Term
Prerenal azotemia is usually caused by:
a. dehydration
b. renal insult
c. too much diuretic medicine
d. A and B
e. A and C |
|
Definition
|
|
Term
| For azotemia to be apparent, at least ___% of the renal parenchyma must be compromised. For animals to be incapable of concentrating their urine, at least ___% of their renal parenchyma must be compromised. |
|
Definition
|
|
Term
GFR is affected by:
a. Renal blood flow
b. Both glomerular and Bowman's capsule hydrostatic pressure
c. Plasma oncotic pressure
d. Loss of glomeruli
e. All of the above |
|
Definition
|
|
Term
| Cortical nephrons make up ____% of the nephron population, while juxtamedullary nephrons make up ___% of the nephron population. |
|
Definition
|
|
Term
Which nephron population contributes to the urine concentration?
a. Cortical nephrons
b. JM nephrons
c. Both
d. Neither |
|
Definition
b. JM nephrons
These are large, deep loops in the renal medulla |
|
|
Term
Which nephron population contributes to increased renin release?
a. Cortical nephrons
b. JM nephrons
c. Both
d. Neither |
|
Definition
a. Cortical nephrons
These are small, short loops in the renal cortex that have a low filtration rate. |
|
|
Term
Most solute reabsorption occurs in the:
a. Proximal tubules
b. Distal tubules
c. Loop of Henle
d. Collecting ducts
e. Bowman's capsule |
|
Definition
a. Proximal tubule
approximately 70-90% of the filtrate is reabsorbed (glucose, Na, K, bicarb); this is also the site where most nephrotoxic drugs act; Note that reabsorption is an active process. |
|
|
Term
| The _______________ loop of Henle is permeable to water and impermeable to solute, while the ______________ loop of Henle is permeable to Na and Cl, and is also the site of action for loop diuretics. |
|
Definition
|
|
Term
The Macula densa are found in the:
a. Proximal tubule
b. Distal tubule
c. Loop of Henle
d. Convoluted tubule
e. Glomerulus |
|
Definition
|
|
Term
All of the following are functions/characteristics of the distal tubule except:
a. Site of action for potassium-sparing diuretics
b. Home to specialized cells called the macula densa
c. Responsible for rennin release
d. Responsible for blood flow and solute delivery in response to rennin
e. The site of action of thiazide diuretics |
|
Definition
| a. site of action for potassium sparing diuretics |
|
|
Term
| The _______________ are responsible for altering urine volume and osmolality in response to ADH release. |
|
Definition
|
|
Term
Which two molecules are primarily resorbed in the collecting ducts of the kidney?
a. Na, Urea
b. Water, Urea
c. K, Urea
d. Na, K
e. H, K |
|
Definition
|
|
Term
The major medullary solutes are:
a. Na, Urea
b. Water, Urea
c. K, Urea
d. K, Na
e. H, Na |
|
Definition
|
|
Term
Animals deficient in ADH have what condition?
a. Diabetes mellitus
b. Diabetes insipidus
c. Hyperthyroidism
d. Hypoadrenocorticism
e. Lymphoma |
|
Definition
|
|
Term
| T/F: The countercurrent mechanism in the kidney is essential for concentrating urine. |
|
Definition
| True--need to have a hypertonic medullary interstitium |
|
|
Term
All of the following are required for urine osmolality to function properly except:
a. ADH
b. Collecting duct receptors
c. Hypertonic medullary interstitium
d. Hypotonic medullary interstitium
e. None of the above |
|
Definition
| d. Hypotonic medullary interstitium |
|
|
Term
| Aldosterone primarily functions in ____ reabsorption and ____ excretion. |
|
Definition
|
|
Term
All of the following will enhance renin secretion except:
a. Hyponatremia
b. Hypovolemia (hemorrhage, diuretics)
c. Cholinergic activity
d. Cardiac failure
e. Aorta or renal artery constriction |
|
Definition
c. Cholinergic activity
Adrenergic activity will enhance renin secretion--I think because of vasoconstriction?? |
|
|
Term
Which of the following is a stimulus for thirst?
