CC: Uremia Flashcards

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1
Q

What is azotemia?

A

High Blood Nitrogen

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2
Q

What is uremia?

A

Clinical disease resulting from azotemia.

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3
Q

Is an azotemic animal always uremic?

A

Nope.

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4
Q

Is a uremic animal always azotemic?

A

Yup.

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5
Q

What was up with Opus’s urinalysis?

A

SG: 1.012 (low for being dehydrated)
pH 6.5
RBC: 9-10 (shouldnt be any)
WBC: 2-3 (shouldn’t be any)

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6
Q

What was up with Opus’s chemistry profile?

A

Hyperproteinemia
really really high BUN
really really high Creatinine
really high Phosphorous

Signs pointing towards kidney problems

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7
Q

Where is urea produced?

A

LIVER, only the LIVER. nowhere but the LIVER!

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8
Q

Is urea production variable?

A

Yup.

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9
Q

What’s the substrate source for urea?

A

Protein

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10
Q

How is urea made?

A

Urea Cycle in the liver!

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11
Q

Where is creatinine produced? Is its procution constant? what’s its substrate source?

A

Muscle; constant; muscle; excreted in urine

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12
Q

How do you get increased production of urea?

A
high protein diet
GI hemorrhage
fever
tissue trauma (inc. released AAs)
drugs: Corticosteroids (cortisol), tetracycline
Protein Catabolism
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13
Q

What are reasons for decreased production of urea?

A

Low protein diet
Hepatic insufficiency
Polyuria-polydipsia (drinking a lot will dilute the concentration and make it appear low)

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14
Q

What are causes of elevated Creatinine?

A

Pre-renal: low flow of blood (not able to filter)
Renal: loss of glomerular function (poor/not filtering)
Post-renal: obstruction (can’t get out)

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15
Q

What are causes of decreased creatinine?

A

Loss of Muscle mass

Cachexia - muscle wasting

cancer and starvation can cause this

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16
Q

What could cause normal or low BUN with increased Creatinine?

A

Decreased BUN:
Hepatic Insufficiency
PU/PD
Low Protein Diet

Increased Creatinine:
Cooked meat diet (high in creatinine)
Muscle trauma/inflammation (unusual)

17
Q

What could cause high BUN and normal creatinine?

A

Increased BUN:
High protein diet
GI Hemorrhage
Protein Catabolism

Creatinine is just normal

18
Q

Is urea or creatinine better for determining GFR?

A

Creatinine - freely filterable, not reabsorbed, relatively constant production

19
Q

What is used to give a better estimate of what is in the serum from abdominal fluid, BUN or Creatinine?

A

Creatinine!

BUN is more readily reabsorbed, thus underrepresented.

20
Q

What indicates Opus has renal failure?

A

Azotemia along with less than maximally concentrated urine SG since he is dehydrated.

21
Q

What are clinincal signs of Uremic Syndrome?

A
Anorexia
Nausea
Vomiting
Lethargy
Oral Ulcers
Dehydration
Anemia
22
Q

What is the pathogenesis behind Uremic Syndrome?

A
Electrolyte imbalance
metabolic acidosis (failure to excrete H+ and retain HCO3)
Toxins that accumulate
Endocrine disorders
ion transport abnormalities
23
Q

What are uremic syndrome toxins?

A

a whole shit load of stuff that he didn’t feel we had to go in to

24
Q

What are Uremic Syndrome Endocrine problems?

A

Gastrin excess (acid production in the stomach - ulcer)
Hyperparathyroidism (reduced activation of vitamin D - poor regulation of calcium)
Insulin Resistance (type 2 diabetes)
GH/IGF resistance (similar function to insulin)
Low thyroid hormone

25
Q

What are Uremic Syndrome Anemia problems?

A

EPO Deficiency (kidney produces it)
GI Blood loss (hemorrhage)
Reduced RBC lifespan
Iron metabolism disruption (chronic anemia; excess hepcidin [iron absorption disrupted in gut])

26
Q

What did they find in Opus upon abdominal ultrasonography?

A

bilateral renomegaly with bilateral dilated renal pelvises –> figured he has Pyelonephritis

27
Q

How did they treat Opus?

A

IV Fluids (rehydration)
Enrofloxacin (antibiotic)
Sent home on enrofloxacin and cimetadine
gave k/d prescription diet

28
Q

Did we get any closure with this clinical correlate?

A

No, dammit! Opus came back in worse condition and there was no further information. I’m guessing he didn’t make it, unfortunately, based on the values on the last slide.