Term
| What are the major causes of proteinuria? |
|
Definition
Urinary tract inflammation (UTI MOST COMMON)
Glomerular injury (ie. amyloidosis) |
|
|
Term
| When trying to differentiate the significance of a proteinuria, what should you do? |
|
Definition
FIRST = look at Urine specific gravity
then - try urine protein-creatinine ratio |
|
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Term
| Bilirubinuria is more significant in which species? Why? |
|
Definition
Cats, because they have a higher renal threshold, so if it is elevated then the serum concentration is also elevated.
*most likely cause = primary hepatic disease* |
|
|
Term
| What are some considerations when preforming a renal biopsy? |
|
Definition
- very vascular, both capsule and parenchyma, so it may bleed
- run biopsy needle parallel to the renal cortex to get to where most of the nephrons are
- rarely preformed |
|
|
Term
| What are some indications for preforming a renal biopsy? |
|
Definition
- young dog that is unable to concentrate urine
- glomerular injury and need to find etiology |
|
|
Term
| What are the most common types of renal neoplasias in a dog? |
|
Definition
Carcinoma, adenocarcinoma
- very aggressive, but also decent prognosis (check for metastisis) |
|
|
Term
| If a dog is presented with unexplained azotemia and icterus, what should be on your differentials? |
|
Definition
LEPTO
titer is easy to run and rule out |
|
|
Term
| Which is more common: Pre-renal, renal, or post-renal azotemia? |
|
Definition
PRE-renal
sometihng causing decreased perfusion to the kidneys
(hypovolemia, shock, decreased cardiac output, dehydration, hypoproteinemia) |
|
|
Term
| What are the common causes of pre-renal azotemia? |
|
Definition
decreased perfusion to the kidneys:
-hypovolemia
-shock
-diuretic use
-anesthesetic event
- cardiac disease (decreased CO)
- dehydration
- hypoproteinemia |
|
|
Term
| How would you diagnose pre-renal azotemia? |
|
Definition
HISTORY and EXAM
-look @ hydration status
-cardiac signs of illness
-tachycardia
-abnormalities in non renal systems
Fully concentrated urine (USG = Normal)
urinalysis = Normal
polycythemia (increased PCV)
biochem may show non renal disease process |
|
|
Term
| What is the prognosis with pre-renal azotemia? What are some long term effects? |
|
Definition
Prognosis is generally good
- if ischemia of kidney persists, it can damage nephrons and cause primary azotemia |
|
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Term
| What is the mechanism of disease in obstructive post-renal azotemia? |
|
Definition
Obstruction (involving BOTH kidneys) prevents excretion of urine.
Urine backs up the urinary tract.
Backs up to kidneys.
Increased Tubular pressure opposes GFR |
|
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Term
Animals with a ruptured bladder and uroperitoneum are unable to pass urine.
True or False? |
|
Definition
FALSE
they may be able to pass small amounts of urine, so it may appear normal to owners |
|
|
Term
| When performing a abdominal paracentesis, which is a better indicator of a ruptured bladder: BUN or Creatinine? |
|
Definition
CREATININE
-takes longer to equilibriate, where BUN is much quicker |
|
|
Term
| What is the functional definition of primary renal azotemia? |
|
Definition
| Solute retention associated with a loss of 75% of functional nephrons |
|
|
Term
Profound dehydration can cause tachycardia.
