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Small animal (fourth year) > Internal medicine (urinary) > Flashcards

Internal medicine (urinary) Flashcards

1
Q

what is acute kidney injury?

A

spectrum of disease associated with a sudden onset of renal parenchymal injury

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2
Q

how much GFR has to be lost before an animal presents as azotaemic?

A

75%

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3
Q

what are the four main causes of acute kidney injury?

A

decreased renal blood flow
toxins
intrinsic renal disease
systemic disease

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4
Q

what are some possible toxins that can lead to acute kidney injury?

A

antibacterials (aminoglycosides)
NSAIDs
ethylene glycol
lillies (cats)
grapes (dogs)

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5
Q

why are kidneys predisposed to toxin damage?

A

high blood flow
high metabolic activity
epithelial cells absorb things

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6
Q

what are the main aminoglycosides used in smallies?

A

gentamicin and amikasin

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7
Q

what are the four pathophysiological phases of acute kidney injury?

A

initiation
extension
maintenance
recovery

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8
Q

what happens in the initiation phase of acute kidney injury?

A

damage to the kidney begins

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9
Q

what pathophysiology occurs in the extension phase of acute kidney injury?

A

ischaemia, hypoxia, inflammatory response, ongoing cellular injury and death

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10
Q

after day 90 what is acute kidney disease called?

A

chronic kidney disease

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11
Q

what are signs of acute kidney injury on physical exam?

A

uraemia breath
hypothermia
kidney pain/enlargement
tachycardia (dehydration/pain)
bradycardia (hyperkalaemia)

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12
Q

what effect does hyperkalaemia often have on the heart?

A

bradycardia

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13
Q

what are the features of haematology of acute kidney injury cases?

A

azotaemia
increased phosphate
hyperkalaemia
calcium variable

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14
Q

what can be seen on urinalysis of acute kidney injury cases?

A

isosthenuric
glucosuria, haematuria
sediment, casts and WBCs

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15
Q

what is the normal size of a kidney on radiograph in dogs?

A

2.5-3.5 times L2

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16
Q

what is the normal size of a kidney on radiograph in cats?

A

2-3 times L2

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17
Q

how does the body condition of AKI and CKD patients compare?

A

AKI - good condition
CKD - weight loss/poor condition

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18
Q

how will the size/shape of the kidneys differ in AKI and CKD cases?

A

AKI - enlarged (painful)
CKD - small, firm, irregular

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19
Q

will anaemia be present with AKI and CKD?

A

non-regenerative anaemia present with CKD
(AKI aren’t anaemic)

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20
Q

in regards to the azotaemia, how sick will AKI and CKD patients present?

A

AKI - disproportionally sick for degree of azotaemia
CKD - surprisingly well for degree of azotaemia

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21
Q

how does the hair coat of animals with AKI and CKD compare?

A

AKI - good
CKD - poor

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22
Q

what potassium levels are expected with CKD and AKI patients?

A

AKI - hyperkalaemia
CKD - normal/low potassium

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23
Q

is sediment more commonly seen with AKI and CKD?

A

AKI

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24
Q

what plant is very poisonous to cats?

A

lillies (entire plant leaves, pollen, stem…)

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25
Q

what is the goals of fluid resuscitation for acute kidney injury?

A

optimise intravascular circulating volume and increase cardiac output to improve renal blood flow, oxygen supply and GFR

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26
Q

how aggressive should fluid therapy be given for acute kidney injury?

A

don’t give aggressively (don’t flush) just give at a normal rate

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27
Q

what is oliguria?

A

abnormally small amounts of urine being produced (<2ml/kg/hr)

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28
Q

what is the goal for urine output?

A

> 2ml/kg/hr

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29
Q

if you have given fluid therapy to an AKI animal and they are still oliguric what should be done?

A

give 3-5% body weight IVFT if not over hydrated then reassess

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30
Q

if an AKI animal is still oliguric after giving 3-5% bodyweight IVFT what should be done?

A

reduce IVFT (otherwise damage will occur), place a urinary catheter and start treatment to increase urine output (furosemide)

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31
Q

what drug is used to increase urine output of oliguric patients?

A

furosemide

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32
Q

does furosemide increase GFR?

A

no

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33
Q

should IVFT be continued when giving furosemide to increase urine output?

