Term
| What determines the BUN in a horse? |
|
Definition
-age
-diet
-rate or urea pdn
-renal function |
|
|
Term
| What are some causes of inc BUN in the horse? |
|
Definition
-inc protein cataboism
-dec renal blood flow or renal function
-GI dz |
|
|
Term
| How does BUN change in relation to fasting in the horse vs the pony? |
|
Definition
-HOrse: inc protein catabolism = BUN inc
-Pony: inc fat catabolism = BUN dec |
|
|
Term
| From what is creatine produced? |
|
Definition
|
|
Term
| What is creatinine concentration, pdn, and excretion proportional to? |
|
Definition
-muscle mass
-THE MORE MUSCLE THE HIGHER PHOSPHOCREATININE AND THUS HIGHER CREATININE |
|
|
Term
| Which horses naturally have a higher creatinine? |
|
Definition
|
|
Term
| How is creatinine excreted? |
|
Definition
| -urine: also in sweat an dGI tract |
|
|
Term
| Describe creatinine levels in a foal. |
|
Definition
-30-50% higher than mare in first few days of life
-don't necessarily put on fluids
-can be as high as 20-30 mg/dl in some premature or asphyxiated foals
-will drop lower than adults after first 5 days |
|
|
Term
| Why do foals have low creatinine? |
|
Definition
| -rapid growth + litle skeletal muscle |
|
|
Term
| What are some other things that can affect creatinine? Why? |
|
Definition
-exercise, rhabdomyolysis, muscle wasting
-due to inc breakdonw of creatinine from m & dec creatinine clearance during exercise |
|
|
Term
| How much does a horse normally drink a day? When does this change? |
|
Definition
-500 kg horse will drink 27-30 L/day
-drink most water in hour after eating & when lactating
-feral ponies only drink once or twice daily |
|
|
Term
| What is the typical blood flow & CO used in the kidneys? |
|
Definition
-15-20% CO
-7,5-10 L/min
-high met rate second only to the heart |
|
|
Term
| How much whole body oxygen does the kidney use? |
|
Definition
|
|
Term
| Describe the standard state of the renal medulla. |
|
Definition
| -always in hypoxic state but highest ATP use and thus oxygen consumption |
|
|
Term
| How does the body protect the renal medulla from hypoxia? How is this clinically relevant? |
|
Definition
-preferential red in cortical blood flow: redistribution to corticomedullary region
-pxn of PGE2, PGI2, and NO as vasodiltory substances
-CLINICAL RELEVANCE: NSAIDs block these prostaglandins |
|
|
Term
| Is it ever a good idea to give NSAIDs to a horse w/ dec perfusion? |
|
Definition
|
|
Term
| The kidney has dopaminergic type I adrenoreceptors. Why is this clinically relevant? |
|
Definition
| -can give Dopamine to inc blodo flow via vasodilation |
|
|
Term
| What are the most common presenting complaints in equine patients w/ kidney dz? Others? |
|
Definition
-wt loss and/or abnormal urination
-others: EXCESSIVE DENTAL TARTAR, urine scalding on pasterns (looks muddy in males), colic w/ repeated posturing tourinate, dysuria, hematuria, fever, anorexia, depression, ventral edema, oral ulceration |
|
|
Term
| What is pollakiuria? When is this common? |
|
Definition
-frequent urination
-females in estrus, cystitis, cystic calculi |
|
|
Term
| What is polyuria? When is this common? |
|
Definition
-inc urine pdn
-renal dz, PPID, behavior, DM or DI, psychogenic drinkers in stalled horses (boredom) |
|
|
Term
| What do we feel for on rectal exam w/ equine kidney dz? |
|
Definition
-bladder size, wall thickness, masses, cystic calculi
-caudal pole of left kidney
-ureters only if abnormal |
|
|
Term
| Does pollakiuria or polyuria occur more frequently w/ kidney dz? |
|
Definition
|
|
Term
| Why would we see a leukocytosis on CBC w/ renal case? |
|
Definition
|
|
Term
| Why would we see an anemia on CBC w/ renal case? |
|
Definition
| -chronic dz: dec erythropoietin & shortened RBC lifespan |
|
|
Term
| True or False: We can diagnose renal dz in the horse based on BUN alone. |
|
Definition
| -FALSE, never ever ever look at equine BUN alone |
|
|
Term
| At what point of renal dz does creatinine inc? |
|
Definition
| -at least 75% nephrons are non-functional |
|
|
Term
| How do sodium and chloride change w/ equine renal dz? |
|
Definition
-hyponatremia & hypochloremia
-also occurs w/ colitis |
|
|
Term
| How does potassium change w/ equine renal dz? |
|
Definition
|
|
Term
| How does calcium change w/ equine renal dz? |
|
Definition
-can be either high or low
-most commonly hgih w/ CRF |
|
|
Term
| Why would we look at CPK & AST w/ renal case horse? |