a. Dryness of the mouth
b. Increased osmolality
c. Hypovolemia
d. A and B
e. A, B, and C |
|
Definition
|
|
Term
All of the following contribute to enhanced ADH secretion except:
a. Increased osmotic pressure (hypertonicity)
b. Decreased ECF volume
c. Hypernatremia
d. Angiotensin II release
e. Hypokalemia |
|
Definition
| e. Hypokalemia--maybe it does in some weird convoluted way, but it's not in the notes so I basically just made up an answer :-) |
|
|
Term
Which of the following is not a way in which the ECF volume is maintained?
a. Hypovolemia activates rennin
b. RAA increases sodium
c. Angiotensin II stimulates thirst
d. ADH increases water reabsorption
e. All of the above are ways to maintain the ECF volume |
|
Definition
| e. All of the above are correct |
|
|
Term
Which of the following is not a COMMON cause of diabetes insipidus?
a. quantitative decrease in ADH
b. Hypercalcemia
c. Cushing's disease
d. Pyelonephritis
e. Pyometra |
|
Definition
a. quantitative decrease in ADH--this is central DI, which is extremely rare
I'm sure the other ones are not entirely common, but they all make up nephrogenic DI, which in itself is much more common than central DI |
|
|
Term
| What are the classical clinical signs of diabetes insipidus? |
|
Definition
Polyuria
Polydipsia
Hypovolemia |
|
|
Term
| A dog would be considered polydipsic if it was consuming > ___ ml/lb/day. |
|
Definition
|
|
Term
Which of the following is not considered a cause of PU/PD?
a. Severe liver disease
b. Hypocalcemia
c. Pyelonephritis
d. Diabetes Mellitus
e. Hyperadrenocorticism |
|
Definition
b. hypocalcemia
Hypercalcemia causes PU/PD |
|
|
Term
Which of the following is not considered a cause of PU/PD?
a. Hyperkalemia
b. Hypoadrenocorticism
c. Chronic renal failure
d. Pyometra
e. Pituitary/Nephrogenic diabetes insipidus |
|
Definition
a. hyperkalemia
Hypokalemia is a cause of PU/PD, presumably because there isn't enough to be exchanged and kicked out when sodium is reabsorbed, so sodium stays out and water follows. |
|
|
Term
Which of the following is not a routine procedure when evaluating the urinary tract?
a. Monitoring BUN and serum creatinine
b. Measuring creatinine clearance
c. Determining the urine concentrating ability
d. Performing a water deprivation test
e. Performing a urinalysis |
|
Definition
d. Performing a water deprivation test
This test differentiates PU/PD patients by evaluating tubular function. However, it is only indicated in well hydrated, non-azotemic patients. To perform, take a BW, USG and TP q2h. The procedure should be stopped if the patient becomes >5% dehydrated, >5% loss of BW, or produces concentrated urine. If no concentration occurs, an ADH challenge can be performed. |
|
|
Term
| T/F: BUN is excreted at a constant rate, making it a good indicator of renal function. |
|
Definition
| False: BUN is not excreted at a constant rate, although renal excretion is the most important mechanism of excretion. BUN can vary due to dietary protein influences, and is therefore affected by both diet and blood flow rates. |
|
|
Term
| T/F: urea concentrations in the blood are inversely proportional to flow rates. |
|
Definition
|
|
Term
Which of the following is not a valid reason for increased BUN values?
a. Renal disease
b. Increased dietary protein
c. Anabolic drugs
d. GI hemorrhage
e. Fever, burns, and starvation |
|
Definition
c. Anabolic drugs
Urea is a product of protein metabolism, so catabolic drugs are more likely to cause increased BUN values. |
|
|
Term
Decreased BUN values would be least likely in a patient with:
a. A low-protein diet
b. Severe hepatic dysfunction
c. A congenital portosystemic shunt
d. An acquired portosystemic shunt
e. All of the above are valid reasons for a low BUN |
|
Definition
e. all of the above are valid reasons for low BUN
BUN is usually affected by diet or by a lack of conversion of ammonia to urea in the liver. |
|
|
Term
| T/F: creatinine is excreted at a constant rate and is therefore a good indicator of renal blood flow. |
|
Definition
True
Creatinine is stored in muscle and constantly released; renal excretion is most important for clearance and excretion parallels GFR. Therefore, determination of creatinine clearance is a good indicator of GFR and renal function. |
|
|
Term
Which of the following is a reason why serum creatinine might be increased?
