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CLIN SCI: Urogenital System > Equine Nephrology > Flashcards

Equine Nephrology Flashcards

1
Q

Is more oxygen available for the kidney to use in the cortex or medulla

A

cortex- blood flow preferentially distributed to the cortex

15% of cardiac output, consumes 10% of oxygen

renal medulla is always finctioning in a state of hypoxia

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2
Q

Factors that change how much horses drink

A

ambient temp
being a foal (nursing and growing)
exercising
all roughage diet

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3
Q

Factors that change how much a horse urinate

A

1) Diets high in protein (nitrogen)
2) Diets high in calcium
3) Lack of water provision (no water no peeing)

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4
Q

What are the two receptors that trigger thirst

A

Osmoreceptors
Baroreceptors: in carotid body

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5
Q

T/F: to make a horse drink more, you can put more salt in their diet

A

False- it does not work

kidneys are too good at regulating the salt

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6
Q

What part of the nephron receives the least amount of oxygen

A

the thick ascending limb

(in the medulla- has oxygen tension about 10mmHg)

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7
Q

During times of low oxygen or blood flow, what does the kidney do?

A

Increases vasodilation
-Prostaglandins (PGE2)
-Nitric oxide
-Dopamine

*NSAIDs inhibit prostaglandins and leads to less blood flow

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8
Q

How can NSAIDs worsen kidney hypoxia

A

because they inhibit the conversion of arachadonic acid to prostaglandins
prostaglandins are important to increase vasodilation during times of low oxygen or blood flow

therefore, NSAIDs worsen hypoxia and the first place of damage is the medulla (thick ascending limb)

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9
Q

What is the first target to hypoxic death in the kidneys

A

Medulla (thick ascending limb)

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10
Q

What are the clinical signs of renal disease in horses

A

Weight loss
abnormal urination
less common: fever, anorexia, ventral edema, oral ulcers/ dental tartar, “kidney colic”

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11
Q

Are the kidneys often the cause of colic in horses

A

No- not likely
but can be with nephroliths/neoplasia

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12
Q

When do you suspect kidney problems in horses

A

Abnormal urination
1) Polyuria: abnormal urine output in volume
-PPID
-Renal Disease
-Polydipsia
-Diabetes

2) Pollakiuria: abnormal urine frequency
-Cystic calculi
-cystitis
-mares in estrus

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13
Q

increased urination in volume

A

polyuria

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14
Q

increased urination in frequency

A

pollakiuria

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15
Q

Causes of polyuria in horses

A

PPID
Renal Disease
Polydipsia- psychogenic
Diabetes

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16
Q

Causes of pollakiuria in horses

A

Cystic calculi
Cystitis
Mares in estrus

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17
Q

Compared to small animals, BUN in horses is

A

variable

related to:
-age
-diet
-rate
-urea production
-renal function

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18
Q

T/F: in equine patients, BUN is unpredictable and difficult to assess

A

true

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19
Q

urea excretion in the loop of henle of the kidney is a

A

passive mechanism (no ATP or oxygen)

putting a horse on a low protein diet does not decrease the workload on the kidney

having a protein diet is not going to make the kidneys worse, but it might benefit having less nitrogenous waste

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20
Q

Does putting a horse on a low-protein diet help to decrease the workload on the kidney

A

NO

urea excretion is a
passive mechanism (no ATP or oxygen)

putting a horse on a low protein diet does not decrease the workload on the kidney

having a protein diet is not going to make the kidneys worse, but it might benefit having less nitrogenous waste

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21
Q

freeling filtered at the glomerulus
stores for energy in the muscles and brain as phosphocreatinine.

A fixed portion is released as creatinine daily, proportional to muscle mass

A

Creatinine

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22
Q

What is the high end of creatinine in horses

A

1.8 mg/dL

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23
Q

What is the normal creatinine in horses

A

0.4-1.8 mg/dL

dietary has little influence

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24
Q

Does a horse with more muscle mass have a lower or high creatinine

A

higher creatinine (may be upper end of the reference interval)
look at clinical signs

