clin path 2 Lab evaluation of renal function

Question 1

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

Answer 1

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

acid base balance

water balance

Question 2

Where does BUN come from?

Answer 2

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

Question 3

why BUN a bad indicator of GFR

Answer 3

it can vary with production, readsorption

Question 4

BUN and ruminants are special

Answer 4

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

Question 5

where does creatinine come from

Answer 5

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

its not reabsorbed

Question 6

define USG

Answer 6

estimate of urinary concentrating ability.

Question 7

even at 33% there is still concentration of the urine

Answer 7

USG. the kidney can still concentrate

Question 8

inability to concentrate urine causes____

Answer 8

polyuria

Question 9

polyuria implies

Answer 9

loss of 66% mass

Question 10

dog USG

Answer 10

1.001-1.060

Question 11

cat USG

Answer 11

1.001- 1.080

Question 12

bovine and horse USG

Answer 12

1.001 - 1.055

Question 13

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

Answer 13

yes, yes it does

Question 14

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

Answer 14

dog, 1.030

cat, 1.035

Question 15

where are most proteins absorbed?

Answer 15

the PCT

Question 16

what are the renal and extra renal DDxs of polyuria

Answer 16

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

Question 17

chemistry profile aspect that defines azotemia

Answer 17

inc BUN; inc creatinine

Question 18

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

Answer 18

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

will also decrease GFR (check for NUM and CREA)

Question 19

explain the DDXs for prerenal azotemia

Answer 19

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

Question 20

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

Answer 20

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

Question 21

prenreal azotemia can lead to ____urea production?

a: increased
B: decreased

Answer 21

a: increased

Question 22

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

Answer 22

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

Question 23

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

Answer 23

increased muscle mass as is the case with greyhounds and males

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

Question 24

what is the general biochemical pattern for renal azotemia

Answer 24

inc BUN
inc crea
dec SpGr

Question 25

who is the posterchild for renal azotemia

Answer 25

old skinny cat.

Question 26

renal azotemia results in a _____GFR, _____BUN, and ____CREA

Answer 26

increased all the way round

Question 27

DDxs of renal azotemia

Answer 27

``` •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 ```

Question 28

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

Answer 28

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

Question 29

post renal azotemia basic biochemical pattern

Answer 29

inc BUN inc. CREA variable SpGr

Question 30

DDxs dor post renal azotemia

Answer 30

urolithiasis in castrated males (FLUTD, goat urolithiasis) uroabdomen (urolithiasis and trauma

Question 31

T/F. Polyuria occurs before azometemia?

Answer 31

True (66% and 75% damage respectively)

Question 32

azotemia and isosthenuria is

Answer 32

renal disease until proven otherwise

Question 33

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

Answer 33

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.

Question 34

what are prerenal causes of decreased BUN ONLY

Answer 34

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)

Question 35

Do we care about decreased CREA?

Answer 35

hellz to the NO!

Question 36

DDx fore pre- renal proteinuria

Answer 36

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

Question 37

DDx's for renal proteinuria

Answer 37

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

Question 38

how does post renal proteinuria come about?

Answer 38

hemorrhagic/inflammatory

Question 39

urine protein:creatinine ratio

Answer 39

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

Question 40

general trends in the biochemical profile ass with renal failure

Answer 40

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

Question 41

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

Answer 41

uroperitoneum

Question 42

laboratory findings of acute renal failure

Answer 42

abrupt decrease in GFR azotemia hyperkalemia and acidemia variable SpGr oliguria/anuria variable proteinuria and cellular casts

Question 43

are chronic renal failure patients often hypertensive?

Answer 43

yes they are.

Question 44

blood work for an animal with chronic renal failure

Answer 44

non regenerative anemia ``` dehydration azotemia hyperphasphatemia metabolic acidosis normokalemia to hypokalemia ```

Question 45

urinalysis in a cat with chronic renal failure

Answer 45

oliguria and anuria and isosthenuria

Question 46

what is glomerularnephritis and what can cause it?

Answer 46

glomerular damage from immune complex deposition and amyloid deposition soft coated wheated terriers, especially those with coccidiomycosis that live in Arizona

Question 47

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

Answer 47

proteinuria and hypoproteinemia

Question 48

lab findings of glomerularnephritis

Answer 48

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

Question 49

define nephrotic syndrome

Answer 49

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

Question 50

what is a biomarker?

Answer 50

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

Question 51

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

Answer 51

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)