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Veterinary Medicine > Clinical Urinary Disease (SA) > Flashcards

Clinical Urinary Disease (SA) Flashcards

1
Q

Define AKI.

A

Rapid loss of function resulting in abnormal GFR, tubular function and urine production.

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2
Q

Define CKD

A

Structural/Functional abnormalities of 1/both kidneys for 3m or longer.

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3
Q

Why is nausea/vomiting a sign of reduced kidney function?

A

Uraemic toxins act on CRTZ

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4
Q

Which electrolyte derrangement is a consequence of reduced kidney function?

A

Metabolic Acidosis

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5
Q

What are the two mechanisms which cause metabolic acidosis in kidney derrangement?

A

Can’t produce enough ammonia to buffer H+

Reduced recovery of bicarbonate.

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6
Q

How will Phosphorus change on biochemistry in advanced renal Dz?

A

Increased

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7
Q

How will Ca change on biochemistry in advanced renal Dz?

A

Increase, Normal or Dec

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8
Q

How will Albumin change on biochemistry in advanced renal Dz?

A

Decrease

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9
Q

What is normal urine pH in a cat/dog?

A

5.5-7

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10
Q

What may give a false + protein in urine?

A

Alkaline pH

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11
Q

a UPC > what value would be considered proteinuric in cats?

A

> 0.4

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12
Q

a UPC > what value would be considered proteinuric in dogs?

A

> 0.5

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13
Q

a UPC > what value would be consistent considered with glomerulonephropathy?

A

> 3

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14
Q

What are the 2 occasions where glucosuria is present?

A

DM

Tubular resorption defect i.e. Fanconis

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15
Q

Is ketonuria normal in cats and dogs?

A

Yes dog

No Cat

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16
Q

Which urinary crystals are “coffin” shaped?

A

struvite

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17
Q

Which urinary crystals are hexagonal?

A

Cystine

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18
Q

Which urinary crystals appear like envelopes?

A

calcium oxalate

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19
Q

Which urinary crystals are spiky?

A

ammonium biurate

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20
Q

How do you obtain a sample from a bladder mass for cytology?

A

Catheter and wash!! DO NOT FNA

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21
Q

How does CKD cause hyperPTH?

A

Inc P:

  1. Direct promotion of PTH induced release
  2. decreasing calcitriol production
  3. Forms complex with ionized Ca
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22
Q

Bleeding at the end of urination signals a problem where?

A

Lower UT

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23
Q

What does SDMA correlate well with?

A

GFR

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24
Q

If you want to culture a urine sample - how is it best to obtain it?

A

Cystocentesis (use lab offering MIC)

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25
Q

What is canine urine pH?

A

5.5-7

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26
Q

is trace proteinuria more significant in conc or dilute urine?

A

dilute

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27
Q

What would the UPCR be in UTI’s and glomerulonephropathy?

A

UTI: 1-3
GN: >3

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28
Q

Which Dz may cause ketonuria?

A

DM

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29
Q

In which species is a small amount of bilirubin normal?

A

Dog

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30
Q

What is the cause of hyposthenuria?

A

Active dilution of urine by kidney (in DI, psychogenic PD and HAC)

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31
Q

How many cells is abnormal on sediment exam?

A

> 5-8 WBC per HPF

>5 RBCs per hpf

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32
Q

How large should cat/dog kidneys be on a VD Rx?

A

CaT: 2.5-3x L2
Dog: 2.5-3.5xL2

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33
Q

What is fractional clearance used to assess?

A

Degree of tubular reabsorption - compare w/creatinine

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34
Q

What are the clinical signs of AKI?

A 
PUPD
anorexia
V+/D+
Uraemic Breath
Mouth ulceration
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35
Q

How may AKI cause either tachycardia or bradycardia?

A

Tachy: dehydration
Brady: hyperkalaemia

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36
Q

Which underlying cause of AKI would lead to a low blood Ca?

A

Ethylene Glycol

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37
Q

Which underlying cause of AKI would lead to a high blood Ca?

A

Neoplasia

Vit D intoxication

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38
Q

What will USG be in AKI?

A

Isosthenuric 1.008-1.012

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39
Q

What signs are present with CKD but NOT AKI?

A 
Weight Loss
Non-regen anaemia
Small Kidneys
Surprisingly well for degree of azotaemia
Low K+
Poor Hair Coat
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40
Q

What should be done FIRST in cases of acute AKI?