a. Muscle necrosis
b. Strenuous exercise
c. Renal tubular damage
d. A and B
e. A, B, and C |
|
Definition
|
|
Term
| T/F: both BUN and Creatinine are very sensitive indicators of renal function, with increased concentrations implying that 75% of nephrons are not filtering. |
|
Definition
| False: BUN and Creatinine are insensitive indicators, though creatinine is the more sensitive of the two. The magnitude of the BUN/Creatinine values are of little value--they give no indication of the origin of azotemia, irreversibility, acute vs. chronic, progressive vs. nonprogressive. |
|
|
Term
A BUN of 38 and a creatinine of 3.2 are indicative of:
a. Post-renal azotemia
b. Irreversible kidney failure
c. Acute kidney failure
d. Progressive renal failure
e. None of the above |
|
Definition
e. None of the above
The magnitude of BUN and creatinine levels are of little predictive value, so we have no way of knowing what the diagnosis/prognosis of the patient is without further diagnostics. |
|
|
Term
The test best suited to evaluating the GFR in the dog an cat is the:
a. Endoginous Creatinine Clearance
b. Endogenous BUN Clearance
c. Urinalysis
d. Serum BUN levels
e. Serum Creatinine levels |
|
Definition
a. Endogenous creatinine clearance
This detects reductions in GFR prior to azotemia; a 24 hours study is best, as it minimizes lab errors and collection errors; other tests include Scintigraphy (iodine 131) or iohexol clearance, and measuring how readily those compounds leave the system. |
|
|
Term
| Dogs with a USG > or equal to ______________ and cats with USG > or equal to _______________ demonstrate urine concentrating ability. |
|
Definition
|
|
Term
Which of the following components is not needed to concentrate urine?
a. ADH
b. H+
c. Na
d. Urea
e. Loop of Henle |
|
Definition
|
|
Term
For a non-traumatic, sterile urine sample, the best method of collecting urine would be:
a. Midstream voided
b. Manual expression
c. Catheterization
d. Cystocentesis
e. All of the above are equally efficacious |
|
Definition
| d. Cystocentesis--may get slight hemorrhage, but pretty atraumatic and won't risk retrograde infection or trauma like catheterization will |
|
|
Term
| T/F: small amounts of proteinuria is normal in dogs. |
|
Definition
|
|
Term
| Urinary protein should always be interpreted in light of the ___________. |
|
Definition
|
|
Term
Which of the following will NOT result in a protein-containing urine sediment with RBCs, WBCs, and casts?
a. Renal amyloidosis
b. Bacterial infection
c. Urinary stones
d. Urinary neoplasia
e. All of the above will cause urine sediment as described above |
|
Definition
a. Renal amyloidosis
There are two main causes of proteinuria: glomerular injury (causes a benign sediment and is the result of amyloidosis or immune-complex deposition) and urinary tract inflammation (see sediment of WBCs, RBCs, casts, and bacteria caused by bacterial infection, neoplasia, or urinary stones) |
|
|
Term
If a patient's urinalysis comes back with benign sediment, what test could be done to determine if the patient has pathology or not?
