Clin Med - Renal

drraythe's version from 2016-03-15 13:41


Question Answer
3 tasks of the tubules?Reabsorption
Mass reabsorption takes place in the...PCT
Which part of the tubules talk to the glom?DCT - Make final adjustments based on what they are saying to each other
Acid base adjustments where?Collecting duct
Whats osmosis?Diffusion of molecules from a place of ↑er conc to a place of lower conc until conc on both sides are equal
Don’t forget starling’s forces. Why not forget?([capillary hydrostatic pressure - interstitial hydrostatic] - [capillary oncotic-interstitial oncotic]) → how do you think the glom filters? Based on this principal
(Prolly wont ask questions) Explain basic principal of Counter Current MultiplierLoop of Henle has fluid going in 1 direction, vasa recta (BVs) has blood flowing in opposite direction, helps pull fluid into blood more
The collecting ducts do fine tuning how?ADH/ Aldosterone
*When do you see the 1st CS of Renal Dz & what are they? (What amount of damage)66% damage, 1st lose ability to conc
What % damage is renal insufficiency? Failure?Insufficiency = 66%
Failure = 75%
What is Renal Dz?Any pathology affecting the kidneys. THERE MAY OR MAY NOT BE CS
Renal insufficiency happens after how much damage? How would you describe it? Is there azotemia?This is 66% damage (cant concentrate) but Impaired fxn w/o azotemia! It often Suggests tubular dysfxn & they are polyuric!~!!
What are the characteristics of renal failure? How much damage to classify it as such? Is there azotemia?75% damage & you WILL see azotemia. This will progress to UREMIA
If she says azotemia, you sayPre
Post Renal
How to differentiate pre vs renal azotemia?USG (if conc, its pre)
What’s prerenal azotemia?Dehydration
Why might you wanna do a rectal exam if you suspect kidney dz?Can palpate urethra from rectum (& prostate)
What serum chemistries do you esp. want to check out if you suspect renal probs?BUN
Creatinine (← both BUN & Crea are crude estimates of GFR)
Which urine diagnostic is more sensitive than a dipstick for protein?Microalbuminuria
Explain how collection method of urine changes your view of the resultsCysto is best bc there is the least contamination of things > catheter > voided has the most contamination
***Urine Protein:Creatinine Ratio → what does this tell you?? Why do you look at creatinine w/ the protein levels you found? Why must you do before this?It’s the Quantification of protein loss. Look at creatinine bc it eliminates the factors of concentration & volume of urine bc this is a fairly constant value. Must do URINALYSIS 1st (hematuria or pyuria will up the protein)
NORMAL protein:creatinine ratio for DOGS? CATS?DOGS: <0.5 is normal
CATS: <0.4 is normal
What is a type of Nuclear Imaging you can do on the kidney & why would you want to do nuclear imaging in particular?Renal Scintigraphy this is how you know which kidney is doing all the work, in case you need to remove or biopsy 1 (don't kill the working kidney please) (GFR studies are radioactive)
When is the ONLY TIME you would ever do a water deprivation test?? (When would you esp never do one, when would you stop?)1st OFF, NEVER DO UNLESS TALK TO AN INTERNIST FIRST. It is extremely EASY TO KILL A DOG w/ THIS. NEVER DO ON AN AZOTEMIC OR DEHYDRATED DOG. You only do this test if the only options left are central/renal DI & psychogenic polydipsia. Stop water dp if urine conc, dehydrated, or loss 5% of BW. (She said this is basically never the right answer, yo)
What should the size of the kidney be on radiographs?2.5-3.5 times the size of L2
What stones can you NOT see on rads, but CAN see on ultrasound?Cysteine & Urates (I can't C U ← cant see pee in the chapel)
(Thing she said in class) if can see fluid under capsule of both kidneys in cat, prolly is....Renal lymphoma
What is Excretory Urography? What does it tell you about?IV contrast of kidneys. Inject contrast IV, then goes into kidney since makes urine, leaves cortex & starts collecting in pelvis. Use radiography to assess the results. You can use this test to look at... Filling defects, renal pelvic dilation, Hydronephrosis, Hydroureter, Ureteral obstruction, Ectopic ureters, Extravasation of contrast material
What are the kinda endoscopies you can do & what other things can you do w/ these endoscopies aside from looking?Cystoscopy/ Urethroscopy/ Ureteroscopy
Allows for Visualization, Biopsy & Therapeutics

