Exam 2 Flashcards
What are the homeostatic functions of the renal system
Acid-base, fluid, and electrolytes
How does the kidney do its job
Blood filtration, reabsorption, secretion, fluid balance regulation, hormonal influence, and elimination of hydrogen and bicarbonate
What is diuresis
Excessive production of urine
What is oliguria
Low urine output
What is anuria
Failure to produce urine from the kidneys
What is the kidneys hormonal influence on the body
Responses to ADH and aldosterone and produces renin, erythropoietin, and prostaglandins
What is the only species where the right kidney is not more cranial than the left
The pig
What are the 2 different types of kidneys
Multilobar and unilobar kidneys
What is the functional unit of the kidney
The nephron
What are the parts of the nephron in the renal cortex
Bowman’s capsule, glomerulus, PCT, and DCT
What are the two things in the renal medulla
Loop of Henle and collecting duct
What are the basic steps in urine formation
Afferent arteriole, blood flow, efferent arteriole, reabsorption of solutes and water, peritubular capillaries, secretion of additional wastes, and excretion
What are the 2 main things in the renal corpuscle
The glomerulus and Bowman’s capsule
What is the glomerulus
The capillary bed in the kidneys
What is the Bowman’s capsule
A double walled capsule that covers the glomerulus that has a inner visceral layer comprised of podocytes, capsular space that continues w/ the PCT, and an outer layer parietal layer
What is the function of the renal corpuscle
To filter any small molecules from the blood going thru the glomerulus
What is the proximal convoluted tubule
Longest part of the tubular system of the nephron that is primarily in the cortex and is comprised of cuboidal epithelium w/ a brush border
What is the function of the PCT
To reabsorb tubular filtrate such as actively Na+ and Cl-, passively K+, Ca+2, and glucose and AA via sodium cotransport
What is the loop of Henle
A continuation from the PCT into the medulla that has a thinner walled narrower lumen u-turn
What is the function of the loop of Henle
Water and electrolyte balance and some reabsorption
What is the distal convoluated tubule
Continuation of the ascending loop of Henle that is located in the cortex
What is the function of the DCT
Water balance
What do multiple DCTs converge into
A collecting duct
What is the function of the collecting duct
Acid-base regulation, water balance, and some Na regulation
What are the two sites of ADH and aldosterone action in the kidneys
Primarily the collecting duct and minorly in the DCT
What is the path of developing/form urine
Multiple nephrons, collecting duct, papillary duct, minor calyx, major calyx, renal pelvis, and ureter
What does the sympathetic nervous system do in the kidneys
Vasoconstriction of renal vessels to decrease urine production
What is the blood flow in the kidney
Renal artery, afferent glomerular arterioles, efferent glomerular arterioles, peritubular capillaries, venules, and renal vein
What does the peritubular capillaries do in the nephron
Oxygen transfer to the nephron, tubular reabsorption, and tubular secretion
What is the only set of capillaries where oxygenated blood enters and exits
The glomerular capillaries
What is the difference in diameter btw the afferent and efferent arteriole
The diameter of the afferent arteriole is larger than the efferent to help w/ glomerular pressure for efficient filtration
What cannot be filtered in a normal glomerulus
RBCs, WBCs, and most plasma proteins
When do proteins leak into the glomerular filtrate
If there is endothelial damage
What is glomerular filtration rate
Volume of plasma that would have to be filtered by glomeruli each minute to account for the amount of a given substance to appear in the urine
What is the ultimate renal function test
GFR
What is the GFR influenced by
The hydrostatic pressure of blood in the glomerulus, oncotic pressure of the glomerular filtrate, filtration barrier permeability, filtration barrier area, and if kidney production has decreased
What does a high GFR reflect on kidney production
If the GFR is increased that means the kidney function is low
