Clinical Urinary Disease (SA) Flashcards
1
Q
Define AKI.
A
Rapid loss of function resulting in abnormal GFR, tubular function and urine production.
2
Q
Define CKD
A
Structural/Functional abnormalities of 1/both kidneys for 3m or longer.
3
Q
Why is nausea/vomiting a sign of reduced kidney function?
A
Uraemic toxins act on CRTZ
4
Q
Which electrolyte derrangement is a consequence of reduced kidney function?
A
Metabolic Acidosis
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.
6
Q
How will Phosphorus change on biochemistry in advanced renal Dz?
A
Increased
7
Q
How will Ca change on biochemistry in advanced renal Dz?
A
Increase, Normal or Dec
8
Q
How will Albumin change on biochemistry in advanced renal Dz?
A
Decrease
9
Q
What is normal urine pH in a cat/dog?
A
5.5-7
10
Q
What may give a false + protein in urine?
A
Alkaline pH
11
Q
a UPC > what value would be considered proteinuric in cats?
A
> 0.4
12
Q
a UPC > what value would be considered proteinuric in dogs?
A
> 0.5
13
Q
a UPC > what value would be consistent considered with glomerulonephropathy?
A
> 3
14
Q
What are the 2 occasions where glucosuria is present?
A
DM
Tubular resorption defect i.e. Fanconis
15
Q
Is ketonuria normal in cats and dogs?
A
Yes dog
No Cat
16
Q
Which urinary crystals are “coffin” shaped?
A
struvite
17
Q
Which urinary crystals are hexagonal?
A
Cystine
18
Q
Which urinary crystals appear like envelopes?
A
calcium oxalate
19
Q
Which urinary crystals are spiky?
A
ammonium biurate
20
Q
How do you obtain a sample from a bladder mass for cytology?
A
Catheter and wash!! DO NOT FNA
21
Q
How does CKD cause hyperPTH?
A
Inc P:
- Direct promotion of PTH induced release
- decreasing calcitriol production
- Forms complex with ionized Ca
22
Q
Bleeding at the end of urination signals a problem where?
A
Lower UT
23
Q
What does SDMA correlate well with?
A
GFR
24
Q
If you want to culture a urine sample - how is it best to obtain it?
A
Cystocentesis (use lab offering MIC)
25
What is canine urine pH?
5.5-7
26
is trace proteinuria more significant in conc or dilute urine?
dilute
27
What would the UPCR be in UTI's and glomerulonephropathy?
UTI: 1-3
GN: >3
28
Which Dz may cause ketonuria?
DM
29
In which species is a small amount of bilirubin normal?
Dog
30
What is the cause of hyposthenuria?
Active dilution of urine by kidney (in DI, psychogenic PD and HAC)
31
How many cells is abnormal on sediment exam?
>5-8 WBC per HPF
| >5 RBCs per hpf
32
How large should cat/dog kidneys be on a VD Rx?
CaT: 2.5-3x L2
Dog: 2.5-3.5xL2
33
What is fractional clearance used to assess?
Degree of tubular reabsorption - compare w/creatinine
34
What are the clinical signs of AKI?
```
PUPD
anorexia
V+/D+
Uraemic Breath
Mouth ulceration
```
35
How may AKI cause either tachycardia or bradycardia?
Tachy: dehydration
Brady: hyperkalaemia
36
Which underlying cause of AKI would lead to a low blood Ca?
Ethylene Glycol
37
Which underlying cause of AKI would lead to a high blood Ca?
Neoplasia
| Vit D intoxication
38
What will USG be in AKI?
Isosthenuric 1.008-1.012
39
What signs are present with CKD but NOT AKI?
```
Weight Loss
Non-regen anaemia
Small Kidneys
Surprisingly well for degree of azotaemia
Low K+
Poor Hair Coat
```
40
What should be done FIRST in cases of acute AKI?
Induce vomiting if toxin ingested
xylazine in cats
apomorphine in dogs
41
What is the antidote to EG poisoning and how soon does it need to be given?
fomepizole
8h dog
3h cat
42
What is the main tx for AKI?
IVFT - based on electrolytes and hydration status
DO NOT GIVE EXCESSIVE AMOUNT!!
43
How often should a UCath be changed?
every 2-3d
44
What is your 1st line Tx choice to inc urine output of an AKI patient? 2nd line?
Furosemide
Mannitol 2nd line
45
How should hyperkalaemia in the AKI patient be treated?
IVFT (0.9%/HM)
CaGluconate 10%
Dextrose/insulin
HCO3 if life-threatening
46
How can hypertension be treated in the AKI patient?
Nitroprusside
Hydralazine
Amlodipine
47
What 2 options should be considered if renal function is not restored in AKI after Tx?
Euthanasia
| Dialysis (RVC only)
48
What are the signs of an upper UTI?
Abdo pain
Renal Failure
Septicaemia
49
What are the signs of a lower UTI?
Dysuria
Pollakuria
Haematuria
Incontinence
NOT PUPD!
50
What is seen on haem/biochem of a UTI?
Leukocytosis
Neutrophilia (L shift)
Azotaemia
51
Which test gives pathogen susceptibility to an AB?
Agar disk diffusion
52
Which test allows interpretation of the MIC?
Antimicrobial dilution technique
53
What are the 3 mainstays of UTI Tx?
Eradicate underlying cause
AB therapy
Prevent Recurrence
54
How long should AB therapy be conducted in Entire dogs, most cats, upper UTIs or animals with predisposing causes for UTIs?
4-6w
55
How long should a course of ABs be for an uncomplicated UTI?
10-14d
56
What are the 3 criteria used for staging CKD?
Creatinine Conc
Proteinuria
BP
57
What changes may be seen on haematology of CKD?
normocytic
normochromic
Non-regen anaemia
58
What is the 1st stage of CKD Tx?
