Cases 1-5 Flashcards
What is azotemia?
Abnormally high levels of nitrogen-containing compounds (Urea, creatinine) in the blood
What is uremia?
Clinical manifestations of azotemia.
What are the 3 main mechanisms of azotemia?
pre-renal, renal, post-renal
Pre-renal azotemia is due to _____.
decreased renal perfusion
What is the most common cause of pre-renal azotemia?
dehydration
What are some clinical signs of dehydration?
sunken eyes, prolonged CRT, tacky/dry gums and other MMs, excessive skin tenting
What lab results would be consistent with pre-renal azotemia?
All blood components are more concentrated (PCV, albumin, TP)
USG = high
In pre-renal azotemia, what would the USG be?
high
What does it mean if the USG is high in pre-renal azotemia?
The kidney is concentrating urine in a dehydrated animal
What is renal azotemia?
Decreased renal function
What is the USG in renal azotemia?
Isosthenuric (1.007-1.013)
Isosthenuria indicates decreased renal function IF an animal is _____ and/or _____.
azotemic, dehydrated
What is one main clinical sign of renal azotemia?
PU/PD
What is post-renal azotemia?
Obstruction of ureters, bladder, urethra, or a ruptured bladder.
What is the USG in post-renal azotemia?
variable
What are clinical signs associated with post-renal azotemia?
Anuria, straining to urinate, painful urination
What would we find on PE/imaging if there is post-renal azotemia?
+/- distended bladder (depends on if it has ruptured)
+/- fluid in abdomen (uroabdomen following rupture)
What is one thing you MUST have in order to properly assess renal function?
USG
If an animal is dehydrated and/or azotemic and the kidney is functioning adequately, the USG should be _____.
elevated (above 1.013)
What is a common cause of renal failure in dogs?
toxins
What is a common disease of Shih Tzu’s that can cause azotemia?
renal dysplasia
After determining the type of azotemia we have, what would be some good tests to run after that?
Ultrasound, renal biopsy
What is renal dysplasia and in what 2 breeds is it most commonly found?
A developmental or genetic defect of the kidneys; common in Shih Tzus and Lhasa Apsos.
What is stage 1 of renal dysplasia?
Absence of symptoms
What is stage 2 of renal dysplasia?
PU/PD, weight loss, lack of vigor, intermittent loss of appetite
What is stage 3 of renal dysplasia?
Vomiting, weakness, dehydration, severe debilitation, eventual death from renal failure
What is the most common cause of hyperphosphatemia?
Decreased urinary phosphorus excretion in association with chronic renal failure
What are the major differentials for hyperproteinemia?
Dehydration and hyperglobulinemia
Dehydration causes _____, which causes hyperproteinemia.
hemoconcentration
What do serum proteins consist of?
Albumin and globulins
TP = _____ + ______
Albumin + globulins
Globulins = _____ - _____
TP - Albumin
What is the normal A:G ratio?
1:1
High TP with normal A:G ratio suggests _____.
dehydration
High TP with low A:G ratio suggests _____.
hyperglobulinemia
What is chronic antigenic stimulation?
Something that happens with hyperglobulinemia; chronic infectious process
What PE and CBC changes might be expected with chronic antigenic stimulationi?
Increased WBCs, increased NPs, +/- anemia, +/- fever
What are monoclonal gammopathies?
Something that happens with hyperglobulinemia such as a plasma cell myeloma (multiple myeloma)
What is a multiple myeloma?
Tumor that produces antibodies
With monoclonal gammopathies, proteins will also typically appear in _____.
urine
What is relative erythrocytosis?
Occurs with a decrease in plasma volume, such as dehydration.
What is transient erythrocytosis?
Type of relative polycythemia that occurs when excitement or fear causes spleen to contract, resulting in release of large numbers of RBCs into circulation.
What is absolute erythrocytosis?
RARE;
Real increase in RBCs resulting from increased production.
Can be due to bone marrow disroder or by excessive release of hormones that stimulate RBC production.
What 4 fluids might be found in the abdomen?
- Urine
- Exudate
- Blood
- Transudate
What can cause uroabdomen?
Ruptured bladder due to HBC/trauma, urethral obstruction (increased BUN and creat)
What can cause there to be exudate in the abdomen?
GI perforation, external penetration, navel ill, systemic infections
What can cause hemoabdomen?
Trauma, neoplasia, bleeding issues (i.e. anticoagulant rodenticides)
What are the 2 main mechanisms of transudation?
- Increased hydrostatic pressure
2. Decreased colloidal osmotic pressure
What are 2 things that can cause increased hydrostatic pressure?
heart failure and portal hypertension
What are 2 things that can cause decreased colloidal osmotic pressure?
Hypoproteinemia (<3.5) and hypoalbuminemia (<2.0)
With hemoabdomen, what would the belly tap look like?
RBCs present
Low WBCs
Opaque and red
>3 g/dL protein
With transudate, what would the belly tap look like?
<1500/ul cells
Clear, straw-colored
<3 g/dL protein
With exudate, what would the belly tap look like?
> 1500/ul cells (NPs)
Turbid (cloudy)
3 g/dL protein
With uroabdomen, what would the belly tap look like?
Usually <1500/ul cells
Clear, yellow
<3 g/dL protein
How can you differentiate a transudate from a urine?
Creatinine level in the peritoneal fluid is at least double that of serum
What could cause peritonitis and hyperproteinemia in a cat?
FIP (feline infectious peritonitis)
What causes FIP?
coronavirus
What is the prognosis of FIP?
condition is fatal
Can FIP cause anemia?
Can cause mild to severe anemia
What is commonality?
If an animal develops a variety of clinical signs over a short period of time, some or all are likely related
What is polychromasia?
RBCs are different colors
What is anisocytosis?
RBCs are different sizes
What are spherocytes?
Small, round RBCs that lack central pallor; indicator of IMHA
What are the 3 main mechanisms for anemia?
- Hemorrhage
- Hemolysis
- Ineffective hematopoiesis
What clinical/bloodwork signs would you have with hemorrhage?
Decreased TP and albumin, evidence of bleeding (trauma, epistaxis, melena, hemoabdomen)
What CBC signs would you have with hemolysis?
Elevated bilirubin, icterus,+/- hemoglobinuria, hemoglobinemia, RBC morphology changes
What CBC signs would you have with ineffective hematopoiesis?
Low reticulocytes with lack of anisocytosis and polychromasia in anemic animal
What is regenerative anemia?
Population of cells consists of mature and immature cells; see increase in absolute number of reticulocytes
What is non-regenerative anemia?
Population of cells has only mature cells
What color are reticulocytes on a smear?
blue
What is auto-agglutination?
Grape-like cluster of RBCs; seen with IMHA
What are 3 causes of icterus?
- Pre-hepatic (hemolysis)
- Hepatic (Liver disease)
- Post-hepatic (Bile duct obstruction)
What does an elevated ALP indicate?
cholestasis