a. Protein:creatinine ratio
b. Creatinine clearance evaluation
c. BUN:creatinine ratio
d. Repeat the urinalysis
e. serum chemistry to evaluate protein levels |
|
Definition
| a. Protein:creatinine ratio |
|
|
Term
| T/F: pathologic proteinuria in the cat is common, while in the dog it is much more rare. |
|
Definition
| False: common in the dog to see pathologic proteinuria, but rare in the cat |
|
|
Term
Glucosuria would be least expected in:
a. A female lab with diabetes mellitus
b. A cat that comes into your clinic for a routine exam following a cross-country move
c. A foal receiving total parenteral nutrition
d. A tom with a urethral plug of 12 hours duration
e. A Keeshond with a congenital inability to reabsorb glucose |
|
Definition
d. A tom with a urethral plug
Probably won't affect the renal tubules that quickly (if at all), but all of the others are reasons for increased glucose in the urine. In addition, renal tubular disease (glomerulonephritis, pyelonephritis, etc., etc.) that causes proximal tubular defects will lead to sub-par filtration and glucose reabsorption by the proximal tubule. Note that glucosuria may lead to an increased risk of UTI, as glucose can be used as an energy source for bacterial growth. |
|
|
Term
| Bilirubinuria is always unconjugated/conjugated and is always considered significant when found in cats/dogs. |
|
Definition
|
|
Term
When examining urinary sediment:
a. Evaluations should always be in light of the USG and method of collection.
b. Fresh specimens are best, as WBCs, casts, bacteria, and crystals can degrade over time.
c. A is true and B is false
d. A is false and B is true
e. Both statements are true |
|
Definition
| e. Both statements are true |
|
|
Term
| T/F: renal biopsy is routinely performed, as it allows for determining a definitive diagnosis, helps establish a prognosis, evaluates disease progression, and helps to evaluate proteinuric patients. |
|
Definition
| False: all of those factors are true, but renal biopsies are not commonly performed due to the risk of complications. |
|
|
Term
| When performing a renal biopsy, how should you position your biopsy instrument? |
|
Definition
| Try to run it parallel to the renal cortex, because that's where 75% of the nephrons are. |
|
|
Term
To document morphologic changes concerning the kidney, all of the following can be performed except:
a. Survey radiographs
b. Nuclear medicine
c. Contrast procedures
d. Ultrasound
e. A and C |
|
Definition
b. Nuclear medicine
Nuclear medicine and Creatinine clearance tests are done to evaluate GFR, not for documenting morphologic changes. |
|
|
Term
| T/F: renal failure is different from renal insufficiency. |
|
Definition
| True. Renal failure is defined as a critical loss of at least 3/4 of nephrons. |
|
|
Term
| ___________ is responsible for immediate regulation of acid-base balance, while the _____________ is responsible for long-term regulation of acid-base balance. |
|
Definition
|
|
Term
The most important diagnostic test for determining the cause of azotemia is the:
a. Serum chemistry
b. Protein: Creatinine ratio
c. Urinalysis
d. Creatinine Clearance Evaluation
e. Nuclear medicine |
|
Definition
| c. Urinalysis--want to evaluate the urine specific gravity before fluids are administered--tells a lot about source of azotemia (prerenal, renal, postrenal) |
|
|
Term
The most common category of azotemia is:
a. Prerenal
b. Renal
c. Postrenal |
|
Definition
|
|
Term
Prerenal azotemia can occur from all of the following except:
a. Hyperproteinemia
b. Hyponatremia
c. Shock
d. Cardiac insufficiency
e. Catecholamine-induced vasoconstriction |
|
Definition
a. Hyperproteinemia
It would occur with hypoproteinemia due to loss of oncotic pressure and decreased renal perfusion? |
|
|
Term
Which of the following would be least likely to have a prerenal azotemia?
a. A cat with pancreatitis
b. A dog with foreign body obstruction
c. A cat with Addison's disease
d. A dog with a transitional cell carcinoma
e. A dog with dilated cardiomyopathy |
|
Definition
| d. A dog with TCC--this would likely cause a post-renal azotemia (although prerenal azotemia could eventually result from systemic illness associated with the cancer) |
|
|
Term
| A USG of an animal with prerenal azotemia will be > _______ in dogs and > __________ in cats prior to institution of fluid therapy. |
|
Definition
>1.030 in dogs
>1.035 in cats |
|
|
Term
Abdominal radiographs are most likely to be abnormal in which azotemic patient?