True or False? |
|
Definition
|
|
Term
| What are some clinical signs of dehydration? |
|
Definition
Increased skin tenting
dry mucous membrnaes
prolonged capillary refill time
enophthalmia
weakened femoral pulses
tachycardia |
|
|
Term
| What are the three components of 24 hour fluid replacement therapy? |
|
Definition
Replacement therapy (to get animal back to normal)
Maintenance therapy (maintain normal hydration)
On-going losses (lost in vomit/diarrhea) |
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Term
| What are some causes of acute renal failure? |
|
Definition
Nephrotoxins
-Acetominophen in cats
-ethylene glycol poisoning
Obstructions
Ischemia
-thromboembolisms |
|
|
Term
| What is the most common electrolyte imbalance seen in acute renal failure? |
|
Definition
HYPERKALEMIA
because the potassium is not excreted properly in the urine |
|
|
Term
What is most often seen in acute renal failure:
A) metbolic alkalosis
B) metabolic acidosis
C) respiratory alkalosis
D) respiratory acidosis |
|
Definition
|
|
Term
| What are the common nephrotoxins that cause acute primary renal failure? |
|
Definition
Antibiotics
Ethylene glycol
chemotherapy agents
NSAIDS
ACE inhibitors
acetominophine |
|
|
Term
| How do nephrotoxins cause acute renal failure? (mechanism of pathogenesis) |
|
Definition
cause renal hypoperfusion
- disturb proximal tubular cellular metabolism |
|
|
Term
| What are some physical exam findings of acute renal failure? |
|
Definition
Uremic breath, oral ulcers
congested mucous membrnaes
dehydration, fever with nephritis
renal pain on palpation
normal-enlarged kidneys |
|
|
Term
Which is not associated with Acute Renal Failure:
A) PU/PD
B) mucous membrane congestion
C) Kidney pain on palpation
D) Small bladder
E) dehydration |
|
Definition
Answer: A)
with acute renal failure there is not enough time to make the animal pu/pd !!
the rest can all be seen though |
|
|
Term
| Why would you preform serological assays in diagnostic workups of acute renal failure? |
|
Definition
- leptospirosis
- ethylene glycol metabolites |
|
|
Term
| What are some considerations when administering antibiotics to an animal with acute renal failure? |
|
Definition
- *culture and sensitivity*
may need specific abx for lepto, etc
- may need to reduce dose, or increase dosing interval because many abx are eliminated in the urine (compensate for decreased GFR) |
|
|
Term
| What is the drug of choice for treating Leptospirosis? |
|
Definition
- Ampicillin
(we were taught Doxycycline Previously, but he says ampicillin then doxy if needed) |
|
|
Term
| What are the most common bacterial infections associated with acute renal failure? |
|
Definition
|
|
Term
| What measurements are indicative of metabolic acidosis (in acute renal failure) ? |
|
Definition
Blood pH below 7.2
bicarb of 12 or less
**start on bicarb therapy** |
|
|
Term
| Why might a dopamine infusion be used to treat acute renal failure? What are some precautions? |
|
Definition
- dopaminergic receptors on the heart and kidneys
- kidney receptors cause vasodilation
- cats have no renal receptors (increased perfusion from cardiac effects)
net effect = increase renal blood flow to increase GFR
* long term use can have cardiac effects |
|
|
Term
| What are the treatment strategies for treating hypovlemia of acute renal failure? What happens if your first choice still doesn't increase urine output? |
|
Definition
1) Fluids (LRS)
2) Mannitol to draw fluid into vasculature
if not increase for 2 hours...
3) add diuretic (furosemide), but needs to be well hydrated to work
4) finally Dopamine - to increase renal perfusion from cardiac and renal vasodilating receptors |
|
|
Term
| What are the indicators for bicarb therapy? |
|
Definition
blood pH of 7.2 or less
bicarb levels of 12 or less
(he said this at least three times, so Im assuming its important...) |
|
|
Term
| What is the best prognostic factor when treating Acute Renal Failure? |
|
Definition
|
|
Term
| What would be seen with the kidneys on necropsy of a dog with ethylene glycol poisoning? |
|
Definition
Severe tubular necorsis
calcium crystals |
|
|
Term
| What is the more common cause of renal failure in dogs? |
|
Definition
|
|
Term
| What effects do renal failure have on RBCs? |
|
Definition
decreased erythropoeitin released from the kidneys - so there is less ability to synthesis and release RBCs into periphery
- life span of circulating RBCs are REDUCED
=non regenerative anemia
(bone marrow also replaced to fibrous connective tissue) |
|
|
Term
| What are some radiographic findings of renal failure? |
|
Definition
Reduced Renal size
irregular renal contours
renal mineralization |
|
|
Term
| What might cause enlarged kidneys? |
|
Definition
infectious: FIP
obstructions (trigone neoplsia, etc)
Neoplasia
inflammation |
|
|
Term
| What are the differences between Chronic renal failure and Acute renal failure? |
|
Definition
Acute - increased renal size, NO pu/pd, no anemia, hyperkalemia (not excreting), metabolic acidosis
Chronic - hypokalemia, no metabolic acidosis, DECREASED kidney size, osteoporosis (bone loss), pu/pd, non regenerative anemia |
|
|
Term
| Why should management of chronic renal failure include low protein diets? |
|
Definition
| Because minimizing the protein will decrease the azotemia, damage to the kidneys, and amount of solutes that the glomeruli should filter. |
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|
Term
| Why should management of chronic renal failure include decreased sodium diet? |
|
Definition
| Because it can increase the risk of hypervolemia and hypertension - which would have substantial systemic effects |
|
|
Term
Animals with chronic renal failure often are hypocalcemic, which causes bone resorption.
