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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
Q

Compared to adults, creatinine in foals is generally

A

30-50% higher than the mare.

Higher if there is asphyxia and prematurity

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26
Q

Spurious neonatal creatinine (foals)

A

a creatinine of 5-15mg/dL is okay
should reduce within first few days of life

higher if there is asphyxia, prematurity

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27
Q

Why might placentitis be a source of increased creatinine in a horse

A

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

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28
Q

What are non-renal increases in creatinine of the horses

A

fasting
rhabdomyolysis
muscle wasting

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29
Q

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

A

Pre-Renal Azotemia

-give fluids to see if it resolves before giving anything nephrotoxic

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30
Q

In a horse with pre-renal azotemia, USG is typically

A

> 1.020

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31
Q

Azotemia in the horse that is related to acute or chronic kidney injury
USG may be isosthenuria: 1.008-1.012

A

renal azotemia

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32
Q

azotemia associated with failure to urinate in the horse

A

post-renal azotemia

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33
Q

What are the major electrolyte abnormalities is seen in horses *

A

Hyponatremia
Hypochloremia
Hyperkalemia (in severe diseases)

hypoalbuminemia (if glomerulus is injured)

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34
Q

to get horses to urinate

A

catch when placed on a freshly bedded stall

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35
Q

normal horse urine is

A

turbid to mucoid owing to mucous
calcium carbonate crystals and concentration

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36
Q

What might cause you overestimate the USG

A

glucose and protein will lead to overestimation when read on the refractometer

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37
Q

USG <1.008

A

hypoesthenuria

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38
Q

USG 1.008-1.012

A

isosthenuria

39
Q

USG >1.025

A

hyperesthenuria

40
Q

The USG of foals is typically ___________ due to their milk diet

A

isosthenuric to hypoesthenuric

USG <1.012

41
Q

On a free catch sample in horses, WBCs and RBCs are normal as long as they are

A

<5 RBC/hpf
<10 WBC/hpf

42
Q

In horses, if their urine is culturing bacteria, does this mean they have a UTI

A

NO- not until you see increased WBCs in addition (pyuria)

bacteria is likely a contaminate

43
Q

Dipstick results in horses

A

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
Q

What is the normal pH of horse urine

A

Alkaline 7.0-9.0

foals will not have alkaline urine

45
Q

Why do horses typically have trace protein in their urine

A

because their urine is alkaline

false + protein

46
Q

Why might you see glucose in the horse’s urine that is completely normal

A

they have a lower urine threshold (150mg/dL)
1) Stress
2) Alpha 2s (xylazine) and steroids
3) Fanconi syndrome (tubular dysfunction)
4) AKI

47
Q

Dipstick blood + can be ____ in horses

A

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
Q

How do you differentiate between whole blood, hemoglobin, and myoglobin

A

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
Q

If you want to see casts on urine sediment you need to do the analysis within

A

30-60 min after collection

50
Q

molds of glycoproteins and cells that form in tubules and pass into the bladder
associated with inflammation or infection

A

Casts

51
Q

What ultrasound change to the kidneys will you see in horses with renal damage

A

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
Q

Why does it appear that horses have a larger kidney on the right side

A

because when doing an ultrasound, that kidney is closer to the body wall

53
Q

What on ultrasound is associated with acute or chronic NSAID toxicity in horses

A

Medullary Rim sign - bright wall right at the corticomedullary junction

see this because the thick ascending limb is fibrotic

54
Q

extra fluid in the renal pelvis

A

hydronephrosis

55
Q

bladder ultrasounds in horses

A

performed transcutaneous or transrectal

always looks turbid (fluid is echoic- calcium carbonate)

assess for stones, masses, cystitis

ureters

-scope after you ultrasound

56
Q

If you even need to do a renal biopsy in a horse, you should only do it

A

ultrasound guided

57
Q

Possible complications with equine renal biopsy

A

perirenal hemorrhage (1-3% of patients may require a blood transfusions)

Hematuria

Bowel penetration

58
Q

how might pre-renal disease lead to AKI

A

ischemic tubular insult/necrosis

59
Q

T/F: AKI can occur as a result of pre-renal, renal, or post-renal disease

A

true

60
Q

non-oliguric renal failure

A

minimal urine (less volume)