a. Prerenal
b. Renal
c. Postrenal
d. A and B
e. B and C |
|
Definition
e. B and C
Renal azotemia may show enlarged kidneys, and post-renal azotemia may show dilation of the urinary tract proximal to the obstruction. Prerenal azotemia has to do with the perfusion to the kidneys, so the abdominal cavity should not present any abnormalities that have to do with the azotemia. |
|
|
Term
| T/F: with prerenal azotemia, primary renal failure can be a sequella if there is prolonged ischemia. |
|
Definition
|
|
Term
| The two broad categories of causes of post-renal azotemia are: |
|
Definition
Urinary obstruction
Urinary tract rupture |
|
|
Term
Urinary tract rupture due to trauma USUALLY occurs at:
a. The proximal ureter
b. The neck of the bladder
c. The distal ureter
d. The apex of the bladder
e. The distal urethra |
|
Definition
| b. The neck of the bladder |
|
|
Term
Which of the following least resembles a cause of post-renal azotemia?
a. A cat diagnosed with feline lower urinary tract disease
b. A cat with a urethral plug
c. A dog with a transitional cell carcinoma in the trigone of the bladder
d. A dog with unilateral renal hypoplasia
e. A dog with E. coli prostatitis |
|
Definition
d. A dog with unilateral renal hypoplasia
Postrenal azotemia MUST involve BOTH kidneys, and usually indicates a problem south of the kidneys. Other causes of LUT obstruction can be severe neurologic dysfunction (rare) and urolithiasis (urethral plug has same outcome, but is gelatinous matrix rather than stones). |
|
|
Term
Obstructive postrenal azotemia presents with all of the following signs except:
a. Small urinary bladder
b. Renal enlargement and pain
c. Pollakiuria
d. Oliguria
e. Stranguria |
|
Definition
a. Small urinary bladder
Animals with obstructive postrenal azotemia should have a large, turgid urinary bladder because the urine is stuck (obstruction) and can't exit. |
|
|
Term
Which biochemical abnormality is practically pathognomonic for a decreased GFR?
a. Hyperkalemia
b. Hyponatremia
c. Hyperphosphatemia
d. Hypercalcemia
e. Increased H+ |
|
Definition
c. Hyperphosphatemia
All of the other abnormalities can occur with decreased GFR (I think) but can also be caused by other body abnormalities, while hyperphosphatemia is rarely caused by anything but a decrease in GFR. |
|
|
Term
| T/F: animals with obstructive postrenal azotemia will become acidotic over time due to H+ ions exchanging with K in the serum. |
|
Definition
| True--K gets kicked out and H+ goes in |
|
|
Term
| Animals with obstructive post-renal azotemia will typically die in _______ days if treatment is not performed. |
|
Definition
|
|
Term
| For an obstructive postrenal azotemia, what is the prognosis? |
|
Definition
Guarded generally--about 50/50
For an acute obstruction--good
For a chronic obstruction--guarded due to risk of permanent pressure necrosis |
|
|
Term
| T/F: when animals have uroperitoneum due to trauma, they will be anuric. |
|
Definition
| False: they will be oliguric--animals can still urinate small volumes with rupture |
|
|
Term
Which diagnostic would yield the most accurate diagnosis of uroperitoneum?
a. Serum BUN levels
b. Serum creatinine levels
c. Paired serum and urine BUN levels
d. Paired serum and urine creatinine levels
e. None of the above |
|
Definition
d. paired serum and urine creatinine levels
BUN is small and therefore equalizes rapidly between the abdominal cavity and the serum. Creatinine is a much larger molecule and therefore takes longer to equilibriate. |
|
|
Term
A urinary tract rupture would carry a good to excellent prognosis if the site were the:
a. Bladder
b. Urethra
c. Ureter
d. Kidney
e. Renal pelvis |
|
Definition
a. Bladder
Urethra is fair to guarded
Ureter is guarded
Kidney/renal pelvis is fair to good |
|
|
Term
| A urine specific gravity of _______________ is indicative of renal azotemia. |
|
Definition
|
|
Term
| Primary renal azotemia results when there is a loss of _____% of functional nephrons. |
|
Definition
|
|
Term
| T/F: Acute renal failure always manifests with oliguria (1-2 ml/kg/hr). |
|
Definition
| False: ARF often presents with oliguria, but any urine volume can be produced |
|
|
Term
Which body system is most significantly affected by uremia?