A

yes continue IVFT

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34
Q

what are some possible adverse effects of giving furosemide and IVFT to treat oliguria in AKI patients?

A

polyuria
acid-base/electrolyte abnormalities (metabolic acidosis…)
hyperkalaemia

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35
Q

how does hyperkalaemia look on an ECG?

A

flattened P wave
slow HR
spike T waves

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36
Q

what is the best anti-emetic?

A

maropitant

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37
Q

what is the prognosis for AKI patients?

A

fair (50% mortality)

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38
Q

are urinary tract infections more common in dogs or cats?

A

dogs

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39
Q

are urinary tract infections more common in males or females?

A

females

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40
Q

what is pyuria?

A

white blood cells in urine

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41
Q

what is a urinary tract infection?

A

adherence, multiplication and persistence of an infectious agent within the urinary system

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42
Q

what is the difference between a bacteraemia and urinary tract infection?

A

bacteraemia is when they are just sat there but UTI is when they are adhering and multiplying

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43
Q

what are the clinical signs of cystitis?

A

dysuria, pollakiuria, haematuria, urinary incontinence

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44
Q

what is cystitis?

A

inflammation of bladder

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45
Q

what results should be ignored on a dipstick?

A

leucocytes
nitrites

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46
Q

how is sporadic bacterial cystitis treated?

A

antibiotics for 3-5 days (amoxicillin, cephalexin, trimethoprim)
NSAIDs

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47
Q

how long should you treat pyelonephritis with antibiotics for?

A

10-14 days

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48
Q

how long should subclinical bacteriuria be treated for?

A

treatment isn’t recommended

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49
Q

does cystitis cause PUPD?

A

no (causes stranguria and pollakiuria)

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50
Q

what is chronic kidney disease?

A

structural/functional abnormalities of one or both kidneys that have been there for 3 months or longer

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51
Q

is CKD reversible?

A

no - slowly progressive irreversible disease

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52
Q

what are some congenital causes of CKD?

A

renal dysplasia
polycystic kidney disease
amyloidosis
fanconi-like syndrome

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53
Q

what breed is predisposed to polycystic kidney disease?

A

Persian cats

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54
Q

what are the main two acquired causes of CKD?

A

idiopathic tubulointerstitial nephritis
glomerular disease

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55
Q

is glomerular disease more common in cats or dogs?

A

dogs

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56
Q

is idiopathic tubulointerstitial nephritis more common in cats or dogs?

A

cats

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57
Q

what are the possible reasons CKD progresses in the absence of the initial disease?

A

intraglomerular hypertension - loss of nephrons so blood forced through remaining ones at a higher pressure
proteinuria - high levels of tubular protein is harmful
phosphorous - precipitates with calcium in tubules to cause damage

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58
Q

why is staging CKD useful?

A

determines treatment
can predict clinical signs for owners (easier for owner understanding)

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59
Q

what are some possible clinical signs of CKD?

A

weight loss/poor appetite
dullness/lethargy
PUPD
dehydration
vomiting
constipation
poor hair coat
neurological signs
hypertension (associated signs)

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60
Q

what are the criteria for staging CKD?

A

creatinine
proteinuria
blood pressure

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61
Q

what is the first way of staging CKD?

A

creatinine

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62
Q

what is the most important parameter to look at on haematology of CKD animals?

A

haematocrit/RBC count (need to treat anaemia)

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63
Q

what does urea correlate with on haematology of CKD patients?

A

severity of clinical signs

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64
Q

what does creatinine correlate with on haematology of CKD patients?

A

GFR

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65
Q

in cats with CKD is potassium usually increased/decreased?

A

decreased

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66
Q

what is increased phosphorous linked to in CKD cases?

A

increased progression and mortality

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67
Q

what extra-renal causes should be ruled out before blaming the kidneys for inadequately concentrated urine?

A

hypercalcaemia
Addisons
drugs - furosemide

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68
Q

what are the aims for treating CKD?

A

provide good quality of life, reduce severity of clinical signs, minimise progression (can’t cure it)

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69
Q

what is a uraemia crisis?

A

a CKD patient that destabilises acutely

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70
Q

what is done first when treating a uraemia crisis?

A

IVFT (don’t flush)

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71
Q

what stage CKD aren’t azotaemic?

A

stage 1

72
Q

what are the initial actions needed to treat stage 1 CKD?

