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Equine > Equine kidney disease > Flashcards

Equine kidney disease Flashcards

1
Q

What pH is equine urine normally

A

Alkaline

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2
Q

What are the isothenuric, hypothenuric and hyperthenuric ranges

A

Hypo = <1.008
Iso = 1.008 - 1.014
Hyper = >1.014

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3
Q

What is GGT:creatinine ratio used for

A

Sensitive marker of tubular injury/dysfunction because GGT is high when there is leakage from tubular epithelium

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4
Q

What counts as polydipsia

A

> 100ml/kg/day

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5
Q

What is the most common cause of polydipsia in horses

A

Psychogenic

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6
Q

When do we see an increase in creatinine in blood

A

When 75% of kidney function is lost

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7
Q

What is SDMA

A

Endogenous arginine released into bloodstream during protein catabolism
-Not excreted in kidney failure
- Suggested to detect kidney injury earlier than creatinine but not clear

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8
Q

What electrolyte abnormalities are seen in AKI

A

Hyponatraemia and hypochloraemia are main ones

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9
Q

What electrolyte abnormalities are seen in CKD

A

Hyperkalaemia
hypercalcaemia
Hyponatraemia

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10
Q

Why do we see hypercalcaemia in CKD

A

Lack of excretion in CKD
BUT also should investigate possibility of paraneoplastic syndrome

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11
Q

What effect can hypoalbuminaemia have on calcium levels in CKD

A

Less protein bound calcium can lead to underestimation of biologically active calcium and mask hypercalcaemia

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12
Q

Signs of acute kidney injury

A

Vague; dull, inappetant
Oliguria more common than anuria

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13
Q

Difference between hypovolaemia and dehydration

A

Hypovolaemia = loss of water from the circulation
Dehydration = loss of body water

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14
Q

What can be a drug related cause of internal haemorrhage

A

Phenylephrine administration causnig rupture of great vessels of spleen in older horses

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15
Q

Blood results in haemorrhagic shock

A

High lactate due to poor tissue perfusion
Pre-renal azotaemia due to poor renal perfusion + just small volume urine

No evidence of blood loss immediately (takes ~24hrs for protein and RBCs to drop)

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16
Q

Why doesn’t PCV drop for 24hrs in acute blood loss

A

Due to splenic reserves and catecholamine induced contraction of spleen following tissue hypoxia

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17
Q

What nephrotoxins can cause acute kidney injury

A

NSAIDs
Aminoglycosides
Bisphosphonates
Pigment

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18
Q

When is NSAID toxicity most likely

A

In sick, dehydrated horses recieving IV NSAIDs

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19
Q

What type of antibiotics are aminoglycosides and how can we do the dosing to avoid tubular damage

A

= contration dependent
Small % of every dose goes to prox tubular epithelial cells

Key = using longer dosing intervals (>24hrs) to avoid accumulation and to allow some time where tubules are not exposed

Therapeutic drug monitoring is a good idea to check that drug concentration gets down to 0

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20
Q

What are bisphosphonates and how can we reduce risk of kidney damage

A

= used to reduce osteoclastic activity in bones

Do not use if impaired renal function
Do not use concurrently with NSAIDs
Give adequate access to water

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21
Q

How do pigments cause kidney damage

A

Oxidative damage

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22
Q

Two types of pigment nephropathy and how might we get them

A

Myoglobin: muscle injuriies, hypoglycin A, myopathies
Haemoglobin: haemolysis e.g from IMHA, neonatal isoerythrolysis

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23
Q

If we see myoglobin pigment in urine what should we look for on the bloods

A

Evidence of myopathy; CK and AST

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24
Q

What is the most common cause of pigmenturia

A

Atypical myopathy

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25
Q

What is acute glomerular nephritis and how do we diagnose

A

= nephrotic syndrome; biopsy shows immune complexes
May see with other autoimmune diseases

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26
Q

What does biopsy of acute interstitial nephritis show

A

Interstitial oedema and infiltrate

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27
Q

Treatment for acute interstitial nephritis

A

Rare condition; rapid increase in urea and creatinine
Give corticosteroids but poor prognosis

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28
Q

Treatment principles for AKI

A

Get rid of risk factors e.g NSAIDs, haemorrhage
Replace and maintain fluids with IV therapy Can use furosemide to reduce metabolic demands on cell to save tubular cells (inhibits Na/K ATPase) + cause diuresis

29
Q

Clinical signs of chronic kidney faliure

A

WEight loss, inappetance, PU/PD, oedema, lethargy,
May have uraemic syndome

Tend to look good UNTIL there is loss of protein

30
Q

What are the signs and aetiology of glomerulonephritis

A

Immune mediated deposition of immune complexes on glomerulus BM
see haematuria and proteinuria

Poor prognosis

31
Q

Differentiate chronic renal disease from acute

A

Urine is isothenuric (rather than concentrated)
Azotaemia often very marked
Mild anaemia
Hypoalbuminaemia

Electrolytes: high K+, low Na+/Cl-, high Ca2_

32
Q

Treatment of chronic kidney disease

A

palatable diet highly caloric diet without starch/sugar
Very poor prognosis once thin due to low albumin

33
Q

What is idiopathic renal haemorrhage and how do we treat it

A

= spontaneous severe haemorrhage
May respond to steroids
Consider nephrectomy if unilateral

