General urinary

Question 1

Compare stranguria and dysuria

Answer 1

Stranguria - slow and painful urination

Dysuria - painful or difficult urination

Question 2

What would be considered polyuric?

Answer 2

> 50ml/kg/day (so when measuring its 2ml/kg/hr)

Question 3

What would be considered polydipsic?

Answer 3

Dogs - >90-100ml/kg/day

Cats - >40ml/kg/day

Question 4

What is uraemia?

Answer 4

Clinical manifestation of urinary disease

Question 5

What types of kidney cancer are considered more painful?

Answer 5

Sarcoma - likely painful

Lymphoma or carcinoma less so

Question 6

What is azotaemia

Answer 6

Elevation of urea and creatinine in serum or plasma

Question 7

Outline the use of urea

Answer 7

Affected by non renal factors - increases after feeding, with protein catabolism (sepsis/ fever), decreases with a low protein diet, liver disease, sometimes PUPD
Affected by hydration status
Best to starve for 12 hours prior to sampling
Better correlated to the signs of azotaemia than creatinine

Question 8

Outline the physiology of urea

Answer 8

Freely filtered by the glomerus, then re-absorbed mostly in the renal tubule (this helps to concentrate u+)
Protein metabolised to ammonia - goes into the urea cycle, then goes to the kidneys to the u+

Question 9

Outline the physiology of creatinine

Answer 9

From creatine in muscle therefore higher in well muscled animals
Some clearance from GI bacteria
Freely filtered at glomerulus but not reabsorbed, so less affected by hydration status
75% of renal function has to be gone before you see increases
Levels increase exponentially with decreasing GFR

Question 10

Outline the use of creatinine

Answer 10

Vaules vary between labs - look for patient trends instead
Increases in haemolysed samples
better predictor of disease than urea, but less predictive of clinical signs of uraemia
Values are given for medium dogs so may vary with size

Question 11

What is special with Birmans and creatinine

Answer 11

Have increased urea and creatinine - not all go on to develop kidney disease
Therefore important to assess other renal parameters
Always go Pre GA bloods before sx - some issues associated with neutering

Question 12

What can cause pre-renal azotaemia?

Answer 12

Dehydration
Shock
Cardiac disease
Recent feeding
GI bleeding
Increased protein catabolism

Question 13

What causes renal or post renal azotaemia?

Answer 13

Renal - failure

Post - obstruction or rupture

Question 14

How can S.G help you decide if something is renal or pre-renal

Answer 14

Cut off of 1.035, although need to check there aren’t other reasons for a low S.G (glucose, hypercalcaemia, addisons etc)
N.B with pre renal, urea is normally higher than creatinine

Question 15

Outline the physiology of SDMA

Answer 15

In every nucleated cell in the body - released when there is cell breakdown
Freely filtered by the glomerulus, not protein bound
Excreted by the kidney
No muscle mass effect

Question 16

Outline the use of SDMA

Answer 16

Useful for earlier detection of renal failure
Lower specificity than creatinine (PPV 86%, although NPV 100%)
Increases with 40% loss of renal function
Increases with dehydration, possibly also with hyperthyroidism, neoplasia and hypertension
If SDMA is very high compared to creatinine, consider IRIS staging the pet on level higher
Can be useful for proteinuric cats that are non azotaemic with a low S.G
Greyhounds appear to have higher levels in general

Question 17

When is it most important to diurese IMHA cases?

Answer 17

When there is lots of u+ pigment - need to prevent renal damage

Question 18

How long should you wait before intervening with ureteral ostruction?

Answer 18

1-3 days

Don’t wait if the patient is unstable

Question 19

How many dogs with ureteral stones have UTIs?

Answer 19

59% of dogs

85% if neutrophilia present

Question 20

Is it easier for uretheral stones to pass in dogs or cats?

Answer 20

Dogs

Cats often associated with strictures, and have a more awkward connection between ureters and bladder

Question 21

What should be your main suspicion for a dog with kidney disease, liver disease, and thrombocytopaenia?

Answer 21

Lepto

Question 22

How do you test for lepto?

Answer 22

Microagglutination test (MAT)
Anything above 1/800 considered positive
Normally don't get vaccine titres higher than 1/200

Question 23

What mediteranian disease can cause kidney disease?

Answer 23

Leishmania