Clin Med- Renal

kelseyfmeyer's version from 2015-11-30 13:53


Question Answer
three tasks of the tubules?reabsorption, secretion, concentration
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 adjustements where?collecting duct
whats osmosis?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 Multiplierloop 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?ADH/ aldosterone
*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 saypre, renal, post???
how to differentiate pre vs renal azotemia?USG (if conc, it's pre)
what's prerenal azotemia?dehydration
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?Microalbuminuria
explain how collection method of urine changes your view of the resultscysto 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.... 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 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

Lower Urinary Tract Disease

Question Answer
Common clinical signs of LUTI?Pollakiuria, Dysuria, Stranguria, Periuria, Incontinence, Hematuria
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, 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!
Urolithiasis Definition?Organized crystal aggregates of mineral and matrix (matrix is mucoprotein and protein) (<-all that stuff mixed together basically)
Crystal ≠ Stone ≠ Mucous Plugderp
Cystic calculi in Dogs--> 6 examples?Struvite, Calcium oxalate, Urate, Cystine, Calcium Phosphate, Silica
most common cystic calculi in dogs?struvite
which calculi can't you see?(cant CU) cystine and urate
If you suspect a dog has stones, do what first?RADS, even if there are invisible ones, bc struvite is visible and is most common one
yorkie prolly prone to what stones?PSS prone so prone to urate stones
dalmation/bulldog prolly has what stones?urate urolithiasms-- these have genetic prob where have extra urates (metabolism prob) so prone to urate stones
possible Sequellae to Cystic calculi in Dogs?Urinary tract infection, obstruction, polyp formation
who gets UTIs more-- dogs or cats?dogs
explain complicated vs uncomplicated UTIadult 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 UTIsdont 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?Cystocentesis > catheterization > mid stream voided
Recurrent UTI’s should have....advanced diagnostics. recurrent=complicated! Systemic work up, Imaging and contrast studies, Vaginoscopy, Cystoscopy
if the dog has a fever and you suspect cystitis, what should you know?no fever with 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) and US (ultrasound) abnormalities you'd see with 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 Disease

Question Answer
****POLYURIA IS CONSIDERED HOW MUCH? (#)> 50 ml/kg/day
list come clinical signs of upper UT dzPU/PD***, azotemia, Proteinuria, +/-hematuria, +/-Systemic illness, +/-anemia, +/-GI signs, +/-Halitosis, ADR, Vomiting, Inappetance, +/-Hemoglobinuria, Oliguria (<5 ml/day), anuria
what are Glomerulonephropathies?Inflammation of glomerulus+/-tubules (basically anything affecting glam causes this)
**what is the hallmark of Glomerulonephropathies?Proteinuriais
Glomerulonephropathies are a Common cause of... CKD
what is usually the most common cause of Glomerulonephritis(GN)?IMMUNE MEDIATED CAUSES (Ab-Ag complex deposition, gloms tiny and they get all stuck in there and damage it) OR or in-situ deposition (the Abs will target the the glom membrane itself)
what can Amyloidosis often cause? why? who's prone to this dz?Glomerulonephropathies- the amyloid protein deposits in the glom and causes Glomerulonephritis like how Ab-Ag complexes can. GENETIC problem often in sharpei and 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 functions renal tubules are responsible for?Secretion, Absorption, Fluid balance, Acid/base balance
PU/PD--> (AGAIN!) POLYDIPSIA IS HOW MUCH?> 100 ml/kg/day
PU/PD--> (AGAIN!) POLYURIA IS HOW MUCH?>50 ml/kg/day
THIRST and ADH are stimulated by the same receptors, which is...Osmoreceptors, Low Blood pressure, Pyrexia, pain, drugs
how can you do a work up for PU/PD?Measure water intake, Evaluate for systemic disease, Evaluate for urinary tract disease (Follow with appropriate diagnostic tests)
Must rule out all diseases (and discuss with Internist) on R/O list PRIOR to...what two tests?ADH response, Modified water deprivation test
what is Azotemia?Increased BUN AND / OR creatinine.
if she says azotemia, you say...pre, renal, or post?
cause of Pre-renal azotemia?problem with renal blood flow (ie dehydration)
if you are trying to figure out why there is azotemia, you MUST evaluate in conjuntion with..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?High protein intake/GI bleeding, Renal disease, Dehydration, exercise
what are reasons for a DEC in BUN?Poor Diet/Restricted Diet, Malabsorption, Liver disease, Diuresis
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 one was raised but the other wasnt..)Creatinine more specific
what are some reasons for an inc in creatinine?Renal Disease, Muscle degeneration/ damage, drugs, dehydration
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 diseases
Common clinical signs or uremia?Gastroenteritis, Acidosis, Pneumonitis, Osteodystrophy, Encephalopathy, 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, and 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)