Stop all nephrotoxic drugs
| Treat other abnormalities/Dz
59
What can be used alongside dietary protein reduction to reduce proteinuria?
ACEI
60
What should be given to animals if CKD has caused hypoprotienaemia?
Antiplatelet drugs (aspirin/clopidogrel)
61
What are the 1st, 2nd and 3rd line Tx used to reduce BP in dogs?
ACEI at std dose (benazepril)
ACEI at 2xdose
ACEI & Ca channel blocker
62
What are the 1st, 2nd and 3rd line Tx used to reduce BP in cats?
1. Amlodipine/telmisartan
2. Inc dose of amlod
3. Combine Am+Tel
63
When should a renal diet be fed to CKD cats/dogs?
Cat: Stage II-IV
Dog: Stage III/IV
64
What can be given in addition to a renal diet to combat the effects of CKD?
Phosphate binders
(Al hydroxide, Ca acetate, pronefra)
K+ supplements
65
What can be done to control vomiting/nausea associated with CKD?
H2 antagonists (cimetidine)
Sucralfate
Antiemetic (maropitant/metaclop)
Appetite Stimulant (mirtazapine)
66
Which 2 supplements can be given with a rneal diet to reduce the metabolic acidosis associated with CKD?
Sodium Bicarbonate
| Potasisum Citrate
67
How can iron deficiency anaemia be tretad in CKD patients?
Orall ferrous sulphate or IM iron dextran
68
Which urine crystals form in acid urine?
Cystine
69
Which urine Crystals form in alkaline urine?
Struvite (MgAmmP)
| Ca Phosphate
70
Which crystals are radio-opaque?
Struvite
| Ca Oxalate
71
UTIs predispose to which crystals?
Struvite (F)
72
HyperCa predisposes to which crystals?
Ca Oxalate (M)
73
PSS and high Protein diet predisposes to which type of urolith?
Urate
74
Which 3 types of stone may be dissolved?
Struvite
Urate
Cystine
75
How are struvite stones dissolved? How long does it take?
Low Mg & ammonium diet
High Sodium and water intake
ABs throughout!
3m!
76
Which drug can be used to prevent recurrent urate crystals?
Allopurinol
77
What is the best Tx for hydronephrosis associated with nephroliths?
Unilateral nephrectomy
78
Which breed of cats are predisposed to FLUTD?
Persians
79
What are the 4 predisposing factors for FLUTD?
Obesity
Indoor/sedentary cat
Dry diet
Multi-cat household
80
What are the signs of FLUTD?
Dysuria
Pollakuria
Haematuria
Periuria (strange places)
81
If cat shows FLUTD signs but is well in self - Dx/Tx?
FLUTD but not blocked - will resolve 5-10d
82
What are the signs of a blocked cat?
FLUTD + depression/vomiting/anorexia etc
83
What MUST you check on clinical exam of a cat with FLUTD signs?
PALPATE bladder - large and painful = blocked!
84
On endoscopic exam of a cat with interstitial cystitis, what can be seen?
submucosal petechial haemorrhages
85
What is the most common cause of obstruction in male cats?
Urethral plugs
86
What is seen on H/B of blocked cats?
Inc: K+, P+, Acid, Urea/creatinine, Ca
87
What can be seen with contrast Rx in the blocked cat?
uroliths
bladder masses
urethral narrowing
88
What can be seen with US in the blocked cat?
Hyperechoic sediment
Uroliths
Bladder mass
Thickened walls
89
What are the 3 stages to blocked cat Tx?
1. Cysto to relieve pressure
2. IVFT
3. correct electrolytes
90
Which urolith requires surgical rmeoval?
Calcium Oxalate
91
What lifestyles chanegs should be made for a cat with Idiopathic cystitis?
REDUCE STRESS!!
92
What do GAG supplements do?
Attach to bladder wall - dec permeability.
93
Which analgesics aid cats with cystitis?
NSAIDs
94
How can urethral spasm be treated?
ACP
Prazosin
Phenoxybenzamine
95
Which drugs should be used ONLY in cats with chronic cystitis?
Tricyclic ANti-depressants (i.e. amytriptyline)
96
What is the hallmark feature of glomerulopathies?
Proteinuria
97
Which 2 breeds of dog are predisposed to glomerulopathies?
Golden Retrievers
| Labradors
98
What 4 things would inc your suspicion of a glomerulopathy?
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
What is the gold Std method for diagnosis of glomerulopathy?
Biopsy
100
How is glomerulopathy diagnosed in practice?
Proteinuria
+ UPCR
+H/B
Repeat in 3 samples 2w apart
101
What UPCR suggests glomerulopathy vs tubuloiterstitial damage?
>2.0 suggests glomerulopathy
| <2.0 suggests tubulointerstitial
102
Glomerulopathy Tx should be started in which patients?
UPCR:
Dog > 0.5
Cat >0.4
103
What Tx should be used to treat dogs with glomerulopathy?
Benazepril 1st (telmisartan not licenced) for proteinuria
Aspirin or clopidogrel for hypercoagulability
Amlodipine (BP)
104
Which dog/cat preeds are genetically predisposed to renal amyloidosis?
Shar Pei
Beagle
Siamese
Abyssinian
105
How is renal amyloidosis treated?
Glomerulopathy drugs
+colchicine
+/-DMSO
106
Which breeds of cat/dog are presdisposed to PCKD?
```
Persian
Ragdoll
British SH
Bull Terrier
WHWT
```
107
What is the prognosis for PCKD?
Poor
108
How is nephrotic syndrome characterised?
Hypoalbuminaemia
Peripheral oedema
Hypercholesterolaemia
+/- Azotaemia