34
Q

What is oliguria

A

Reduced urine output
- Can be absolute or lack of expected urine output given fluid therapy

35
Q

What is pollakiuria

A

Increased frequency of urination
- Must differentiate infcreased frequency from increased VOLUME with polyuria causing higher freq

36
Q

What other things could cause apparant strnguria

A

GI pain e.g from ulcers, meconium impaction

37
Q

What does hyposthenuric urine show

A

Active water secretion since more dilute than plasma
= indicative of CKD, psychogenic PD, diabetes insipidus

38
Q

What drugs can cause urine to appear isosthenuric

A

Sedatives (may have been used during catheterisation)

39
Q

What can intermittent haematuria e.g after strenuous exercise be a sign of

A

Calculus

40
Q

How common are primary UTIs

A

rare
Because normal flora is protective+ bladder has protective mucous

41
Q

What things can predispose to secondary cystitis

A

Urethral damage e.g from breeding, parturtion, iatrogenic
Abnormal anatomy
Urolithiasis
Bladder paralysis
Bladder neoplasia
Sterile inflammatory cystitis leading to opportunistic infection

42
Q

What is a good first line antibiotics for UTIs

A

TMPS since this is concentrated in the urine

43
Q

What counts as proof of infection in urine

A

Quantitive culture from catheter showing >10 leukocytes/hpf

44
Q

Haematuria possible causes (renal, bladder, urethra)

A
  • Renal: idiopathic haemorrhage, neoplasia, cystic structures
  • Bladder: stones, idiopathic haemorrhagic cystitis, bacterial cystitis, neoplasia
  • Urethra: neoplasia, colliculus seminalis inflammation in geldings

+ haemolysis; not true haematuria

45
Q

If blood coming from both kidneys rather than one on endoscopy what does this suggest

A

Due to haemolytic condition

46
Q

If haematuria coming from just one ureter what are the likely causes

A

neoplasia, kidney stone, idiopathic renal haemorrhage, cystic change

47
Q

Where are uroliths found in horses

A

Bladder (very rare to be urethral or ureteral)
3X more likely in geldings

48
Q

Are uroliths related to UTIs

A

Doesn’t seem likely since geldings most predisposed to stones but mares get more UTIs

49
Q

Are uroliths diet induced

A

NO - all have forage and excrete clacium via kidneys

50
Q

What clinical signs might a horse with nephroliths show

A

[normally asymptomatic]
Can show pain when ridden, biting signs
May try blocking kidney to see if it removes the pain before removing kidney

51
Q

When would we consider nephrectomy for neprholith

A

If causing signs and animal NOT azotaemia

52
Q

Clinical signs of cystoliths

A

Haematuria after exercise
Concurrent UTI signs
Stranguria/dysuria

53
Q

Treatment of cystoliths in horses

A

Need surgery = perineal urethrotomy and cystoscopy guided stone removal

54
Q

What infectious cause of urinary incontinence must we consider/rule out

A

EHV-1 myeloencephalopathy

55
Q

What are the common causes of incontinence

A

Related to neurological dysfunction or idiopathic

56
Q

POssible causes of urinary incontinence

A
  • Sabulous cystitis
  • Sacrococcygeal injury; trauma
  • Bladder calculi
  • EHV myeloencephalitis/opathy
  • Polyneuritis equi
  • Sacral abscessation
  • Sacral neoplasia
57
Q

What do we tend to find with incontinence due to sacral trauma

A

Issue is LMN supply to bladder; feel atonic distended bladder with incomplete emptying and overflow dribbling

58
Q

What do we look for when trying to work out if urinary incontinence could be EHV-1 myeloencephalopathy

A

Ask about vaccination, travel etc
Look for cauda equina signs and ataxia e.g weak anal tone, poor perineal sensation, pelvic limb ataxia, gluteal atrophy

59
Q

What is equine sabulous cystitis

A

When calcium crystals accumulate as seidment in the ventral spect of bladder
Can become so heavy it pulls the bladder over the pelvic brim

See thick yellow sludge of protein, bacteria, ammonia WBCs, RBCs, mucus, chalk

60
Q

Diagnosis and treatment of equine sabulous cystitis

A

Diagnosis = cystoscopy
Treatment = repeated bladder lavage, treat inflammation and secondary infections
NB: poor prognosis

61
Q

At what urine concentration is it worth investigating suspected PU/PD further

A

<1.012

62
Q

What medical diseases can we check for that may be causing PU/PD and how

A

Liver via GGT
PPID via ACTH test
Diabetes mellitus via fasted glucose test
Chronic kidney failure via urea/creantinine

63
Q

When do we want to avoid water deprivation test

A

If chance horse may be in chronic kidney failure

64
Q

If horse is able to concentrate urine during water deprivation test what does it have

A

Psychogenic polydipsia

65
Q

If horse cannot concentrate urine during water deprivation test and becomes dehydrated what does it have

A

Diabetes insipidus

66
Q

What tumours of the penis are common

A

Squamous cell carcinoma; starts as papilloma then neoplastic transformtaino
Melanoma = pigmented solid mass

67
Q

Treatment for equine genital squamous cell carcinoma

A

Early resection, remove lots of penis and do perineal urethrostomy
Can try local chemo?….

68
Q
A

Equine (19 decks)

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