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Metabolism and excretion > Clinical pathology > Flashcards

Clinical pathology Flashcards

1
Q

Four things that could increase blood [urea] other than renal disease.

A
  1. High protein diet
  2. Dehydration and associated reduced GFR
  3. GIT haemorrhage
  4. Protein-losing enteropathy
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2
Q

Two post-renal causes that could increase blood [urea] and how.

A
  1. Obstruction - urine remains in collecting ducts and pelvis for longer due to increased hydrostatic pressure of the filtrate; more urea gets reabsorbed
  2. Uroabdomen - urea equilibrates very quickly with the blood and tissues from the peritoneal fluid.
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3
Q

Is urea useful in large animals?

A

No - it may be within range even in severe kidney disease. Better to use creatinine.

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4
Q

Three things that may cause creatinine to be high in the blood other than reduced GFR?

A

Large muscle mass
Rhabdomyolysis
Training

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5
Q

Two things that might increase SDMA other than renal disease.

A

Hypovolemia
Dehydration
- anything that reduces GFR will increase SDMA!

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6
Q

What is the effect of proteinuria and glucosuria on USG?

A

Each 10g/L increase in these will increase USG by 0.004

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7
Q

What are the values for isosthenuria, hyposthenuria, hypersthenuria?

A

Hyposthenuria USG = < 1.008
Isosthenuria USG 1.008 - 1.012
Hypersthenuria USG > 1.012

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8
Q

What are the two broad mechanisms for post-renal disease?

A

Obstruction or breach of the lower urinary tract

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9
Q

What is the likely behaviour of blood potassium in anuric, oliguric disease or obstruction?

A

Likely rise (hyperkalaemia) due to reduced GFR (either increased hydrostatic pressure of filtrate or other reason)

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10
Q

What is the likely behaviour of blood potassium in polyuric disease?

A

Likely fall (hypokalaemia) due to reduced tubular function or increased flow rate being too fast for them. Also get extra secretion in the collecting duct when the electrochemical gradient is larger.

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11
Q

What is the likely behaviour of blood phosphate if GFR is reduced?

A

It will increase (hyperphosphatemia) as normally 10% is excreted in the urine, and the rest is re-absorbed from the filtrate. Decreased GFR = slower flow rate = more PO43- reabsorbed.

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12
Q

What are two potential causes of high blood phosphate other than reduced GFR?

A 
Haemloysis in the sample
Young patient (lots of bone turnover)
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13
Q

What is the common behaviour of blood phosphate in horses with chronic kidney disease?

A

Goes down (opposite to other species)

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14
Q

What is the usual behaviour of blood calcium in small animals with chronic renal disease?

A

Usually low. Very rare to be high.

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15
Q

What is the usual behaviour of blood calcium in small animals with acute renal disease?

A

May be normal, high or low. Sometimes high due to failure to excrete calcium.

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16
Q

What is the usual behaviour of blood calcium in horses with renal disease?

A

Usually high, no matter if acute or chronic.

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17
Q

What is the usual response of blood Mg2+ when GFR has been reduced (e.g parenchymal damage to kidney, increased hydrostatic pressure of filtrate, low blood volume)

A

Increase due to retention, as Mg2+ is usually reabsorbed by the tubules, though there are exceptions.

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18
Q

What is the usual behaviour of blood Na+ in cattle with renal failure?

A

Often decreases

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19
Q

What are three differential diagnoses for marked hyponatremia + hypochloremia + azotemia?

A

Addisons: no aldosterone so no salt being reabsorbed; low electrolytes plus destruction of the medullary interstitial concentration gradient leading to polyuria
Diabetes insipidus: no ADH, so significantly less water being reabsorbed, electrolytes lost in increased flow rate
Severe GIT disease: low Cl from vomiting, low Na from secretion into lumen, azotemia from reduced GFR in response to low blood volume.

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20
Q

What does secretory acidosis refer to?

A

Dysfunction of the renal tubular HCO3- reabsorption

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21
Q

What are three mechanisms for anemia in chronic renal failure?

A

Reduced EPO production due to reduced functional capacity of the kidneys
Reduced life span of RBC due to circulating uremic toxins

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22
Q

List three conditions where physiological increase in glomerular permeability may occur, resulting in proteinuria.

A

Fever
Dehydration
Exercise

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23
Q

What are the three main renal mechanisms of proteinuria?

A

Physiological increase in permeability

Glomerular disease (mostly albumin lost, tends to produce greater proteinuria than tubular disease)

Tubular disease (albumin + other proteins lost, search for electrolyte disorders and glucosuria)

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24
Q

What are the three major post-renal mechanisms of proteinuria?

A

Inflammation of the urinary tract

Haemorrhage into the urinary tract - coagulopathy, uroliths, neoplasia, FLUTD

Genital tract addition - prostatic, vaginal, uterine disease

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25
Q

When might you get a false positive for protein on the urine dipstick?

A

When the urine is extremely alkaline - especially herbivores

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26
Q

What are the UPC values that determine normal, borderline proteinuria, significant proteinuria, and likely glomerular proteinuria?

A

Less than 0.5 = normal animal

  1. 5 - 1.0 = borderline proteinuria
  2. 0 or more = significant proteinuria

Greater than 3.5 - likely glomerular proteinuria

27
Q

What is the term for leukocytes in urine?

A

Pyuria

28
Q

What is the term for casts present in urine?

A

Cylinduria

29
Q

What might cause gross brown urine discolouration?

A

Myoglobin, bilirubin, old haemorrhage

30
Q

What might increased cloudiness of urine reflect?

A

Mucous, cells, crystals, bacteria

Or storage in cold temperature

31
Q

What is one downfall of cystocentesis or catheterised urine collection?