Lower Urinary Tract dz

Question Answer
Common CS of LUTI?Pollakiuria
Pollakiuria vs polyuriapollakiuria = small amounts frequently = LOWER UT problem. POLYURIA = normal amounts frequently = UPPER UT problem
What is periuria?Peeing outside the litterbox
Who’s prone to UTI's-males or females?FEMALES!! Shorter, wider urethra that starts near the ass
(Said in class) If a boy dog is peeing blood, what is it prolly?From prostate
What should you be aware of when palpating bladder?Be gentle! If blocked cat or dz'd bladder, easy to pop it
If there are signs of systemic illness, do what?Bloodwork
Anatomic reasons for urethral obstruction?Urolithiasis
What is a mucus plug, when & who do you see them in?Idiopathic feline Cystitis dont get obstruction bc of urolithiasis. Get inflammation, lots of protein strands around & crystals & mucus, etc....make a mucus plug. (Plug feels like sand in play-dough)
What is a fxnal cz of urethral obstruction?Reflex dyssynergia (this is when the bladder contracts & the urethra tries to relax but then spasms & pee can't come out.)
Whats Reflex dyssynergia?This is when the bladder contracts & the urethra tries to relax but then spasms & pee can't come out.
If there is a urethral obstruction, what is probably gonna kill the animal?HYPERKALEMIA, leading to bradyarrythmias (cant pee out K+)
If you fix a blocked animal, what is absolutely crucial that they need?Needs LOTS of fluids. Even if pee when get to hospital, need to be in hospital for 3 days to be on fluids. After obstruction, kidneys flush everything through them & you will be polyuric. So keep up on fluids or will get dehydrated. Dont send blocked cats home right away!
Urolithiasis Definition?Organized crystal aggregates of mineral & matrix (matrix is mucoprotein & protein) (<-all that stuff mixed together basically)
Crystal ≠ Stone ≠ Mucous PlugDerp
Cystic calculi in Dogs → 6 examples?Struvite
Calcium oxalate
Calcium Phosphate
Most common Cystic calculi in dogs?Struvite
Which calculi can't you see?(cant CU) Cysteine & Urate
If you suspect a dog has stones, do what 1st?RADS, even if there are invisible ones, bc struvite is visible & is most common one
Yorkie prolly prone to what stones?PSS prone so prone to urate stones
Dalmatian/bulldog prolly has what stones?Urate urolithiasms - these have genetic prob where have extra urates (metabolism prob) so prone to urate stones
Possible Sequale to Cystic calculi in Dogs?Urinary tract infxn
Polyp formation
Who gets UTIs more-dogs or cats?Dogs
Explain complicated vs uncomplicated UTIAdult female dog? Can empirically put on ABiopsy for 7-10 days w/o culture....once. But if 2 days after stopping ABiopsy, start again, DONT just put on another ABiopsy - sign something more complicated is happening. Boy w/ UTI - complicated, period
UTIs most commonly czd by?BACTERIA!! (Rarely Mycoplasma, Chlamydia, viral & fungal)
Look over slide 30/31 for host defense mechanisms for UTIsDont need to memorize but need to have a good idea about
LUT signs of Urinary Tract Infxns?+/-hematuria (can be UUT tho)
+/- ↑ UPC
+/-bacteria noted on UA
Culture & susceptibility → desired collection method?Cystocentesis > Catheterization > Mid-stream voided
Recurrent UTI’s should have....Advanced diagnostics. Recurrent = complicated! Systemic work up, Imaging & contrast studies, Vaginoscopy, Cystoscopy
If the dog has a fever & you suspect Cystitis, what should you know?No fever w/ Cystitis-systemic signs is above bladder!
Progressive UTI → Bacterial Pyelonephritis → what are signs that might indicate the UTI has moved up to this problem?Fever
Leukocytosis, pain on palpation (systemic signs now...)
Casts in sediment
Might even see renal failure (PU/PD, azotemia, uremia)
EU (Excretory Urography aka contrast) & US (ultrasound) abnormalities you'd see w/ a bacterial pyelonephritis (progressive UTI?)Pyelectasia, dilated ureters
How might you dx a Progressive UTI causing Bacterial Pyelonephritis?US (ultrasound) guided pyelocentesis cultures/ Histopath/ Cystoscopy cultures