A

Induce vomiting if toxin ingested
xylazine in cats
apomorphine in dogs

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41
Q

What is the antidote to EG poisoning and how soon does it need to be given?

A

fomepizole
8h dog
3h cat

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42
Q

What is the main tx for AKI?

A

IVFT - based on electrolytes and hydration status

DO NOT GIVE EXCESSIVE AMOUNT!!

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43
Q

How often should a UCath be changed?

A

every 2-3d

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44
Q

What is your 1st line Tx choice to inc urine output of an AKI patient? 2nd line?

A

Furosemide

Mannitol 2nd line

45
Q

How should hyperkalaemia in the AKI patient be treated?

A

IVFT (0.9%/HM)
CaGluconate 10%
Dextrose/insulin

HCO3 if life-threatening

46
Q

How can hypertension be treated in the AKI patient?

A

Nitroprusside
Hydralazine
Amlodipine

47
Q

What 2 options should be considered if renal function is not restored in AKI after Tx?

A

Euthanasia

Dialysis (RVC only)

48
Q

What are the signs of an upper UTI?

A

Abdo pain
Renal Failure
Septicaemia

49
Q

What are the signs of a lower UTI?

A

Dysuria
Pollakuria
Haematuria
Incontinence

NOT PUPD!

50
Q

What is seen on haem/biochem of a UTI?

A

Leukocytosis
Neutrophilia (L shift)
Azotaemia

51
Q

Which test gives pathogen susceptibility to an AB?

A

Agar disk diffusion

52
Q

Which test allows interpretation of the MIC?

A

Antimicrobial dilution technique

53
Q

What are the 3 mainstays of UTI Tx?

A

Eradicate underlying cause
AB therapy
Prevent Recurrence

54
Q

How long should AB therapy be conducted in Entire dogs, most cats, upper UTIs or animals with predisposing causes for UTIs?

A

4-6w

55
Q

How long should a course of ABs be for an uncomplicated UTI?

A

10-14d

56
Q

What are the 3 criteria used for staging CKD?

A

Creatinine Conc
Proteinuria
BP

57
Q

What changes may be seen on haematology of CKD?

A

normocytic
normochromic
Non-regen anaemia

58
Q

What is the 1st stage of CKD Tx?

A

Stop all nephrotoxic drugs

Treat other abnormalities/Dz

59
Q

What can be used alongside dietary protein reduction to reduce proteinuria?

A

ACEI

60
Q

What should be given to animals if CKD has caused hypoprotienaemia?

A

Antiplatelet drugs (aspirin/clopidogrel)

61
Q

What are the 1st, 2nd and 3rd line Tx used to reduce BP in dogs?

A

ACEI at std dose (benazepril)
ACEI at 2xdose
ACEI & Ca channel blocker

62
Q

What are the 1st, 2nd and 3rd line Tx used to reduce BP in cats?

A
  1. Amlodipine/telmisartan
  2. Inc dose of amlod
  3. Combine Am+Tel
63
Q

When should a renal diet be fed to CKD cats/dogs?

A

Cat: Stage II-IV
Dog: Stage III/IV

64
Q

What can be given in addition to a renal diet to combat the effects of CKD?

A

Phosphate binders
(Al hydroxide, Ca acetate, pronefra)

K+ supplements

65
Q

What can be done to control vomiting/nausea associated with CKD?

A

H2 antagonists (cimetidine)
Sucralfate
Antiemetic (maropitant/metaclop)
Appetite Stimulant (mirtazapine)

66
Q

Which 2 supplements can be given with a rneal diet to reduce the metabolic acidosis associated with CKD?

A

Sodium Bicarbonate

Potasisum Citrate

67
Q

How can iron deficiency anaemia be tretad in CKD patients?

A

Orall ferrous sulphate or IM iron dextran

68
Q

Which urine crystals form in acid urine?

A

Cystine

69
Q

Which urine Crystals form in alkaline urine?

A

Struvite (MgAmmP)

Ca Phosphate

70
Q

Which crystals are radio-opaque?

A

Struvite

Ca Oxalate

71
Q

UTIs predispose to which crystals?

A

Struvite (F)

72
Q

HyperCa predisposes to which crystals?

A

Ca Oxalate (M)

73
Q

PSS and high Protein diet predisposes to which type of urolith?

A

Urate

74
Q

Which 3 types of stone may be dissolved?