What things are reabsorbed by the ascending LOH and DCT
K+, CA+2, and Na+ that is exchanged for H+, ammonium, or K+
What is reabsorbed by the ascending LOH and the CD
Mg+2
What is the renal threshold
The limit to reabsorption by the kidney
What wastes products are secreted thru the DCT
H+, K+, ammonia, urea, penicillin, and sulfonamides
What are the 2 ways the kidneys maintain the acid-base balance of the body
Secrete H+ in the PCT and CD and reabsorb HCO3-
What are the urine pH buffers that bind the excess H+
Ammonia and phosphate
Where do ureters exit the kidneys
The hilus
Why are ureters comprised of smooth muscle
Because they use peristalsis to push the urine into the bladder
Where on the bladder does the ureter enter
The trigone
What does the detrusor muscle of the baldder contain that communicates w/ the CNS
Stretch receptors that activate a spinal reflex arc when full and the parasympathetic pelvic nerve
Where can you find an empty bladder in carnivores
The pelvic cavity and abdomen
What is the internal urethral sphincter
Comprised of smooth muscle at the neck of the bladder and cranial urethra and has an innervated by the parasympathetic pelvic nerve and hypogastric sympathetic nerve
What is the external urethral sphincter
Striated urethral sphincter comprised of the urethralis muscle encircles the caudal urethra and is innervated by the pudendal somatic nerve
What are urethral characteristics in females
Shorter, wider, and straighter that exits the pelvic canal ventrally in the vestibule
What are urethral characteristics of males
Longer, narrower, and curved in males that is broken up into the prostatic, membranous, and penile urethra
What is the external opening of the urethra reffered to
The urinary meatus or external urethral orifice
What are common urinary tract diseases
UTIs, urinary calculi (stones), urinary incontinence, feline lower urinary tract disease (FLUTD), prostatic disease, and renal failure, and glomerulonephropathy
What are diagnostics for suspected urinary cases
UA, culture/sensitivity, blood chemistry profile, rads, and ultrasound
What are we looking for in a UA and culture/sensitivity
Infection, pH abnormality, crystalluria, and concentration
What are we looking at on a blood chemistry profile in urinary cases
Blood urea nitrogen (BUN), creatinine, SDMA, HCT, PCV, RBC, and WBC
What are looked at in rads for urinary cases
Kidney size, shape, number, and location and bladder size, shape, density, and location
What are we looking at in ultrasounds in urinary cases
Kidney and bladder internal structures
What is the type of microorganisms are looked for in a urine culture and what does it tell us
Aerobic and it tells us what antibiotics the bacteria is sensitive to
What are common causes of renomegaly
Neoplasia, hydronephrosis, perirenal cyst, and pyelonephritis
What patients are more likely to get UTIs
Females are more likely than males, dogs are more likely than cats, and older cats are more likely than younger cats
What is feline lower urinary tract disease
FLUTD is lower urinary tract inflammation that is present in most overweight male cats above 3 years of age
What are causes of FLUTD
Feline idiopathic cystitis (FIC) is secondary to stress/anxiety, struvite crystalluria, urolithiasis, mucus plug, and rarely a UTI
How do you treat FLUTD
Specific to underlying cause, may involve anti-anxiety supplements/medications, stress reduction in home, diet change, increased water consumption, and urine pH management
What surgery can be done to treat FLUTD
Perineal urethrostomy if there is a severe or repeated urinary blockage
What value will show kidney disease earliest
SDMA
What are the different types of uroliths
Nephrolith/renolith, ureteroliths, cystoliths, and urethroliths
What breeds are more likely to get uroliths
Miniature schnauzer, shih tzu, miniature poodles, and cocker spaniels
What type of urine are struvite uroliths typically found w/
UTIs w/ alkaline urine
How can you diagnosis struvite uroliths
Radiographs, ultrasound, urinalysis, and palpation
How can you treat struvite uroliths
Dissolution w/ special diet and antibiotics, cystotomy, urohydropropulsion, urethrotomy/urethrostomy