61
Q

What are the changes in urination seen in AKI

A

1) non-oliguric renal failure
2) polyuria
3) oliguria
4) anuria

62
Q

What are the main medical nephrotoxins in horses **

A

1) Aminoglycosides (Genamicin)
2) Tetracyclines (Oxytetracycline)
3) NSAIDs (Banamine & Equioxx)
4) bisphosphonates (Osphos)

Need to be handled in care with dehydrated horses

63
Q

1) Aminoglycosides (Genamicin)
2) Tetracyclines (Oxytetracycline)
3) NSAIDs (Banamine & Equioxx)
4) bisphosphonates (Osphos)

need to be handled with care in horses that are

A

dehydrated horses

64
Q

Name 6 nephrotoxins in horses that can lead to acute tubular necrosis

A

1) Aminoglycosides (Genamicin)
2) Tetracyclines (Oxytetracycline)
3) NSAIDs (Banamine & Equioxx)
4) bisphosphonates (Osphos)
5) Myoglobin
6) Hemoglobin

65
Q

acute tubular necrosis in horses can due to ______ or ________

A

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
Q

Clinical signs of acute renal failure in horses

A

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
Q

How do you treat AKI in horses *

A

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
Q

the mainstay of treatment of equine AKI is *

A

provision of JUDICIOUS EUVOLEMIA
1) FLUIDS to maintain blood flow to kidneys (not flushing them) generally 1.5x maintenance

69
Q

What is the risk of dialysis in horses

A

generation of peritonitis

70
Q

What might cause CKD in horses

A

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
Q

What is the first clinical sign of chronic interstitial nephritis in horses

A

loss of concentrating ability

72
Q

chronic interstitial nephritis in horses

A

not rare; catchall for extraglomerular causes of CKD ‘
Eventually leads to nephroliths and hydronephrosis
First clinical sign: loss of concentrating ability

73
Q

chronic interstitial nephritis can eventually lead to

A

nephroliths and hydronephrosis

74
Q

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

A

uremic syndrome

75
Q

is glomerulonephritis or chronic interstitial nephritis a more common cause of CKD in horses

A

chronic interstitial nephritis

76
Q

What does not correlate with uremic syndrome

A

Azotemia

77
Q

Uremic syndrome (horses)

A

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
Q

What are the clinical signs of uremic syndrome in horses

A

1) Uremic encephalopathy
2) lethargy/weakness
3) Vomiting
4) Bleeding diathesis (reduced platelet function)

79
Q

Diseases of the equine bladder

A

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
Q

T/F: bacterial cystitis is common in horses

A

False

they occur due to
-damage from pre-existing stones
-indwelling urinary catheters
-bladder paresis/ paralysis
-underlying neoplasia

-notorously develop antibiotic resistance

81
Q

Bacterial cystitis is rare in horses but how might it occur

A

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
Q

Idiopathic cystitis in horses might be associated with

A

stress/exercise

good chance for resolution

83
Q

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.

A

sabulous cystitis - high chance of recurrent

84
Q

Does sabulous cystitis have a low or high chance of recurrence

A

sabulous cystitis

85
Q

In horses, cystic calculi are almost always

A

carbonate stones
-diet high in calcium or previous infection

86
Q

How do you treat cystic calculi in horses

A

surgical removal is warranted

maybe change the diet to be lower in calcium

87
Q

Ruptured bladders in horses typically occur in _____ because _______

A

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
Q

What might cause neurogenic bladder in horses

A

Generally bladder atony, result of
1) Spinal cord compression
2) Polyneuritis equi
3) Equine Herpes Myeloencephalitis
4) Sudan Grass Toxicity

89
Q

Neurogenic bladder can lead to what kind of cystitis

A

sabulous cystits

90
Q

In horses, how do you do judicious euvolemia

A

1) Plasmalyte 1.5x maintenance

91
Q

Enoxaparin is used to

A

break down triglycerides

92
Q

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…

A

Hematuria

93
Q
A

CLIN SCI: Urogenital System (6 decks)

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