A

Struvite
Urate
Cystine

75
Q

How are struvite stones dissolved? How long does it take?

A

Low Mg & ammonium diet
High Sodium and water intake
ABs throughout!

3m!

76
Q

Which drug can be used to prevent recurrent urate crystals?

A

Allopurinol

77
Q

What is the best Tx for hydronephrosis associated with nephroliths?

A

Unilateral nephrectomy

78
Q

Which breed of cats are predisposed to FLUTD?

A

Persians

79
Q

What are the 4 predisposing factors for FLUTD?

A

Obesity
Indoor/sedentary cat
Dry diet
Multi-cat household

80
Q

What are the signs of FLUTD?

A

Dysuria
Pollakuria
Haematuria
Periuria (strange places)

81
Q

If cat shows FLUTD signs but is well in self - Dx/Tx?

A

FLUTD but not blocked - will resolve 5-10d

82
Q

What are the signs of a blocked cat?

A

FLUTD + depression/vomiting/anorexia etc

83
Q

What MUST you check on clinical exam of a cat with FLUTD signs?

A

PALPATE bladder - large and painful = blocked!

84
Q

On endoscopic exam of a cat with interstitial cystitis, what can be seen?

A

submucosal petechial haemorrhages

85
Q

What is the most common cause of obstruction in male cats?

A

Urethral plugs

86
Q

What is seen on H/B of blocked cats?

A

Inc: K+, P+, Acid, Urea/creatinine, Ca

87
Q

What can be seen with contrast Rx in the blocked cat?

A

uroliths
bladder masses
urethral narrowing

88
Q

What can be seen with US in the blocked cat?

A

Hyperechoic sediment
Uroliths
Bladder mass
Thickened walls

89
Q

What are the 3 stages to blocked cat Tx?

A
  1. Cysto to relieve pressure
  2. IVFT
  3. correct electrolytes
90
Q

Which urolith requires surgical rmeoval?

A

Calcium Oxalate

91
Q

What lifestyles chanegs should be made for a cat with Idiopathic cystitis?

A

REDUCE STRESS!!

92
Q

What do GAG supplements do?

A

Attach to bladder wall - dec permeability.

93
Q

Which analgesics aid cats with cystitis?

A

NSAIDs

94
Q

How can urethral spasm be treated?

A

ACP
Prazosin
Phenoxybenzamine

95
Q

Which drugs should be used ONLY in cats with chronic cystitis?

A

Tricyclic ANti-depressants (i.e. amytriptyline)

96
Q

What is the hallmark feature of glomerulopathies?

A

Proteinuria

97
Q

Which 2 breeds of dog are predisposed to glomerulopathies?

A

Golden Retrievers

Labradors

98
Q

What 4 things would inc your suspicion of a glomerulopathy?

A
  1. Sick animal with proteinuria refractory to treatment.
  2. Newly diagnosed azotaemia and/or high urine protein
  3. Hypertension of unknown origin
  4. Thrombo(embolic) event
99
Q

What is the gold Std method for diagnosis of glomerulopathy?

A

Biopsy

100
Q

How is glomerulopathy diagnosed in practice?

A

Proteinuria
+ UPCR
+H/B

Repeat in 3 samples 2w apart

101
Q

What UPCR suggests glomerulopathy vs tubuloiterstitial damage?

A

> 2.0 suggests glomerulopathy

<2.0 suggests tubulointerstitial

102
Q

Glomerulopathy Tx should be started in which patients?

A

UPCR:
Dog > 0.5
Cat >0.4

103
Q

What Tx should be used to treat dogs with glomerulopathy?

A

Benazepril 1st (telmisartan not licenced) for proteinuria

Aspirin or clopidogrel for hypercoagulability

Amlodipine (BP)

104
Q

Which dog/cat preeds are genetically predisposed to renal amyloidosis?

A

Shar Pei
Beagle
Siamese
Abyssinian

105
Q

How is renal amyloidosis treated?

A

Glomerulopathy drugs

+colchicine
+/-DMSO

106
Q

Which breeds of cat/dog are presdisposed to PCKD?

A 
Persian
Ragdoll
British SH
Bull Terrier
WHWT
107
Q

What is the prognosis for PCKD?

A

Poor

108
Q

How is nephrotic syndrome characterised?

A

Hypoalbuminaemia
Peripheral oedema
Hypercholesterolaemia
+/- Azotaemia

Veterinary Medicine (68 decks)

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