a. Respiratory system
b. GI system
c. Nervous System
d. Cardiovascular system
e. All of the above are equally affected |
|
Definition
|
|
Term
| T/F: patients in acute renal failure may be able to recover as long as the basement membrane in the kidneys remains intact. |
|
Definition
|
|
Term
Which of the following is a cause for oliguria?
a. Ischemia
b. Obstruction
c. Leakage
d. A and B
e. A, B, and C |
|
Definition
|
|
Term
Nephrosis can cause acute primary renal failure by all of the following mechanisms except:
a. Bacterial infection
b. Ischemia
c. Nephrotoxins
d. Thromboembolism
e. Pigments |
|
Definition
a, Bacterial infection
Tricky, tricky--this is nephritis, not nephrosis |
|
|
Term
| List three specific drugs/categories of drugs that can cause nephrotoxicosis: |
|
Definition
Chemotherapeutic agents--cisplatin
Antibiotics--aminoglycosides, ibuprofen
Antifungal agents |
|
|
Term
| What metabolite is in antifreeze that can cause acute primary renal failure? |
|
Definition
|
|
Term
The primary site for nephrotoxin attack is the:
a. proximal tubules
b. descending loop of Henle
c. ascending loop of Henle
d. Distal tubules
e. Collecting ducts |
|
Definition
| a. proximal tubules--this is the site of the majority of reabsorption and metabolism, so nephrotoxins typically destroy this site, disrupting membranes and causing cell death |
|
|
Term
All of the following are characteristic findings for acute primary renal failure except:
a. Uremic breath or oral ulcers
b. Congested mucous membranes
c. Renal pain on palpation
d. Normal to small kidneys
e. Dehydration and a small urinary bladder |
|
Definition
d. Normal to small kidneys
This would be true for CRF, but for ARF, the kidneys are typically normal to large in size |
|
|
Term
| T/F: PU/PD is a common finding in patients with ARF. |
|
Definition
| False: there is no time for PU/PD since the onset is so quick. |
|
|
Term
| T/F: anemia is seen in patients with ARF. |
|
Definition
|
|
Term
All of the following are laboratory findings of acute primary renal failure except:
a. Active sediment with casts
b. USG of 1.030
c. Renal azotemia
d. Hyperphosphatemia
e. Hyperkalemia > 5.5 mEq/L |
|
Definition
b. USG of 1.030
Patients with acute primary renal failure are isosthenuric, and therefore have a USG of 1.008-1.012 |
|
|
Term
Which of the following that can be identified by serologic assay is a key differential in a patient with unexplained azotemia?
a. Escherichia coli
b. Aminoglycoside toxicity
c. Cisplatin toxicity
d. Renal neoplasia
e. Leptospirosis |
|
Definition
e. Leptospirosis
Both lepto and ethylene glycol metabolites can be screened for in serologic assays. Diagnosis of ARF can be done by rads (common), renal biopsy (uncommon), fractional clearance of sodium, and serologic assays (common) |
|
|
Term
Concerning acute renal failure:
a. prerenal ARF should be treated with fluids and cardiac drugs (if cardiogenic)
b. postrenal ARF should be treated with medical and surgical therapy
c. Renal lesions of primary ARF are potentially reversible
d. Many animals with ARF will die
e. All of the above are true |
|
Definition
| e. All of the above are true |
|
|
Term
When treating ARF:
a. Fluid therapy is instituted to overhydrate the animal in an attempt to flush out toxins
b. A central line is contraindicated
c. Klebsiella, Proteus, and E. coli are the most common bacterial isolates from nephritis cases
d. When administering antibiotics, the dosing interval should be increased to account for the decreased GFR, especially if the antibiotic of choice is primarily excreted through the kidneys
e. All of the above are true |
|
Definition
d.