True or False? |
|
Definition
FALSE
the problem is the PHOSPHORUS is increased causing a disturbance in the Ca:P ratio. The body reads this as a decrease in calcium, causing a release of PTH and resorption of bone. |
|
|
Term
| A dog presents with leukocytosis and pu/pd, T: 102.1, HR: 154, lethargy and weight loss. Should you start giving antibiotics? |
|
Definition
NO
there is no fever
and he hates antibiotics
LOL |
|
|
Term
| When you encounter proteinuria, how do you differentiate its significance? |
|
Definition
Preform a urine specific gravity reading.
If there is proteinuria in the presence of adequate concentration, this is normal. If the urine is isosthenuric, then it is a significant finding. |
|
|
Term
| What is the most common cause of glomerulus specific injury? |
|
Definition
IMMUNE mediated
(which is triggered by antigen trapped in the glomerulus) |
|
|
Term
| What mediated immune injury to the glomerulus? |
|
Definition
|
|
Term
Antigen is the trigger for gomerular injury in both cats and dogs.
True or False? |
|
Definition
|
|
Term
| What is the special stain that can be used to look at the golmerulus? |
|
Definition
|
|
Term
Amyloidosis is an inflammatory lesion.
True or False? |
|
Definition
FALSE
Amyloid just crowds out the glomerulus |
|
|
Term
Clinically significant proteinuria is common in cats.
True or False? |
|
Definition
|
|
Term
| Which breed has a familial predisposition for amyloid causing glomerular disease? |
|
Definition
Chinese Shar peis (dog)
Abysinnian cats |
|
|
Term
| What are the systemic consequences of progressive proteinuria? |
|
Definition
- sodium retention causes ASCITES
- Potential for THROMBOEMBOLISM (esp in the lungs)
- SYSTEMIC HYPERTENSION |
|
|
Term
| Why does persistent glomerular injury cause hypertension? |
|
Definition
Multiple reasons.
Activation of Renin Angiotensin-aldosterone system
- catecholamine induced vasoconstriction
- modulation by uremic toxins such as PTH |
|
|
Term
| Why may edema be a sequalae to persistent proteinturia? |
|
Definition
| Because the animal is losing protein in teh urine - causing hypoproteinemia which causes a decrease in oncotic pressure. This is what causes edema |
|
|
Term
| Why may edema be a sequalae to persistent proteinturia? |
|
Definition
| Because the animal is losing protein in teh urine - causing hypoproteinemia which causes a decrease in oncotic pressure. This is what causes edema |
|
|
Term
| How would you diagnose glomerular injury ? |
|
Definition
History of chronic disease (lepto, FIP, etc)
animals are NOT azotemic
will NOT be in renal failure
signs of uremia present
- marked proteinuria w/isosthenuria
- may have casts w/ benign sediment
- hypercholesterolemia
**urine protein:creatinine ratio** to determine loss of protein |
|
|
Term
| How would you differentiate Glomerulonephritis and renal amyloidosis? |
|
Definition
|
|
Term
| What is the treatment for renal amyloidosis? |
|
Definition
NO specific therapy available
DMSO and Colchicine - used in isolated instances |
|
|
Term
| How do you treat glomerulonephritis? |
|
Definition
**ID AND REMOVE ANTIGEN**
manage chronic renal failure
aspirin for anti-platelet
ACE inhibitors to decrease glomerular hypertension (enalapril)
low salt diets/diuretics for effusions
Omega 3 supplements |
|
|
Term
| How do Omega 3 fatty acid supplements help with renal failure? |
|
Definition
Change arachoadonic acids to less inflammatory ones.
