephritis (including: mem-branous, membranoproliferative glomerulonephritis, mixed glomerulonephritis, focal segmental glomerulosclerosis type II) and non-immune complex glomerulopathies (including: amyloidosis, focal segmental glomerulosclerosis type I, minimal change disease, juvenile nephropathies, miscellaneous diseases). Immunosuppressant therapy is indicated in case of histopathologic evidence of an immune-mediated glomerulonephritis. Immunosuppressant therapy trial should be considered in dogs even in the absence of histopathologic diagnosis in case of worsening azotaemia and/or hypoalbuminemia despite standard ther-apy. Immunosuppressant therapy is contraindicated where familial nephropathies or amyloidosis can be suspected.