Upper Urinary Tract Dz

Question Answer
****POLYURIA IS CONSIDERED HOW MUCH? (#)> 50 ml/kg/day
List come CS of upper UT dzPU/PD***
+/- systemic illness
+/- GI signs
+/- halitosis
Oliguria (<5 ml/day)
What are Glomerulonephropathies?Inflammation of glomerulus +/- tubules (basically anything affecting glam czs this)
**What is the hallmark of Glomerulonephropathies?Proteinuriais
Glomerulonephropathies are a Common cz of...CKD
What is usually the most common cz of Glomerulonephritis (GN)?IMMUNE MEDIATED CZS (Ab-Ag complex deposition, gloms tiny & they get all stuck in there & damage it) OR in-situ deposition (the Abs will target the glom membrane itself)
What can Amyloidosis often cz? Why? Who’s prone to this dz?Glomerulonephropathies-the amyloid protein deposits in the glom & czs Glomerulonephritis like how Ab-Ag complexes can. GENETIC problem often in sharpei & Abyssinian cats.
If your animal has some sort of common, chronic infectious dz, what are you worried about?Anything chronic → Ab formation → Ab deposition → Glomerulonephritis
What is responsible for final composition of urine?Renal tubules
What are some fxns renal tubules are responsible for?Secretion
Fluid balance
Acid/base balance
THIRST & ADH are stimulated by the same receptors, which is...Osmoreceptors
↓Blood pressure
How can you do a work up for PU/PD?Measure water intake
Evaluate for systemic dz
Evaluate for urinary tract dz (Follow w/ appropriate diagnostic tests)
Must rule out all dzs (& discuss w/ Internist) on R/O list PRIOR to...what 2 tests?ADH response
Modified water deprivation test
What is Azotemia?↑ BUN & / OR creatinine
If she says azotemia, you say...Pre
Cz of Pre-renal azotemia?Problem w/ renal blood flow (ie dehydration)
If you are trying to figure out why there is azotemia, you MUST evaluate in conjunction w/...USG
Blood Urea Nitrogen (BUN/SUN) → made where? When do you see a rise in this (amount of damage)?Made by the liver, 75% damage before you see it
What are some reasons there would be a rise in BUN?↑ protein intake/GI bleeding
Renal Dz
What are reasons for a ↓ in BUN?Poor Diet/Restricted Diet
Liver dz
How much damage before you see a rise in Creatinine?75%
Which is a little more specific to kidneys-rise in BUN or creatinine? (Like if 1 was raised but the other wasnt..)Creatinine more specific
What are some reasons for an ↑ in creatinine?Renal Dz
Muscle degeneration/ damage
Which is worse-azotemia or uremia?UREMIA, by far
What is uremia?A clinical syndrome where there is The presence of all constituents of urine in the blood
When does uremia usually occur?2⁰ to renal failure or post Renal Dzs
Common CS or uremia?Gastroenteritis
Oral ulcerations
Why might you see gastroenteritis/ulcers in Renal Dz?Kidneys responsible for clearance of gastrin, the hormone which turns on acid production in the stomach.
Why might you see osteodystrophy in Renal Dz?Renal 2° hyperparathyroidism. Losing Ca & not absorbing bc void D not being activated in the kidneys. Not enough Ca so release PTH, bones get decalcified.
Crystals you see in ethylene glycol poisoning?Calcium monohydrate (dx for this tox is 4MP)