|
Definition
-if pigmenturia present may be helpful to differentiate myoglobinuria & hemoglobinuria
-if inc = myoglobinuria |
|
|
Term
| What value on chem panel is most useful in assessing renal function in horse? |
|
Definition
-Creatinine NOT BUN
-b/c BUN cac be inc w/ other things like GI dz |
|
|
Term
| What is the most common cuase of inc creatinine in a neonate (<3d)? |
|
Definition
|
|
Term
| What does equine urine look like on UA? |
|
Definition
-pale yellow to deep tan
-often turbid due to Ca carbonate crystals and mucus (mares) |
|
|
Term
| What is the typical USG in the horse? |
|
Definition
-normal adult: 1.030
-foal: < 1.012 (b/c diet is liquid) |
|
|
Term
|
Definition
| -lose ability to concentrate or dilute so typically have isothenuric urine |
|
|
Term
| What is typical pH of equine urine in adult and foal? |
|
Definition
|
|
Term
| How relevant are dipsticks in horses? |
|
Definition
| -DON'T USE THEM, mucus in urine will cause false positives |
|
|
Term
| How do we detect proteinuria in the horse? |
|
Definition
| -SSA: sulfosalicyclic acid precipitation |
|
|
Term
| What is the though process regarding glucose in equine urine? |
|
Definition
-glucosuria in absence of hyperglycemia => suspect dysfunction
-more common w/ ARF than CRF |
|
|
Term
| What do we think w/ bilirubin on equine UA? |
|
Definition
| -IV hemolysis, hepatic necrosis, obstructive hepatopathies (cholelithiasis) |
|
|
Term
| What is special about the equine sediment? |
|
Definition
| -calcium carbonate crystals are normal |
|
|
Term
| What is the purpose of fractional excretion? |
|
Definition
-used to measure tubular function
-draw blood and urine at the same time, prior to any fluid therapy |
|
|
Term
| True or FAlse: Alpha 2 agonists antagonize ADH causing diuresis in the horse. |
|
Definition
|
|
Term
| Describe presentation of renal agenesis. |
|
Definition
-unilateral: no clinical signs probably ever
-bilateral: anuria & death early in life |
|
|
Term
|
Definition
| -disorganized development of renal tissue not necessarily abnormal size |
|
|
Term
| What are some of the possible causes of renal dysplasia? |
|
Definition
-anomaous differentiation
-intrauterine ureteral obstruction
-fetal viral infection
-teratogens |
|
|
Term
| What is the function of the urachus? |
|
Definition
| -conduit for urine to pass from bladdr into alantoic cavity |
|
|
Term
| What is a patent urachus? |
|
Definition
-incompletely closed at birth
-tension on attachment to body wall = dilation |
|
|
Term
| What are the clinical signs of a patent urachus? |
|
Definition
-persistently moist umbilicus after birth where urine leaks or drips
-2 streams of urine at once |
|
|
Term
| What is the traditional treatment for congenital patent urachus? Explain why it is traditional. |
|
Definition
-use 7% iodine to cauterize wound
-doesnt really close it |
|
|
Term
| How do we really treat patent urachus? |
|
Definition
| -prophylactic abx to prevent ascending infection |
|
|
Term
| What is acquired patent urachus most commonly assoc w/? |
|
Definition
| -local or systemic septicemia |
|
|
Term
| How do we treat acquired patent urachus? |
|
Definition
-BS abx
-resolves w/ systemic dz
-NEVER EVER USE CHEMICAL CAUTERIZATION
-if still open 5-7d after tx think about sx |
|
|
Term
| Who does acquired patent urachus have a worse prognosis if it is associated w/ umbilical vein? |
|
Definition
| -b/c becomes falciform ligament to liver thus cnanot be ligated due to proximity to liver and infection stays |
|
|
Term
| What are the early warning signs of patent urachus? |
|
Definition
-patency on U/S
-frequent attempts to urinate
-wet umbilicus
-look for two streams |
|
|
Term
| What is the most common disorder of the neonatal bladder? Any sex predilection? |
|
Definition
|
|
Term
| What are the clinical signs of rupture bladder in foals? |
|
Definition
-repeated psoturing to urinate, stranguria
-easily misinterpreted as tenesmus (meconium impaction)
-may continue to void small amounts of urine making diagnosis tricky |
|
|
Term
| What lab abnormalities do we see w/ ruptured bladder? |
|
Definition
-dec Na & Cl
-inc Creatinine & K |
|
|
Term
| How do we diagnose ruptured bladder? |
|
Definition
-electrolyte abnormalities
-U/S
-abdominocentesis: abdominal creatinine 2X higher than serum |
|
|
Term
| How do we treat ruptured bladders? |
|
Definition
-sx but stabilize first!!
