CC: Uremia Flashcards
What is azotemia?
High Blood Nitrogen
What is uremia?
Clinical disease resulting from azotemia.
Is an azotemic animal always uremic?
Nope.
Is a uremic animal always azotemic?
Yup.
What was up with Opus’s urinalysis?
SG: 1.012 (low for being dehydrated)
pH 6.5
RBC: 9-10 (shouldnt be any)
WBC: 2-3 (shouldn’t be any)
What was up with Opus’s chemistry profile?
Hyperproteinemia
really really high BUN
really really high Creatinine
really high Phosphorous
Signs pointing towards kidney problems
Where is urea produced?
LIVER, only the LIVER. nowhere but the LIVER!
Is urea production variable?
Yup.
What’s the substrate source for urea?
Protein
How is urea made?
Urea Cycle in the liver!
Where is creatinine produced? Is its procution constant? what’s its substrate source?
Muscle; constant; muscle; excreted in urine
How do you get increased production of urea?
high protein diet GI hemorrhage fever tissue trauma (inc. released AAs) drugs: Corticosteroids (cortisol), tetracycline Protein Catabolism
What are reasons for decreased production of urea?
Low protein diet
Hepatic insufficiency
Polyuria-polydipsia (drinking a lot will dilute the concentration and make it appear low)
What are causes of elevated Creatinine?
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)
What are causes of decreased creatinine?
Loss of Muscle mass
Cachexia - muscle wasting
cancer and starvation can cause this
What could cause normal or low BUN with increased Creatinine?
Decreased BUN:
Hepatic Insufficiency
PU/PD
Low Protein Diet
Increased Creatinine:
Cooked meat diet (high in creatinine)
Muscle trauma/inflammation (unusual)
What could cause high BUN and normal creatinine?
Increased BUN:
High protein diet
GI Hemorrhage
Protein Catabolism
Creatinine is just normal
Is urea or creatinine better for determining GFR?
Creatinine - freely filterable, not reabsorbed, relatively constant production
What is used to give a better estimate of what is in the serum from abdominal fluid, BUN or Creatinine?
Creatinine!
BUN is more readily reabsorbed, thus underrepresented.
What indicates Opus has renal failure?
Azotemia along with less than maximally concentrated urine SG since he is dehydrated.
What are clinincal signs of Uremic Syndrome?
Anorexia Nausea Vomiting Lethargy Oral Ulcers Dehydration Anemia
What is the pathogenesis behind Uremic Syndrome?
Electrolyte imbalance metabolic acidosis (failure to excrete H+ and retain HCO3) Toxins that accumulate Endocrine disorders ion transport abnormalities
What are uremic syndrome toxins?
a whole shit load of stuff that he didn’t feel we had to go in to
What are Uremic Syndrome Endocrine problems?
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
What are Uremic Syndrome Anemia problems?
EPO Deficiency (kidney produces it)
GI Blood loss (hemorrhage)
Reduced RBC lifespan
Iron metabolism disruption (chronic anemia; excess hepcidin [iron absorption disrupted in gut])
What did they find in Opus upon abdominal ultrasonography?
bilateral renomegaly with bilateral dilated renal pelvises –> figured he has Pyelonephritis
How did they treat Opus?
IV Fluids (rehydration)
Enrofloxacin (antibiotic)
Sent home on enrofloxacin and cimetadine
gave k/d prescription diet
Did we get any closure with this clinical correlate?
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.