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25
Compared to adults, creatinine in foals is generally
30-50% higher than the mare. Higher if there is asphyxia and prematurity
26
Spurious neonatal creatinine (foals)
a creatinine of 5-15mg/dL is okay should reduce within first few days of life higher if there is asphyxia, prematurity
27
Why might placentitis be a source of increased creatinine in a horse
post-renal azotemia mare does not filter out the waste product of creatinine but it already has gone through the foals bladder to the placenta then it is post-renal
28
What are non-renal increases in creatinine of the horses
fasting rhabdomyolysis muscle wasting
29
a transient and reversible period of compromised renal function as a result of poor renal blood flow that can lead to a permanent but clinically silent decrease in renal functional mass
Pre-Renal Azotemia -give fluids to see if it resolves before giving anything nephrotoxic
30
In a horse with pre-renal azotemia, USG is typically
>1.020
31
Azotemia in the horse that is related to acute or chronic kidney injury USG may be isosthenuria: 1.008-1.012
renal azotemia
32
azotemia associated with failure to urinate in the horse
post-renal azotemia
33
What are the major electrolyte abnormalities is seen in horses *
Hyponatremia Hypochloremia Hyperkalemia (in severe diseases) hypoalbuminemia (if glomerulus is injured)
34
to get horses to urinate
catch when placed on a freshly bedded stall
35
normal horse urine is
turbid to mucoid owing to mucous calcium carbonate crystals and concentration
36
What might cause you overestimate the USG
glucose and protein will lead to overestimation when read on the refractometer
37
USG <1.008
hypoesthenuria
38
USG 1.008-1.012
isosthenuria
39
USG >1.025
hyperesthenuria
40
The USG of foals is typically ___________ due to their milk diet
isosthenuric to hypoesthenuric USG <1.012
41
On a free catch sample in horses, WBCs and RBCs are normal as long as they are
<5 RBC/hpf <10 WBC/hpf
42
In horses, if their urine is culturing bacteria, does this mean they have a UTI
NO- not until you see increased WBCs in addition (pyuria) bacteria is likely a contaminate
43
Dipstick results in horses
pH: alkaline (7-9) False + protein in alkaline samples Proteinuria: bacteria, glomerular disease, pyuria, acidosis Lower glucose renal threshold suspected (150mg/dL) -alpha 2s and steroids -fanconi syndrome (tubular dysfunction) -AKI Pigementuria -Blood
44
What is the normal pH of horse urine
Alkaline 7.0-9.0 foals will not have alkaline urine
45
Why do horses typically have trace protein in their urine
because their urine is alkaline false + protein
46
Why might you see glucose in the horse's urine that is completely normal
they have a lower urine threshold (150mg/dL) 1) Stress 2) Alpha 2s (xylazine) and steroids 3) Fanconi syndrome (tubular dysfunction) 4) AKI
47
Dipstick blood + can be ____ in horses
1) Whole blood OR 2) Hemoglobin OR 3) Myoglobin differentiate by spinning down 1) Pellet= whole blood 2) Pink urine that doesnt spin down and pink plasma = hemoglobin 3) pink urine that doesnt spin down and clear plasma = myoglobin
48
How do you differentiate between whole blood, hemoglobin, and myoglobin
differentiate by spinning down 1) Pellet= whole blood 2) Pink urine that doesnt spin down and pink plasma = hemoglobin 3) pink urine that doesnt spin down and clear plasma = myoglobin
49
If you want to see casts on urine sediment you need to do the analysis within
30-60 min after collection
50
molds of glycoproteins and cells that form in tubules and pass into the bladder associated with inflammation or infection
Casts
51
What ultrasound change to the kidneys will you see in horses with renal damage
Large- AKI Small and Lumpy-CKD cortico-medullary distinction: should have good distinction Medullary Rim Sign- acute or chronic NSAID toxcity Hydronephrosis vs pyelectasia Nephroliths
52
Why does it appear that horses have a larger kidney on the right side
because when doing an ultrasound, that kidney is closer to the body wall
53
What on ultrasound is associated with acute or chronic NSAID toxicity in horses
Medullary Rim sign - bright wall right at the corticomedullary junction see this because the thick ascending limb is fibrotic
54
extra fluid in the renal pelvis
hydronephrosis
55
bladder ultrasounds in horses
performed transcutaneous or transrectal always looks turbid (fluid is echoic- calcium carbonate) assess for stones, masses, cystitis ureters -scope after you ultrasound
56
If you even need to do a renal biopsy in a horse, you should only do it
ultrasound guided
57
Possible complications with equine renal biopsy
perirenal hemorrhage (1-3% of patients may require a blood transfusions) Hematuria Bowel penetration
58
how might pre-renal disease lead to AKI
ischemic tubular insult/necrosis
59
T/F: AKI can occur as a result of pre-renal, renal, or post-renal disease
true
60
non-oliguric renal failure
minimal urine (less volume)
61
What are the changes in urination seen in AKI
1) non-oliguric renal failure 2) polyuria 3) oliguria 4) anuria
62
What are the main medical nephrotoxins in horses **
1) Aminoglycosides (Genamicin) 2) Tetracyclines (Oxytetracycline) 3) NSAIDs (Banamine & Equioxx) 4) bisphosphonates (Osphos) Need to be handled in care with dehydrated horses
63
1) Aminoglycosides (Genamicin) 2) Tetracyclines (Oxytetracycline) 3) NSAIDs (Banamine & Equioxx) 4) bisphosphonates (Osphos) need to be handled with care in horses that are