-fluids: .45% NaCl, 5% dextrose
-supportive care
-BS abx |
|
|
Term
| Why do we give 5% dextrose to foals w/ ruptured bladder? |
|
Definition
| -inc blood glucose causes insulin release which drives K+ into the cells |
|
|
Term
| What are the general causes of acute renal failure? |
|
Definition
| -dec perfusion: dec CO, inc renal vascualr R |
|
|
Term
| What are the most common causes of dec CO? |
|
Definition
-diarrha
-endotoxemia
-acute blood loss
-septic shock: babies
-prolonged exercise |
|
|
Term
| What is the most common cause of reversible azotemia in the horse? |
|
Definition
|
|
Term
| How does acute renal failure lead to azotemia? |
|
Definition
| -dec RBF, GFR, & urine output |
|
|
Term
| What are the two major sites of injury due to acute renal failure in the horse? |
|
Definition
-renal medullary crest necrosis: NSAIDs
-acute tubular necrosis: aminoglycosides, ischemia, other toxins (myoglobin/hemoglobin) |
|
|
Term
| What are the two most common sites of injury w/ equine acute renal failure? |
|
Definition
-renal medullary crest necrosis: NSAIDs
-acute tubular necrosis: ischmia & nephrotoxins |
|
|
Term
| What are the clinical signs of acute renal failure in horses? |
|
Definition
-dehydration
-depression
-anorexia
-tachycardia
=pyrexia
-mild abdominal pain
-LAMINITIS
-OLIGURIA |
|
|
Term
| How do we diagnose acute renal failure in horses? |
|
Definition
-inc creatinine
-rule out pre & post renal
-hyponatremia, hypochloremia, hyperkalemia
-proteinuria: SSA
-isosthenuria: loose ability to concentratie AND dilute |
|
|
Term
| How do we treat acute renal failure? |
|
Definition
-remove inciting cause!!
-fluids: electrolyte correction
-TDM
-Furosemide CRI |
|
|
Term
| How do we treat acute renal failure in horses? |
|
Definition
-correct initialfluid deficit in first 6h & continue until creatinine corrected
-avoid overhydration
-treat hyperkalecia: fix acid/base, give HCO3/glucose
-treat hypocalcemia |
|
|
Term
| How do we monitor overhydration in acute renal failure horse? |
|
Definition
-Central Venous Pressure (CVP) best
-also use BW, HCT |
|
|
Term
| What do we do if acute renal failure is oliguric after 10-1212 hrs of fluid therapy? Any causes for caution? |
|
Definition
-start dopamine: vasodialtor to inc blood flow to kidney
-be careful if hyperkalemic b/c causes VPCs |
|
|
Term
| What is the general prognosis for equine acute renal failure? |
|
Definition
| -depends on underlying cause, DURATION OF RENAL FAILURE, response to treatment and development of secondary complications |
|
|
Term
| What are some poor prognostic indicators w/ acute renal failure? |
|
Definition
-early intervention is not taken
-prolonged (>12h) oliguria or anuria |
|
|
Term
| How common is chronic renal failure found in horses? |
|
Definition
|
|
Term
| What is the most common presenting complaint w/ equine chronic renal failure? Other clinical signs? |
|
Definition
-wt loss
-CS: excessive dental tartar, ginigivitis, oral ulcers, PU/PD |
|
|
Term
| What lab findings do we see w/ equine chronic renal failure? |
|
Definition
-mild anemia
-hypoalbuminemia
-hyponatreia
-hypophosphatemia
-metabolic acidosis |
|
|
Term
| What is the prognosis of chronic renal failure in horses? |
|
Definition
|
|
Term
| How do we treat chronic renal failure in horses? |
|
Definition
|
|
Term
| Is cystitis typically a primary or secondary problem? Explain. |
|
Definition
-secondary
