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Proteinuria

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Abstract

Persistent proteinuria with inactive urine sediment has long been a clinicopathological hallmark of chronic kidney disease in dogs and more recently cats. This chapter will discuss the importance of assessing and classifying proteinuria, the disorders which may cause proteinuria, and the mechanisms by which it may cause progressive renal injury.

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Figures

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5.1 (a) Structure of the glomerular filter, showing the three components that the fluid elements of the blood have to transverse to move from the capillary to the urinary space. These consist of the capillary wall (fenestrated endothelium), the glomerular basement membrane and the visceral epithelium (podocytes with slit pores). (b) Transverse electron micrograph of a normal glomerulus. BM = basement membrane; CL = capillary lumen; E = endothelial cell; FP = foot process; MFP = major foot process; US = urinary space. (b, © Gregory F. Grauer). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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5.2 Conventional semi-quantitative tests are used to screen for protein in the urine.
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5.3 A set of standards demonstrating the increasing turbidity (from left to right) that develops when 3–5% SSA is mixed with urine containing increasing protein concentrations.
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5.4 Flow diagram for the diagnosis of proteinuria in dogs and cats. Urine dipstick screening is not recommended for cats because of the high level of false-positive results. A negative value (which is a rare result for a cat) may be useful in ruling out proteinuria. BP = borderline proteinuria; NP = non-proteinuria; P = proteinuria; UPC = urine protein to creatinine ratio; USG = urine specific gravity.
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5.6 Unstained urine sediment viewed by light microscopy. The field of view shows >20 leucocytes and numerous chains of rod-shaped bacteria, suggesting urinary tract inflammation secondary to a bacterial urinary tract infection. (Original magnification X400)
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5.8 The mechanisms involved in progressive renal injury caused by proteinuria. Ang II = angiotensin II; ET-1 = endothelin-1; MCP-1 = monocyte chemoatractant protein-1; RANTES = immunoregulatory cytokine regulated on activation, normal T cell expressed and secreted; TGF-β = tissue growth factor-beta. (Adapted from )

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