dehydrated horses
64
Name 6 nephrotoxins in horses that can lead to acute tubular necrosis
1) Aminoglycosides (Genamicin) 2) Tetracyclines (Oxytetracycline) 3) NSAIDs (Banamine & Equioxx) 4) bisphosphonates (Osphos) 5) Myoglobin 6) Hemoglobin
65
acute tubular necrosis in horses can due to ______ or ________
Nephrotoxins 1) Aminoglycosides (Genamicin) 2) Tetracyclines (Oxytetracycline) 3) NSAIDs (Banamine & Equioxx) 4) bisphosphonates (Osphos) 5) Myoglobin 6) Hemoglobin Ischemia 1) Dehydration 2) Hypovolemia 3) hypoxia
66
Clinical signs of acute renal failure in horses
anorexia, depression, dehydration, abnormal urination, fluid retention sometimes may seem clinically silent- electrolye derangements: hyponatremia/ hypchloremia + acidosis weight to see if there is fluid retention
67
How do you treat AKI in horses *
1) Restore plasma volume and maintain euvolemia * 2) Prevention * 3) Moderate electrolyte imbalances 4) Dialysis: removal of waste products from the blood while the kidneys recover, in adult horses generally peritoneal (not really done) you could treat uremia with furosemide? butttttt
68
the mainstay of treatment of equine AKI is *
provision of JUDICIOUS EUVOLEMIA 1) FLUIDS to maintain blood flow to kidneys (not flushing them) generally 1.5x maintenance
69
What is the risk of dialysis in horses
generation of peritonitis
70
What might cause CKD in horses
1) Glomerulonephritis: RARE- immune mediated glomerular damage from SLO, lepto, equine infectious anemia, strep See proteinuria and microscopic hematuria 2) Chronic Interstitial Nephritis (CIN)- not rare; catchall for extraglomerular causes of CKD ' Eventually leads to nephroliths and hydronephrosis First clinical sign: loss of concentrating ability
71
What is the first clinical sign of chronic interstitial nephritis in horses
loss of concentrating ability
72
chronic interstitial nephritis in horses
not rare; catchall for extraglomerular causes of CKD ' Eventually leads to nephroliths and hydronephrosis First clinical sign: loss of concentrating ability
73
chronic interstitial nephritis can eventually lead to
nephroliths and hydronephrosis
74
in horses develops as a result of effect of uremic toxins on cell metabolism and function not just urea but all kinda of nitrogenous waste does not correlate with azotemia
uremic syndrome
75
is glomerulonephritis or chronic interstitial nephritis a more common cause of CKD in horses
chronic interstitial nephritis
76
What does not correlate with uremic syndrome
Azotemia
77
Uremic syndrome (horses)
develops as a result of effect of uremic toxins on cell metabolism and function not just urea but all kinda of nitrogenous waste does not correlate with azotemia signs: 1) Uremic encephalopathy 2) lethargy/weakness 3) Vomiting 4) Bleeding diathesis (reduced platelet function)
78
What are the clinical signs of uremic syndrome in horses
1) Uremic encephalopathy 2) lethargy/weakness 3) Vomiting 4) Bleeding diathesis (reduced platelet function)
79
Diseases of the equine bladder
1) Cystitis (idiopathic, sabulous, or bacterial) 2) Cystic calculi (stones) 3) Neurogenic bladder 4) Ruptured bladder 5) Neoplasia Clinical signs: Abnormal urination frequency/volume Straining to urinate Urine dribbling Blood/debris in urine Diagnosis: Urinalysis Cystoscopy Ultrasound
80
T/F: bacterial cystitis is common in horses
False they occur due to -damage from pre-existing stones -indwelling urinary catheters -bladder paresis/ paralysis -underlying neoplasia -notorously develop antibiotic resistance
81
Bacterial cystitis is rare in horses but how might it occur
they occur due to -damage from pre-existing stones -indwelling urinary catheters -bladder paresis/ paralysis -underlying neoplasia -notorously develop antibiotic resistance (be careful treating)
82
Idiopathic cystitis in horses might be associated with
stress/exercise good chance for resolution
83
cystitis in horses associated with a collection of inflammatory debris, usually resulting in poor bladder emptying seen in conjunction with polyneuritis equi, lumbosacral injury, etc.
sabulous cystitis - high chance of recurrent
84
Does sabulous cystitis have a low or high chance of recurrence
sabulous cystitis
85
In horses, cystic calculi are almost always
carbonate stones -diet high in calcium or previous infection
86
How do you treat cystic calculi in horses
surgical removal is warranted maybe change the diet to be lower in calcium
87
Ruptured bladders in horses typically occur in _____ because _______
Neonates Predisposing factors in foals: 1)Pre-existing necrosis of the dorsal aspect 2)Straining 3) Neonatal encephalopathy 4) being lifted by the abdomen if a down neonate has not urinated in 4-6 hours, you should ultrasound to ensure the bladder is intact
88
What might cause neurogenic bladder in horses
Generally bladder atony, result of 1) Spinal cord compression 2) Polyneuritis equi 3) Equine Herpes Myeloencephalitis 4) Sudan Grass Toxicity
89
Neurogenic bladder can lead to what kind of cystitis
sabulous cystits
90
In horses, how do you do judicious euvolemia
1) Plasmalyte 1.5x maintenance
91
Enoxaparin is used to
break down triglycerides
92
You got a urine sample that has some pigment in it! You spin down the blood and urine and find the urine has a small red cell pellet and the horse's plasma is clear. The urinary pigment is most likely to be...
Hematuria
93

CLIN SCI: Urogenital System (6 decks)

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