A
  • requires special skillset, must be sterile

- may get blood contamination

32
Q

What is the normal USG range for a cat?

A

1.035 - 1.060 /// 1.035 if concentrated

33
Q

What is the normal USG range for a dog?

A

1.015 - 1.045 //// 1.030 if concentrated

34
Q

What is the normal USG range for a horse?

A

1.015 - 1.030 //// 1.025 if concentrated

35
Q

What are four things that can increase USG?

A

Glucose
Protein
Turbidity
Electrolytes

36
Q

What are the normal UPC values for dog and cat?

A

Dog < 0.5

Cat < 0.4

37
Q

What does UPC result of >1 suggest?

What about >3.5?

A

> 1 = significant protein loss - renal proteinuria

> 3.5 = most likely glomerular than tubular disease e.g glomerular amyloidosis

38
Q

What are the potential causes of glucosuria in a cat?

A

Hyperglycemia
Tubular disease
Stress (can go up to 20mmol/L)

39
Q

What are the normal glucosuria values for cats, dogs, horses, cows?

A

Dogs: ~ 10mmol/L
Cats: ~ 15mmol/L
Horses: ~ 9mmol/L
Cattle: ~ 5mmol/L

40
Q

How could one animal have ketonuria but not ketonaemia?

A

Because the dipstick measures different ketones to the blood test
- dipstick = acetoacetic acid + acteone
- blood test = beta-hydroxybutyrate
Ketonuria usually precedes ketonaemia

41
Q

Is it normal to see any bilirubin in dog urine? What about cats?

A

Dogs can conjugate bilirubin in their tubules - yes small positive is okay, especially if concentrated

In cats, bilirubinuria is always indicative of bilirubinaemia. May appear before bilirubinaemia.

42
Q

What does the blood section of the dipstick react with? How can you differentiate which compound is present in the urine?

A

Haemoglobin, myoglobin and intact erythrocytes
Do sediment > RBC?
Observe spun urine > red?
CBC results > high or low PCV?
Check CK in blood , which will be increased in myopathy

43
Q

What might lead to artefactural increase in urine pH?

A

Storage

44
Q

What might lead to pathological increase in urine pH?

A

Urease + bacteria

45
Q

Count cells in sediment per ‘high power field’

What is the normal range for RBC and WBC?

A

Less than 5 per HPF

46
Q

What is normal dog and cat urine pH?

A

Around 7

47
Q

Which species commonly has a lot of lipid in urine?

A

Cats

48
Q

What is a urinary cast?

A

An accumulation of protein or cells in the renal tubule due to slow flow +/- tubular damage

49
Q

What does a cellular cast signify? List cellular > waxy in the correct order from youngest to oldest.

A

Cellular cast = fresh tubular damage

Cellular > coarsely granular > finely granular > Waxy

50
Q

What is a hyaline cast made of? What does it signify?

A

Normal Tamm-horsfall protein

Slow flow through tubules and/or increased protein leakage

51
Q

What are four physiological causes of a hyaline cast?

A
  1. Strenuous exercise
  2. Dehydration
  3. Oliguria
  4. Proteinuria
52
Q

What does a granular cast contain? What does it indicate?

A

Mucoprotein, plasma, protein, cells

Indicates renal tubular necrosis

53
Q

What does a waxy cast contain? What does it indicate?

A

Is a degenerating cellular or granular cast

Oliguria, nephron obstruction, chronic renal failure, end stage renal disease

54
Q

Name three crystals that precipitate in acidic urine

A

Calcium oxalate
Uric acid
Bilirubin
Cysteine

55
Q

Name three crystals that precipitate in alkaline urine

A

Calcium carbonate
Ammonium biurate
Magnesium ammonium phosphate (struvite)

56
Q

Which are the rooftop crystals? Normal? Acidic or alkaline urine? Visible on xray?

A

Magnesium ammonium phosphate
Normal
Alkaline
No not visible on xray

57
Q

Which are the jacket studs? Normal? Acidic or alkaline urine? Visible on xray?

A

Calcium oxalate dihydrate
Normal in low numbers
Acidic urine
Yes visible on xray

58
Q

Which are the cucumbers? Normal? Acidic or alkaline urine? Visible on xray?

A 
Calcium oxalate monohydrate
ABNORMAL
Indicate acute renal oxalate nephrosis
Form in acidic urine
Yes visible on xray
59
Q

Which are the muddy spheres? Acidic or alkaline? Normal? Visible on xray?

A

Calcium carbonate. Normal in horses, rabbits (give cloudy mucoid appearance). Alkaline urine
Yes visible on xray- anything with calcium is

60
Q

Which are the fireworks? Normal? Acidic or alkaline urine? Visible on xray?

A

Bilirubin crystals - low numbers okay in dogs, abnormal in cats - indicates bilirubinaemia
Acidic urine
Probably not visible on xray

61
Q

Which are the sarcoptes crystals? Normal? Acidic, alkaline?

A

Ammonium biurate - abnormal in most species except some dogs, where they may just be due to defect in purine metabolism. Though they can indicate hepatic insufficiency. Form in alkaline urine. Dog breeds that may have them in health include English bulldogs, dalmatians, black russian terrier

62
Q

Which are the hexagons/pentagons? Normal? Acidic or alkaline?

A

Cysteine crystals - never normal - indicate inability to reabsorb cysteine at PCT
Acidic urine

63
Q

What might fungal hyphae signify in sediment?

A

Infection or sample contamination

64
Q

If you get positive protein in a urine sample >8 pH what does this signify?

A

Could be false positive - search for inflammation, if none, run UPC, if none, then was false positive likely.

Metabolism and excretion (9 decks)

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