inflammation is a significant part of the problem |
|
|
Term
| What is the consequence of renal glucosuria? |
|
Definition
the glucose provides a substrate for bacteria so it predisposes the animal for Urinary tract infections.
A small amount of glucose in the urine is normal in Elk hounds |
|
|
Term
| What defines the abnormal boundaries of pyuria? |
|
Definition
|
|
Term
| Most urinary tract infections are monomicrobic or polymicrobic? |
|
Definition
MONOmicrobic
this is the case of over 75% of the cases |
|
|
Term
| What are the most common microbial isolates of urinary tract infection? |
|
Definition
**Ascending infection of normal flora**
E.COLI
gram +
(then proteus, klebsiella, pasteurella, pseudomonas) |
|
|
Term
Urinary tract infection in the cat is an uncommon finding.
True or False? |
|
Definition
|
|
Term
| Urinary tract infections are commonly caused by normal flora. These infections are typically Ascending or Descending? |
|
Definition
|
|
Term
| When evaluating for a urinary tract infection what is the only accurate collecting method? |
|
Definition
|
|
Term
| What is the gold standard of diagnosing a UTI? |
|
Definition
Urine CULTURE
also preform susceptibility to identify proper antibiotics to use |
|
|
Term
| What are predisposing factors to UTIs? |
|
Definition
-exposure to organisms
- residual urine volumes
-anatomical abnormalities
-urinary calculi (take XRAY)
-impairment of systemic immune function (diabetes mellitus and Cushings disease) & steroid use
-glucose in the urine
-catherization of the urinary tract |
|
|
Term
| What is an uncomplicated UTI? |
|
Definition
No underlying structural, neurological or functional abnormality
- clinical signs often resolve after 48 hours of treatment onset
**dont use fluoroquinolone (try clavamox ** |
|
|
Term
Cats should always be considered as Complicated UTI cases.
True or False? |
|
Definition
|
|
Term
| What is the benefit of preforming a Culture and sensitivity when evaluating UTIs? |
|
Definition
So that you can give the appropriate antibiotics and prevent a multi-drug resistant infection.
It costs a lot to do these cultures, but the antibiotics that you would have to end up using will ALSO be expensive. |
|
|
Term
| What is the difference between feline interstitial cystitis and feline lower urinary tract disease? |
|
Definition
|
|
Term
Obstructive FLUTD occurs primary in males or females?
What is the most common cause? |
|
Definition
MALES
cause = urethral plugs |
|
|
Term
FLUTD is often infectious.
True or False? |
|
Definition
FALSE
often triggered by predisposing factors like stress |
|
|
Term
Which of the following is NOT a predisposing factor for FLUTD?
a) Ad lib feeding of wet food
b) recent move
C) sleeping inside
D) Use of a litter box only for elimination
E) 21 hrs/day + indoor confinement |
|
Definition
Answer: A)
wet food decreases the risk of flutd, and ad lib feeding of dry food is a predisposing factor |
|
|
Term
| PU can mean two very important things in renal disease. What are these two things?? |
|
Definition
PU = Polyuria
PU = Perineal Urethrostomy (common surgical treatment of male FLUTD cats) |
|
|
Term
| What are the treatment strategies for non obstructive FLUTD? |
|
Definition
MANAGEMENT:
Dilute the urine (decrease urine specific gravity)
-wet food
-increase water
Also
litter box management
clean soiled areas |
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