What does the dissolution treatment do to break down uroliths
Promote acidic urine and restrict protein, phosphorus, and magnesium
What type of urine can cause calcium oxalate uroliths
Acidic urine
How can calcium oxalate uroliths be diagnosised
Rads, ultrasound, and UA
How can calcium oxalate uroliths be treated
Diet to prevent future stones, B6 or hydrochlorothiazide, urohydropropulsion, cystotomy, urethrotomy/urethrstomy
What causes urate uroliths
High excretion of ammonium biurate crystals
What can increase the risk of getting urate uroliths
Portosystemic shunt and being a dalmatian
How can urate uroliths be diagnosised
Radiolucent so ultrasound is best
How do you treat urate uroliths
Urohydropropulsion, cystotomy, and urethrotomy/urethrostomy
What can increase the risk of cystine uroliths
Excessive elimintaion of cystine such as disorder of renal tubular transport, high concentrations of cystine in an acidic environment, and in male dachshunds 3-6 yrs
How can cystine uroliths be diagnosised
Stones may be difficult to see on rads and ultrasound
How can cystine uroliths be treated
Urohydropropulsion, cystotomy, and urethrotomy/urethrostomy
What can we link w/ the formation of silicate uroliths
Corn gluten and soy bean hull consumption
What breeds are specifically prone to silicate uroliths
German shepherds, old english sheepdogs, shih tzus, and labs
How can silicate uroliths be diagnosised
Radiographs and ultrasound
How can silicate uroliths be treated
Urohydropropulsion, cystotomy, urethrotomy/urethrosotomy, and alkalinzing urine can help prevent in the future
What are the 3 types of urethral catheters we can use for unblocking cats
Tom cat, slippery sam, and milia
What urethral catheters do we typically use for unblocking dogs
Red rubber catheter and a foley catheter
What are neurogenic reasons for urinary incontinence
IVDD, trauma, degenerative myelopathy, and malformed spinal cord
What are non neurogenic issues that lead to urinary incontinence
Urethral sphincter mechanism incompetence, ectopic ureters, UTI, urethroliths or urethral disease
How can you treat spay incontinence
Diethylstilbestrol (DES), phenylpropanolamine (proin and proin ER), and estrogen
What are causes of prostatic disease
Prostatitis typically from infection, benign prostatic hyperplasia, and neoplasia
What are clinical signs of prostatic disease
Strangiuria, difficulty having bowel movements, hematuria, abdominal pain, and prostatomegaly on digital rectal exam
What can progression of renal disease lead to
Inability to excrete wastes or maintain homeostasis, azotemia, and then uremia/uremic syndrome
How much of renal function must be lost for clinical signs to begin
2/3
How can CKD be diagnosised
Clinical signs, CBC, chemistry, UA, UPC, rads, and ultrasound
What are treatments of CKD
To slow progression we can change the diet, subcutaneous fluids, and if hypertension is present we can give amlodipine (cats), enalapril (dogs), and telmisartan (cats)
What is the goal w/ changing the diet in CKD patients
Limit phosphorus and protein
What is uremia
Clinical sighs of dogs/cats w/ azotemia
What are clinical signs of uremic syndrome
Vomiting, nausea, anorexia, oral/lingual ulcerations, halitosis, lingual necrosis, gastroenteropathy, oliguria, anuria, dehyrdation, injected mm, melena, diarrhea, hypothermia, optic neuropathy, vision loss, and seizures
How can uremic syndrome diagnositics
CBC, chem, UA, abdominal radiographs, ultrasound, direct blood pressure, renal biopsy, screening for toxins, and fundic exam
What are treatments of uremic syndrome
IV fluids, correct hyperkalemia, correct metabolic acidosis, treat oliguria if not resolved, renal diet, feeding tubes, parenteral feeding, antiemetics, gastroprotectants, and dialysis
What is azotemia
Increased nitrogen containing compounds in the blood such as BUN and or creatinine
What is the classification of azotemia based on
Urine specific gravity
What are the USG vales for pre renal azotemia
> 1.035 in dogs and >1.040 in cats
What is the range of USG values for renal azotemia
1.007<USG<1.034 (dogs) or 1.039 (cats) or total loss of concentrating ability by the kidney seen in isosthenuria
