Azotemia, Specific Gravity, Proteinuria Flashcards
what is specific gravity used to measure?
urine concentration
what is the gold standard for urine solute concentration?
osmolality
what is osmolality?
number of solute particles per liter of solution
what does osmolality measure?
vapor pressure or freezing point depression
what is specific gravity?
density of solution as compared to (distilled) water
what is specific gravity affected by?
temperature
number and size of particles
what is used to measure specific gravity?
refractometers
what is isosthenuria?
same concentration as original glomerular filtrate
what is hyposthenuria?
excess water is eliminated from body and added to glomerular filtrate
what specific gravity and mOsm is isosthenuria?
1.008-1.012
300 mOsm
what specific gravity and mOsm is hyposthenuria?
<1.008
<300mOsm
what is hypersthenuria?
concentrated urine: water resorbed from filtrate to meet body’s needs
what specific gravity is hypersthenuria in a dog?
> 1.030
what specific gravity is hypersthenuria for a horse?
> 1.020
what specific gravity is hypersthenuria for a cat?
> 1.040
what specific gravity is hypersthenuria for a cow?
> 1.026
is there a normal range for specific gravity of urine?
no: must take into account hydration status, electrolyte balance, and concentration of nitrogen waste products (urea and creatinine) in blood
when should urine be hypersthenuric?
when the animal is:
dehydrated
hypovolemic
decreased cardiac output
urine specific gravity value between hypersthenuric and isostheuric referred to as _____________________
minimally concentrated urine
what does poorly concentrated urine in an animal that should be concentrating urine indicate?
renal tubular dysfunction
what complicates using urine specific gravity to evaluate the kidneys?
2/3 of nephrons (maybe more in cats) must be lost before you detect a problem
animals with glomerular disease may still be able to concentrate urine
some ____________ of the filtered water is reabsorbed in the proximal tubules by osmosis
60-70%
what is reabsorbed in the proximal tubules other than water?
Na (60%)
Cl
HCO3
how does water move out of the the proximal tubule?
aquaporins
leaky tight junctions
the increased oncotic pressure in peritubular capillaries favors ____________________________
movement of H2O into the capillary
what does increased concentration of the remaining filtrate in the proximal tubule promote?
passive reabsorption of K, Cl, Ca, and urea by diffusion
what are the nitrogenous waste products?
urea
creatinine
what is used in serum chemistries to asses glomerular filtration rate function?
nitrogenous waste products
serum phosphorous
SDMA
what is azotemia?
increase urea and/or creatinine
what is azotemia usually a sign of?
decreased glomerular filtration rate
what is produced by protein (amino acid) catabolism?
ammonia
how is ammonia transported to the liver?
portal blood
what converts ammonia to urea?
liver
what are the main causes of increased urea?
decreased renal urea excretion
modulated by tubular reabsorption and recycling of urea
mild increases caused by increased protein catabolism
amount of reabsorption is inversely related to _____________________
urine flow rate
what are some causes of increased protein catabolism?
hemorrhage into gut: bacteria catabolize hemoglobin
fever, burns, tissue necrosis, infection
starvation
how would liver failure affect the blood urea nitrogen level?
decreased BUN
what makes up urea excretion through the gastrointestinal tract in ruminants?
urea from blood diffuses into rumen
urea is secreted by salivary gland
what happens to urea in the rumen?
microorganisms breakdown urea and use NH3 to make amino acids
what can blunt the rise in blood urea nitrogen in ruminants?
urea going into gastrointestinal tract
does urea metabolism occur in hindgut fermenters?
some does
what makes creatinine a good measure of glomerular filtration rate?
freely filtered, no tubular reabsorption
what is the energy storage molecule produced from creatinine?
phosphocreatine
other than being freely filtered and not reabsorbed, what makes creatinine a good indicator of GFR?
not affected by diet or gastrointestinal hemorrhage
not significantly changed by muscle disease
what spontaneously degrades into creatinine and what does creatinine do after?
phosphocreatine and creatine
freely escapes from muscle
what is prerenal azotemia caused by?
decreased renal perfusion: hypovolemia and/or decreased cardiac output
increased production of urea
what is renal azotemia caused by?
renal parenchymal disease: glomerular, inflammation, tubular necrosis, parenchymal scarring
what are some causes of decreased glomerular filtration rate?
replacement of nephrons with fibrosis, cells, inflammatory cells
tubules plugged by cells, casts, crystals
back-pressure counteracts pressure from renal blood flow
tubuloglomerular feedback
what fraction of nephrons must be lost to compromise concentrating ability?