Want to avoid overhydration/dehydration
CVP can be measured by placing a central line
E. coli, staph, and strep are most common isolates |
|
|
Term
| Cardiotoxicity can result when K is > _________. |
|
Definition
6.0mEq/L
The acid-base status should be corrected first
Ca-gluconate can be used as an emergency therapy |
|
|
Term
| Bicarbonate therapy should be implemented when the blood pH is _____________ or when the CO2 is ___________. |
|
Definition
|
|
Term
| T/F: a hypocalcemia may be seen in patients with ARF |
|
Definition
True
I would imagine this is due to the hyperphosphatemia offsetting the ratio and the inability of the kidneys to produce all their good calcium/vitamin D hormones? |
|
|
Term
Which of the following are acceptable therapies to use in an attempt for volume expansion/diuresis in a patient with ARF?
a. Mannitol
b. Furosemide
c. Dopamine
d. B and C
e. A, B, and C |
|
Definition
e. A, B, and C
Furosemide should only be administered if patient is well-hydrated
Mannitol is first choice; can readminister if no response within 2 hours
All three drugs should be administered within 6-8 hours--the goal is to produce urine and to have pretty rapid volume expansion |
|
|
Term
| Cats/dogs have dopaminergic receptors in their heart and kidney, while cats/dogs have dopaminergic receptors in their heart only. |
|
Definition
|
|
Term
| The goal for volume expansion is to provide _______% of the patient's body weight. |
|
Definition
|
|
Term
| T/F: peritoneal dialysis is a routine procedure to help minimize uremic toxin buildup in the body. |
|
Definition
| False: cumbersome, technically difficult, complications occur, and not many places do it |
|
|
Term
| T/F: chronic renal failure is more common than acute renal failure and is manifested as irreversible nephron loss. |
|
Definition
|
|
Term
All of the following correctly describe chronic renal failure except:
a. decreased distinction between renal cortex and medulla and replacement of renal parenchyma by fibrous tissue
b. normal to small kidneys
c. PU/PD
d. hyperphosphatemia
e. regenerative anemia |
|
Definition
e. regenerative anemia
CRF causes decreased EPO production, leading to non-regenerative anemia |
|
|
Term
Compensatory hypertrophy, as it applies to the development of chronic renal failure, means:
a. The increase in size of remaining nephrons in an attempt to maintain GFR
b. The increase in size of the kidneys in an attempt to maintain GFR
c. The increase in size of the ureters in an attempt to adapt to polyuria
d. The increase in size of the urethra in an attempt to adapt to polyuria
e. None of the above. Compensatory hypertrophy refers only to conditions of the heart. |
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Definition
a. increase in size of remaining nephrons
Eventually these "supernephrons" will become overwhelmed and PU/PD will result. |
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Term
| T/F: The rapidity of azotemia development often modulates the severity of uremic signs. |
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Definition
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Term
In patients with chronic renal failure patients are:
a. Hyponatremic
b. Hypernatremic
c. Hyperphosphatemic
d. A and C
e. B and C |
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Definition
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Term
| Why must patients in CRF be put on a sodium-restricted diet? |
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Definition
| Hypernatremia promotes volume expansion and hypertension, which can cause deleterious effects on other organ systems (heart) |
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Term
| Concentrating ability of the kidneys is lost when ______ of the total nephron population is lost. |
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Definition
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Term
| Essay time: describe the process for development of renal secondary hyperparathyroidism: |
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Definition
| Animals with CRF are hyperphosphatemic. In normal circumstances, the Ca:P ratio should be about 2:1; in CRF, the hyperphosphatemia alters this ratio. Even though calcium stays the same, the body perceives that it is hypocalcemic and stimulates PTH secretion from the parathyroid glands. PTH causes bone calcium resorption and renal calcium resorption, and phosphorous excretion; in addition vitamin D is stimulated to absorb more calcium from the gut. The result is increased serum calcium and osteoporosis, or fibrous osteodystrophy. As serum Ca and P values increase, soft tissue mineralization can occur, which can further alter renal function. |
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Term
All of the following blood abnormalities are typical of CRF except:
a. non-regenerative anemia
b. decreased erythropoietin
c. increased RBC lifespan
d. Myelofibrosis
e. Platelet defects |
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Definition
c. increased RBC lifespan
Will see an increased turnover of RBCs; we will also see a replacement of normal bone marrow with fibrous tissue (myelofibrosis); blood loss in GIT d/t uremic ulcers, myelofibrosis, decreased RBC lifespan, and decreased EPO all lead to non-regenerative anemia. |
