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Jorge URO > Assessment of renal function > Flashcards

Assessment of renal function Flashcards

1
Q

What clinical pathological markers can be used to assess renal function?

A

Bloods:
GFR
Blood conc of:
- urea
- creatinine
- Phosphorous
- SDMA
- potassium
FGF-23

Urinalysis:
USG
Fractional clearance
Proteinuria

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2
Q

What factors determine renal clearance?

A

GFR
Tubular reabsorption
Tubular secretion

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3
Q

How do you calculate renal clearance?

A
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4
Q

For what substances is clearance = GFR

A

If the substance is:
- filtered
- not reabsorbed
- not secreted (non-toxic, not plasma protein bound)

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5
Q

why is creatinine a better marker to use for assessing renal function than urea?

A

50% of Urea is reabsorbed to maintain medullary tonicity
Creatinine only changes in advanced renal disease

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6
Q

Why is it important to get a baseline creatinine level for each animal when using it to assess GFR?

A

A small change in creatinine (still within normal range) can be present with a large change in GFR

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7
Q

What does proteinuria suggest?

A

issue with filtration in glomerulus

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8
Q

What are the causes of pre-renal, renal and post renal proteinuria?

A

Pre renal - overload of proteins e.g., glucosuria in hyperglycaemia
Renal (glomerular) - damaged glomeruli
Renal (tubular) - unable to resorb normal amounts of filtered protein
Post renal - inflammatory, haeorrhagic conditions e.g. urinary tract inflammation

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9
Q

How is cystatin C used to assess renal function

A

Measured in blood - estimate of GFR
Measured in urine - should be completely resorbed in tubules, presence suggests tubular dysfunction/damage

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10
Q

What is fractional clearance?

A

the clearance of a substance (X) compared to creatinine that is neither absorbed or secreted
Example:
Volume depletion => sodium retained => fractional clearance falls
Tubular disease => sodium lost => fractional clearance rises

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11
Q

What is normal canine USG?

A

1.015 - 1.045

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12
Q

What is normal feline USG?

A

1.035 - 1.065

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13
Q

What is normal equine USG?

A

1.020 - 1.050

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14
Q

What is normal bovine USG?

A

1.025 - 1.045

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15
Q

How is USG used to determine if there is problem with concentrating ability?

A

Needs correlation with hydration state and/or azotaemia

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16
Q

What is azotaemia and indicator of in an animal with healthy renal function?

A

poor renal perfusion

17
Q

What is azotaemia an indicator of in an animal with typical renal perfusion?

A

insufficient nephrons

18
Q

Why is hyposthenuria and ADH problem and not a renal failure problem?

A

Kidney is functioning to produce dilute urine
ADH is not working to concentrate it in distal convoluted tubules and collecting duct

19
Q

What are the types of urinary casts (cylinduria)?

A

Hyaline - protein
Cellular - RBC/WBC/epithelial
Granular - fine/coarse
Waxy - end product of degeneration

20
Q

What does cellular casts in urine suggest?

A

disease process in tubules

21
Q

What does granular casts in urine suggest

A

Degenerate cellular casts - implies longer stasis
Precipitated protein
Degenerate epithelial cells

22
Q

What does waxy casts in urine suggest?

A

long period of stasis

23
Q

Summarise the clinical pathology of renal failure

A

Non-regenerative anaemia
Increased plasma waste - urea, creatinine, phosphate, potassium
Inappropriately dilute USG
Urinalysis:
- evidence of pathology
- renal proteinuria
- tubular function

24
Q

What is the outcome of acute kidney insufficiency?

A

Hyperkalaemia

25
Q

What is the outcome of chronic kidney insufficiency

A

Progressive as functional nephrons decrease:
inappropriate USG => azotaemia => hyperphosphataemia, acidosis

26
Q

Is this pre-renal or renal kidney insufficiency?

A

Pre-renal

27
Q

Pre-renal or renal kidney insufficiency?

A

Renal

28
Q

Pre-renal or renal kidney insufficiency?

A

Pre-renal

29
Q

Pre-renal or renal kidney insufficiency?

A

Pre-renal

Jorge URO (105 decks)

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