Exam 2 Flashcards
How do renal insufficiency and renal failure differ in regard to amount of nephrons lost?
insufficiency–66% (2/3) are lost
failure–75% (3/4) are lost (azotemic)
What amount would be considered polyuric in small animals?
> 50ml/kg/day
If azotemia is present, you would expect the USG to be at least ______ to call it pre-renal
*Give value for both dog and cat
dog: >1.030
Cat: >1.035
What are the 4 phases of renal failure
induction
extension
maintenance
recovery
4 most likely causes of death during initial management of acute renal failure in small animals
1) hyperkalemia
2) metabolic acidosis
3) severe azotemia
3) overhydration/pulmonary edema
When selecting fluid therapy for acute renal failure, what two things influence your choice?
1) acid/base status of patient
2) electrolyte status of patient
concerning fluid composition, which fluid:
1) has highest Na concentration? lowest?
2) has highest pH? lowest?
1) highest= 0.9% NaCl;
lowest= LRS
2) highest= plasma (7.4)
lowest= 0.9% NaCl (5.6)
What 3 components of fluid therapy do you add together to determine amount needed
rehydration volume
maintenance volume
estimated ongoing losses
Concerning fluid calculations:
1) how do you calculate fluids needed for dehydration?
2) what is the maintenance rate for dogs? Cats?
1) bodyweight(kg) x (%dehydration)= total deficit in L (convert!!!! x1000 to ml)
2) dogs= 60ml/kg/day
cats= 40ml/kg/day
Which treatment for hyperkalemia does NOT alter serum K levels? What does it do instead?
10% Ca gluconate
cardioprotective–protects heart from effects of hyperkalemia
When managing oliguric renal failure, how does your fluid calculation change?
Instead of calculating dehydration deficit and replacing it, you measure the urine output and add that to maintenance and ongoing losses
Delivered over 4hr
When monitoring CVP for overhydration, you don’t want it to be greater than?
8cm H2O
Fanconi syndrome primarily affects which breed? It’s due to a defect in ______ ________
Basenji
proximal tubule
Staging of CKD is based on? What do we look at to determine substage?
based on creatinine levels
substage: is there presence of hypertension or proteinuria
cervical ventroflexion in cats is commonly due to which electrolyte abnormality?
Hypokalemia
What dietary factors in cats are risk factors for hypokalemia (3)
1) acidifying ingredients
2) low Mg
3) high protein
CKD diets should be low in (3 things) and high in (2 things)?
LOW:
–protein, phosphorous, Na
High:
–B vitamins, caloric density
Calcitriol would be contraindicated in CKD patients with which electrolyte abnormality?
Hyperphosphatemia
**remember, Vit D increases absorption of both Ca AND PO4 from gut…
Which medication commonly used to manage hypertension in CKD patients may potentiate hypokalemia
Amlodipine
Describe the how ACE inhibitors can be used to treat PLN. Name 2.
Two drugs: Benazepril, enalapril
they block formation of angiotensin II so there is no constriction of efferent arteriole–> decreased glomerular pressure
The 3 main categories of diseases assoc. with acute intrinsic renal failure (i.e. not pre or post-renal)
Acute glomerlonephritis
Acute interstitial nephritis
Acute tubular necrosis (majority*)
Concerning polycystic kidney disease (PKD):
1) what are the two forms of inheritance
2) which spp/breeds are predisposed to each form
3) what is the age (young or old) of those who get the different forms
1) Autosomal dominant and autosomal recessive
2) Dominant= bull terriers & persian cats
Recessive= west highland whites, Cairn terrier, perendale sheep
3) dominant= adults
recessive= young
What are the 3 components of the selective filtration system in the glomerulus
1) fenestrated endothelium
2) basement membrane
3) podocytes
What is the hallmark of glomerular disease?
proteinuria in the absence of urinary tract inflammation
Which disease of the glomerulus involves sticky of the basement membrane to bowman’s capsule?
Focal segmental glomerulosclerosis
Where are the immune complexes deposited with:
1) membranoproliferative GN
2) membranous GN
1) subendothelial & mesangial (hypercellularity)
2) subepithelial (spikes with JMS stain)
Which form of amyloidosis is most common in animals?
Secondary (AA amyloidosis)
Two important metabolites of ethylene glycol
Glycoaldehyde
Glyoxylate
Pyelonephritis implies involvement of which two areas of the kidney
renal pelvis and renal parenchyma
How do embolic nephritis and pyelonephritis differ in their primary cause?
Embolic= secondary to bacteremia
Pyelonephritis= ASCENDING infection from cystitis
How does the appearance of an infarct vary based on the affected artery?
renal artery–entire kidney necroses
arcuate artery–wedge-shaped area in cortex and medulla (most common)
interlobular–necrosis of cortex only
What type of lesion/necrosis is seen in the kidney with NSAIDs
renal medullary/papillary necrosis
**blocked PGE2 production
For horses:
1) normal water intake
2) normal urine production
1) 40-60ml/kg/day (less if grazing, more if hot/lactating/working)
2) 15-30ml/kg/day
Normal USG for:
1) adult horses
2) foals
1) 1.020-1.050
2) 1.001-1.027
Most common cause of tubular necrosis in horses?
Aminoglycoside antimicrobials
If you are trying to improve renal perfusion and urine production in a horse secondary to aminoglycoside toxicity, which medication should you avoid?
Furosemide–exacerbates aminoglycoside toxicity
What are the 3 hallmarks of chronic interstitial disease in horses
azotemia
hypercalcemia
USG 1.008-1.014
What are the 2 forms of renal tubular acidosis in horses and how do they differ?
RTA I–can’t excrete hydrogen
RTA II–can’t reabsorb bicarb
What is considered a low USG in food animals?
<1.020
