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clin path > clin path 2 Lab evaluation of renal function > Flashcards

clin path 2 Lab evaluation of renal function Flashcards

1
Q

what the the important substances that the kidneys want to preserve?

A

Na, Cl, bicarb, Ca, Mg, Glucose, amino acids, water

acid base balance

water balance

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2
Q

Where does BUN come from?

A

the liver deaminates amino acids to make urea which moves into the blood.

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3
Q

why BUN a bad indicator of GFR

A

it can vary with production, readsorption

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4
Q

BUN and ruminants are special

A

Don’t even bother using it to measure GFR, as the rumen microflora use it to make amino acids

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5
Q

where does creatinine come from

A

endogenous muscle catabolism (from the break down of creatinine phosphate in energy creation)

its not reabsorbed

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6
Q

define USG

A

estimate of urinary concentrating ability.

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7
Q

even at 33% there is still concentration of the urine

A

USG. the kidney can still concentrate

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8
Q

inability to concentrate urine causes____

A

polyuria

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9
Q

polyuria implies

A

loss of 66% mass

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10
Q

dog USG

A

1.001-1.060

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11
Q

cat USG

A

1.001- 1.080

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12
Q

bovine and horse USG

A

1.001 - 1.055

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13
Q

if the USG is above 1.017, does that indicate that the urine has some concentrating ability

A

yes, yes it does

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14
Q

in the dog and cat, what is the minimum dehydration concentrating capacity?

A

dog, 1.030

cat, 1.035

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15
Q

where are most proteins absorbed?

A

the PCT

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16
Q

what are the renal and extra renal DDxs of polyuria

A

renal (renal failure and pyelonephritis) extrarenal( diuresis, medullary washout
endocrine (diabetes and hyperadrenocortisim, pyometra

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17
Q

chemistry profile aspect that defines azotemia

A

inc BUN; inc creatinine

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18
Q

pre-renal azotemia is characterized by what pattern on a biochemical profile?

A

inc BUN; inc or dec Creatinine; inc specific gravity.

will also decrease GFR (check for NUM and CREA)

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19
Q

explain the DDXs for prerenal azotemia

A

can be either decreased blood flow or increased urea production

decreased blood flow can be caused by dehydration, shock, and low CO

increased urea production can be caused by upper GI bleed, high protein diet, endogenous protein catabolism, and in ruminants: low renal motility

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20
Q

what might be a normal USG range in a dehydrated Dog, Cat, horse and cattle?

A

Dog:1.030-1.060
cat: 1.040-1.080
horse and cattle: 1.025 - 1.045

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21
Q

prenreal azotemia can lead to ____urea production?

a: increased
B: decreased

A

a: increased

22
Q

what specifically causes an increase in urea production in animals with pre renal azotemia

A

basically any source of amino acids like an upper GI bleed, high protein diet, decreased ruminal motility and endogenous protein catabolism

23
Q

what are the sources of increased creatinine in an animal with pre renal azotemia?

A

increased muscle mass as is the case with greyhounds and males

neonatal foals with whose moms has dysfunctional placentas (usually clears after birth

24
Q

what is the general biochemical pattern for renal azotemia

A

inc BUN
inc crea
dec SpGr

25
Q

who is the posterchild for renal azotemia

A

old skinny cat.

26
Q

renal azotemia results in a _____GFR, _____BUN, and ____CREA

A

increased all the way round

27
Q

DDxs of renal azotemia

A 
•Infectious
Pyelonephritis, Leptospirosis
•Toxins
Ethylene glycol, drugs, grapes, Asiatic lilies,melamine,pigments (myoglobin, hemoglobin)
•Hypoxia
Decreased renal perfusion,infarction
•Neoplasia
Primaryor metastatic
•Congenital
Hypoplasiaor aplasia
•Misc
Hydronephrosis
28
Q

T/F. an animal with azotemia and a really low USG means there is renal failre

A

false, it does not always mean this. it can mean electrolyte imbalances, endocrine function, or other drug effects

29
Q

post renal azotemia basic biochemical pattern

A

inc BUN
inc. CREA
variable SpGr

30
Q

DDxs dor post renal azotemia

A

urolithiasis in castrated males (FLUTD, goat urolithiasis)

uroabdomen (urolithiasis and trauma

31
Q

T/F. Polyuria occurs before azometemia?