-ex: urolithiasis, bladder paralysis, catheterization, bladder neoplasia, sorghum cystitis |
|
|
Term
| HOw do we diagnose equine cystitis? |
|
Definition
-UA
-endoscopy
-U/S
-urine culture |
|
|
Term
| How do we treat equine cystitis? |
|
Definition
-correct primary problem
-may be prolonged |
|
|
Term
| Describe the prevelance of equine urolithiasis. Typical signalment? |
|
Definition
|
|
Term
| What are some predisposing factors for equine urolithiasis? |
|
Definition
-prolonged urine retention
-genetic tendencies to excrete more calcium, uric acid, or oxylates
-tissue damage |
|
|
Term
| What are the clinical signs of equine urolithiasis? |
|
Definition
-dysuria
-hematuria
-stranguria
-pollakiuria
-pyuria
-incontinence |
|
|
Term
| How do we diagnose equine urolithiasis? |
|
Definition
-rectal
-U/S
-don't forget the kidneys |
|
|
Term
| How do we treat equine urolithiasis? |
|
Definition
-sx
-abx
-NSAIDs
-dietary management: no alfalfa |
|
|
Term
| True or False: To correct equine urolithiasis, urinary acidification is suggested practice. |
|
Definition
| -FALSE, cannot acidify the urine of the horse like you can small rums |
|
|
Term
| What is sabulous cystitis? |
|
Definition
-aka sabulous sludge
-abnormal accumulation of sediment in the bladder
-typicallly accompanied by cystitis |
|
|
Term
| Why does cystitis usually accompany sabulous cystitis in horses? |
|
Definition
-irritation of mucosa by sludge
-ammoniagenesis |
|
|
Term
| What are some of the causes of sabulous cystitis in the horses? |
|
Definition
-EHV-1
-EHV-4
-EPM
\-EDM
-sorghum cystitis
-CSM
-neoplasia
-sacral vertebral trauma |
|
|
Term
| Why is sabulous cystitis a vicious cycle? |
|
Definition
-bladder dysfunction leads to inadequate emptying
-irritation and stretching of bladder wall detrimental to detrusor muscle function |
|
|
Term
| How do we treat equine sabulous cystitis? |
|
Definition
|
|
Term
| What is the typical prognosis of equine sabulous cystitis? |
|
Definition
| -historically been poor but recent reports of successful management |
|
|
Term
| What are our major equine differentials for equine hematuria? |
|
Definition
-vascular malformation
-UTI
-urolithiasis
-neoplasia
-exercise induced
-idiopathic
-pyelonephritis
-cystitis |
|
|
Term
| Where and in whom do we find equine urethral defects causing hematuria? |
|
Definition
-geldings & stallions
-weak sports
-proximal urethra/level of ischial arch: hematuria at end of urniation
-QH/QH crosses |
|
|
Term
| How do we treat equine hematuria? |
|
Definition
-may resolve spontaneously, if present > 1mo may need to do PU
-complete sexual rest |
|
|
Term
| Describe idiopathic renal hematuria in horses. |
|
Definition
-sudden onset of gross, often life-threatening hematuria
-one or both kidneys
-passage of blood clots in urine |
|
|
Term
| What breed is predisposed to equine idiopathic renal hematuria? |
|
Definition
|
|
Term
| How do we treat equine idiopathic renal hematuria? |
|
Definition
-no long term treatment
-can be fatal
-can give amino caproic acid to strengthen the clot in the short term |
|
|
Term
| What do we see on cytoscopy w/ Exercise Assoc Hematuria? |
|
Definition
| -bladder erosions or ulcers |
|
|
Term
| What causes exercise associated hematuria? |
|
Definition
| -abdominal contents pounding bladder against pelvis during exercise |
|
|
Term
| What are the clinical signs of cantharadin toxicosis? |
|
Definition
-pollakiruria
-hematuria
-dilute urine in the face of dehydration |
|
|
