DCT-- make final adjustments based on what they are saying to each other
acid base adjustements where?
diffusion of molecules from a place of higher conc to a place of lower conc until conc on both sides are equal
don't forget starlings forces. why not forget?
([capillary hydrostatic pressure - interstitial hydrostatic]-[capillary oncotic-intersittial onctoic]) ---> how do you think the glom filters? based on this principal
(prolly wont ask questions) explain basic principal of Counter Current Multiplier
loop of henle has fluid going in one direction, vasa recta (BVs) has blood flowing in opposite direction, helps pull fluid into blood more
the collecting ducts do fine tuning how?
*when do you see the first clinical signs of renal dz, and what are they? (what amount of damage)
66% damage, first lose ability to conc
what % damage is renal insufficiency? failure?
insufficiency= 66%. Failure= 75%
what is Renal disease?
Any pathology affecting the kidneys. THERE MAY OR MAY NOT BE CLINICAL SIGNS
renal insufficiency happens after how much damage? how would you describe it? is there azotemia?
this is 66% damage (cant concentrate) but Impaired function without azotemia! It often Suggests tubular dysfunction, and they are polyuric!~!!
what are the characteristics of renal failure? how much damage to classify it as such? is there azotemia?
75% damage, and you WILL see azotemia. This will progress to UREMIA
if she says azotemia, you say
pre, renal, post???
how to differentiate pre vs renal azotemia?
USG (if conc, it's pre)
what's prerenal azotemia?
why might you wanna do a rectal exam if you suspect kidney dz?
can palpate urethra from rectum (and prostate)
what serum chemistries do you esp. want to check out if you suspect renal probs?
BUN, creatinine (<--both first two are Both crude estimates of GFR), phosphorus, electrolytes
which urine diagnostic is more sensitive than a dipstick for protein?
explain how collection method of urine changes your view of the results
cysto is best because 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 with 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 and volume of urine because this is a fairly constant value. must do URINALYSIS first (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, and why would you want to do nuclear imaging in particular?
Renal Scintigraphythis is how you know which kidney is doing all the work, in case you need to remove or bx one (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?)
FIRST OFF, NEVER DO UNLESS TALK TO AN INTERNIST FIRST. It is extremely EASY TO KILL A DOG WITH THIS. NEVER DO ON AN AZOTEMIC OR DEHYDRATED DOG. You only do this test if the only options left are central/renal DI, and 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?
Cystine and 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....
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 and 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, and what other things can you do with these endoscopies aside from looking?
Cystoscopy/urethroscopy/ ureteroscopy. allows for visualization, Biopsy, and theraputics
pollakiuria= 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?
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?
anatomic reasons for urethral obstruction?
urolithiasis, neoplasia, cysts, MUCUS PLUGS!!
what is a mucus plug, when and who do you see them in?
idiopathic feline cystitis dont get obstruction bc of urolithiasis. get inflammation , lots of protein strands around, and crystals and mucus, etc....make a mucus plug. (plug feels like sand in play-dough)
what is a functional cause of urethral obstruction?
Reflex dyssynergia (this is when the bladder contracts, and the urethra tries to relax but then spasms and pee can't come out.)
whats Reflex dyssynergia?
this is when the bladder contracts, and the urethra tries to relax but then spasms and 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 and you will be polyuric. so keep up on fluids or will get dehydrated. dont send blocked cats home right away!
Organized crystal aggregates of mineral and matrix (matrix is mucoprotein and protein) (<-all that stuff mixed together basically)
adult female dog? can empirically put on abx for 7-10 days without culture....once. but if 2 days after stopping abx, starts again, DONT just put on another abx-- sign sthing more complicated is happening. Boy with UTI-- complicated, period.
UTIs most commonly caused by?
BACTERIA!! (rarely Mycoplasma, Chlamydia, viral and fungal)
look over slide 30/31 for host defense mechanisms for UTIs
dont need to memorize but need to have a good idea about
LUT signs of Urinary Tract Infections?
+/-hematuria(can be UUT tho), Pyuria, +/-↑ UPC, +/-bacteria noted on UA
Culture and susceptibility--> desired collection method?