2/3
what fraction of nephrons must be lost to see renal azotemia?
3/4
what causes post-renal azotemia?
obstruction of urinary tract
rupture of urinary tract
how does rupture of urinary tract lead to azotemia?
urea and creatinine reabsorbed from fluid in abdominal cavity
urea is reabsorbed more quickly because it diffuses across cell membranes
is an animal with rupture of the urinary tract usually still urinating?
yes
what is the level of creatinine in abdomen compared to creatinine in the blood in a uroabdomen?
> 2x that in blood
what are some lab abnormalities you see with a uroabdomen?
low Na and Cl
high K, urea, creatinine, and phosphorous
what rises less in ruminants with a uroabdomen?
BUN
K
phosphorous
due to salivary gland secretion
what is SDMA?
methylated arginine
when does SDMA increase?
GFR decreases by 25-40%
what can cause SDMA to be high other than renal disease?
slightly higher in growing puppies
dehydration
endothelial dysfunction and cardiovascular disease in people
what is the hallmark of glomerular disease?
proteinuria
can patients with glomerular disease concentrate their urine?
yes
unless downstream failing too
what makes up the glomerular filtration barrier?
fenestrated endothelium
basement membrane
podocyte foot processes separated by gaps
what proteins can go through the glomerular filtration barrier?
small and/or positively charged ones pass freely
what proteins are usually excluded from the glomerular filtration barrier?
large and/or negatively charged molecules
what is the role of the proximal tubule with protein?
takes up rogue proteins through pinocytosis
what is the normal amount of protein in urine?
<20mg/kg/day
what are the semiquantitative methods for detecting proteinuria?
dipstick
sulfosalicylic acid turbidometric test
is dipstick or sulfosalicylic acid turbidometric test more sensitive?
dipstick a bit more sensitive
what protein does dipstick primarily detect?
albumin
what is the gold standard quantitative test for protein in urine?
protein:creatinine ratio
what does a protein:creatinine ratio require?
chemistry analyzer with microprotein assay
in the protein:creatinine ratio, what does creatinine correct for?
urine concentration
why do we look for proteinuria?
glomerular disease
tubular disease
what happens in glomerular disease that leads to proteinuria?
disruption of glomerular wall
loss of negative charges
can you get hypoalbuminemia with glomerular disease and tubular disease?
yes glomerular disease
no tubular disease
what is physiologic proteinuria?
transient overload of tubule absorptive capacity
what can cause physiologic proteinuria?
+/- strenuous exercise (not proven in domestic animals)
neonatal absorption of colostrum
seizures
what is the mechanism of post-renal pathologic proteinuria with inflammation/infection in bladder/urethra/prostate?
increased vascular permeability
what is the most reliable way to know if you have inflammation in the urinary tract?
increased white blood cells in the urine sediment
what is the mechanism of post-renal pathologic proteinuria with hemorrhage?
loss of plasma proteins
what are the etiologies of post-renal pathologic proteinuria with hemorrhage?
tissue trauma
tumor
stones
coagulation defect
what are the etiologies of post-renal pathologic proteinuria with inflammation/infection?
infection
tissue necrosis
trauma
neoplasia
what are the types of red supernatant?
hemoglobinuria
myoglobinuria
what is mild proteinuria?
UPC <2.0
1-2+ on dipstix or SSA test
what are some causes of mild proteinuria?
artifact from highly concentrated urine
pre-renal or post-renal problem
early glomerular disease
tubular disease
systemic disease affecting blood vessels
what is marked proteinuria?
UPC >2.0, usually >5.0
3-4+ dipstix or SSA test
what is marked proteinuria a hallmark of?
glomerular disease
what should you rule out with marked proteinuria?
hemoglobinuria
myoglobinuria
glomerular disease
is pitting edema in hypoproteinemic patients with protein-losing glomerulopathy seen in chronic or acute kidney disease?
chronic