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Term
| T/F: approximately 60-93% of patients with chronic nephropathies will have systemic hypertension, which can lead to lesions in the eye, heart, and CNS. |
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Definition
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Term
| List three causes of systemic hypertension in patients with CRF: |
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Definition
Hypernatremia
renin-angiotensin-aldosterone system
PTH |
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Term
| A primary azotemia, as found with CRF, will manifest as a USG of < _________ in cats and < ____________ in dogs. |
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Definition
<1.030 in cats
<1.035 in dogs |
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Term
| _____________ (species) that are in chronic renal failure tend to present with ventroflexion of the neck, caused by ______________ (electrolyte disturbance). |
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Definition
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Term
All of the following will lead to the paradoxical finding of large kidneys in a chronic renal failure patient except:
a. Renal dysplasia in a dog
b. Polycystic kidneys in a cat
c. Renal lymphoma in a cat
d. FIP in a cat
e. Trigonal masses in a dog |
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Definition
a. renal dysplasia in a dog
With renal dysplasia, a congenital malformation (think congenital with young dogs), the glomeruli are fetal in appearance and there is a dense abundance of fibrous tissue.
Urethral obstructions could also cause an increased kidney size with CRF. |
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Term
For each of the following, state whether it is more common with acute or chronic renal failure:
1. Normal to large kidneys
2. Polyuria/Polydipsia
3. Non-regenerative anemia
4. Hypokalemia
5. Normal to small kidneys
6. Hyperkalemia
7. Anuria |
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Definition
1. Acute
2. Chronic
3. Chronic
4. Chronic
5. Chronic
6. Acute
7, Acute |
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Term
| T/F: animals with CRF should have water restriction in an effort to avoid overwhelming remaining nephrons. |
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Definition
| False--always give fresh water--otherwise, these patients are prone to water-soluble vitamin depletion (B vitamins) |
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Term
All of the following are appropriate therapies for CRF except:
a. Attempting to remove any underlying cause (UTI, calculi, glomerulonephritis)
b. Institution of fluid therapy as well as offering fresh water.
c. Starting the patient on a low-protein, low-sodium diet.
d. None of the above are appropriate therapies
e. All of the above are appropriate therapies |
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Definition
| e. All of the above are appropriate therapies |
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Term
The goal of a low-protein diet is to:
a. Prevent injury to the remaining nephrons
b. Delay renal failure
c. Reduce urea production
d. A and B
e. A, B, and C |
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Definition
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Term
Which of the following are appropriate therapies for a patient with CRF?
a. Anabolic steroids
b. Blood transfusions
c. Metoclopramide or cerenia
d. H2 blockers
e. All of the above |
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Definition
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Term
Which of the following is the first line of therapy? Why?
a. rEPO
b. Blood transfusions |
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Definition
| b. blood transfusions--there is less of a risk of antibody formation, which is a relatively high risk when using recombinant EPO--the goal is to prolong life |
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Term
Metoclopramide and Martopitant function by:
a. inhibiting visceral stimulus for vomiting
b. inhibiting the chemoreceptor trigger zone for vomiting
c. inhibiting the vomiting center
d. inhibiting the vestibular center that triggers vomiting
e. None of the above. These aren't even anti-emetics. |
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Definition
| b. inhibit CTZ, which is set off by blood-borne toxins, such as uremic toxins. |
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Term
Which of the following is Dr. J's H2 blocker of choice for CRF patients?
a. Famotidine
b. Ranitidine
c. Cimetidine |
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Definition
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Term
All of the following are antihypertensive drugs that can be used to combat hypertension secondary to CRF except:
a. Amlodipine
b. Atenolol
c. ACE inhibitors
d. Epinephrine
e. All of the above are acceptable choices for antihypertensive therapy. |
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Definition
| d. epinephrine--causes vasoconstriction, so probably not good for hypertensive patients |
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