A

True (66% and 75% damage respectively)

32
Q

azotemia and isosthenuria is

A

renal disease until proven otherwise

33
Q

is it true that cats can still maintain some concentrating capacity with renal failure

A

Yes, because they live to make your life hard….makes them the best animals…they know humans are evil and deserve to be messed with.

34
Q

what are prerenal causes of decreased BUN ONLY

A

decreased urea production as is the case with decreased blood to the liver (decreased dietary protein or a shunt; hepatic insufficiency)

intestinal loss in monogastics and horses (also exist to make you cry…damn suicidal animals horses are)

decreased water resorption to PCT in the renal tubules, means increased GFR and tubular flow (osmotic diuresis)

35
Q

Do we care about decreased CREA?

A

hellz to the NO!

36
Q

DDx fore pre- renal proteinuria

A 
inc in small proteins in blood
paraproteins (bence Jones)
hemoglobinuria
myoglobinuria
post- colostral proteinuria
37
Q

DDx’s for renal proteinuria

A

glomerular and tubular

glomerular:
hypoalbuminemia
damages to filtration

Tubular:
normal serum alb (maybe increased)

acute or congenital renal disease

defective PCT

loss of low molecular weight proteins

38
Q

how does post renal proteinuria come about?

A

hemorrhagic/inflammatory

39
Q

urine protein:creatinine ratio

A

Normal < 0.5
Borderline0.2 –0.5
Tubular or glomerular> 0.5
Glomerular >1.0

glomerular is more serious

40
Q

general trends in the biochemical profile ass with renal failure

A

hyperCa (causes PU, renal mineralization, generally starts the kidney disease)

might see a very mild hypoCa ass with decreased vit C, diet and excretion in horses

hyperphosphatemia (decreased GFR and 75% loss at this point; low serum Ca leads to secondary hyperparathyroidism; horses lose P from the gut; may or may not happen in cattle)

metabolic acidosis in severe renal disease frim the loss of bicarb and secretion of H

hypochloremia seem particularily in cattle

the case of potassium ( normal in CRF; hypokalemia in uremic animals who are not eating; hypokalemic nephropathy; hyperkalemia (oliguria/anuria/ARF and or post renal condition)

uroabdomen and electrolyte imbalances (dogs, cats and newborn foals, look for inc KPP and dec NaCl

special note, in cattle hyperkalemia barely happens as any excess is excreted in the saliva

41
Q

a peritoneal creatinine that is two times greater than serum creatinine is diagnostic for?

A

uroperitoneum

42
Q

laboratory findings of acute renal failure

A

abrupt decrease in GFR

azotemia

hyperkalemia and acidemia

variable SpGr

oliguria/anuria

variable proteinuria and cellular casts

43
Q

are chronic renal failure patients often hypertensive?

A

yes they are.

44
Q

blood work for an animal with chronic renal failure

A

non regenerative anemia

dehydration
azotemia
hyperphasphatemia
metabolic acidosis
normokalemia to hypokalemia
45
Q

urinalysis in a cat with chronic renal failure

A

oliguria and anuria and isosthenuria

46
Q

what is glomerularnephritis and what can cause it?

A

glomerular damage from immune complex deposition and amyloid deposition

soft coated wheated terriers, especially those with coccidiomycosis that live in Arizona

47
Q

glomerularnephritis allows for the passage of proteins past the membrane. this results in?

A

proteinuria and hypoproteinemia

48
Q

lab findings of glomerularnephritis

A

hypoproteinemia
hypoalbuminemia.normoglobulinemia
mild to marked proteinuria
ecidence of renal insufficiency like axotenia and isosthenuria

49
Q

define nephrotic syndrome

A

PLN leading to the formation of an abdominal transudate

will see hypoalbuminemia and hypercholesterolemia

alomerular disease, edema/abdominal effusion/hyper coagulable state from the loss of antithrombin

50
Q

what is a biomarker?

A

a measurable sustance or its products used to predict the incidence of outcome or disease

51
Q

what are some other biomarkers besides BUN and CREA used in renal disease

A

albumin
microalbuminuria (borderline patients)
cystatin C (the upcoming one)
SDMA (increases with 40% loss of renal tubular function (best to rule out renal failure in cats SDMA is)

clin path (9 decks)

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