A

stop all nephrotoxic drugs
identify/eliminate ongoing disease
measure BP and UPCR
treat

73
Q

what is UPCR?

A

urine protein creatinine ratio

74
Q

how can proteinuria be reduced in stage 1 CKD cases?

A

inhibit RAAS
reduce dietary protein
antiplatelet drugs if severe (clopidogrel)

75
Q

why should ACE inhibitors not be used on dehydrated/hypovolaemic patients?

A

dilates the efferent arteriole causing a drop in GFR

76
Q

what needs to be treated in stage 1 CKD?

A

control/prevent dehydration
control blood pressure
control proteinuria (if present)

77
Q

what drugs can be used to control hypertension in stage 1 CKD?

A

ACE inhibitors
telmisartan (angiotensin receptor blocker)
amlodipine

78
Q

what is the most important treatment that starts in stage 2 CKD?

A

begin a renal diet

79
Q

what are the beneficial features of a renal diet?

A

restricted protein (reduces uraemia crisis…)
restricted phosphate
omega 3 fatty acids
fibre
low sodium
water soluble vitamins

80
Q

what are the benefits of the restricted protein of a renal diet?

A

reduction in clinical sings
less risk of uraemia crisis
reduced proteinuria
reduced PUPD
reduced acid load

81
Q

what stages of CKD in cats and dogs is a renal diet recommended for?

A

cats - stage 2, 3, 4
dogs - stage 3, 4

82
Q

what can be added if a renal diet doesn’t reduce phosphate enough?

A

phosphate binder (ipakitine)

83
Q

what are the treatment recommendations for stage 2 CKD?

A

same as stage 1 (control, dehydration, hypertension, proteinuria)
start renal diet
control phosphate
supplement potassium if needed

84
Q

what stage of CKD do clinical signs begin to worsen?

A

stage 3

85
Q

what are the recommendations for treated stage 3 CKD?

A

same as stage 1 and 2
treat nausea/vomiting
consider erythropoetin
control metabolic acidosis
consider subcutaneous fluid

86
Q

what drugs can be used to stimulate an animals appetite?

A

mirtazapine
capromorelin

87
Q

what drugs are available to control vomiting, poor appetite and GI signs in stage 3 CKD patients?

A

anti-emetics
appetite stimulants
reduce mastic acid secretion
sucralfate
(feeding tube considered)

88
Q

what drug is used as an erythropoietin replacer?

A

darbepoeitin

89
Q

what always needs to be given with darbepoetin?

A

iron supplements

90
Q

what is the major side effect of erythropoietin treatment?

A

they develop antibodies to them - can cross react with the patients own erythropoietin (hence only use in severe anaemia)

91
Q

what are the recommendations for treating stage 4 CKD?

A

same as stage 1, 2, 3 but phosphate control is more relaxed

92
Q

what are the things to control to minimise progression of CKD?

A

phosphate
proteinuria
blood pressure
(use renal diet)

93
Q

do congenital or acquired CKD cases progress quicker?

A

acquired tend to progress quicker

94
Q

what are the three most common uroliths?

A

struvite
calcium oxalate
urate (purine)

95
Q

what is the shape of calcium oxalate crystals?

A

envelopes

96
Q

what is the shape of struvite crystals?

A

coffin lid

97
Q

what is the shape of irate crystals?

A

thorn apples

98
Q

what uroliths form in acidic urine?

A

calcium oxalate
urate
cystine

99
Q

what uroliths form in alkaline urine?

A

struvite

100
Q

what is the centre of a urolith called?

A

nidus

101
Q

what uroliths can be resolved by medical dissolution?

A

struvite
urate
cystine

102
Q

what are the disadvantages of using medical dissolution to treat uroliths?

A

can block the urethra when smaller
some don’t dissolve
needs repeated radiographs/urinalysis
need sooner compliance with the diet

103
Q

what are some indications for removal of uroliths?

A

if its causing obstruction
persistant clinical signs
lack of response to medical therapy
if uroliths are increasing in number/size

104
Q

what is a non-surgical method of removing uroliths?

A

voiding urohydropropulsion - sedate and fill bladder with saline then position them to massage the uroliths out

105
Q

what are struvite uroliths associated with?

A

urinary tract infections

106
Q

are struvite stones viable on X-rays?

A

yes - they are radiopaque

107
Q

what type of uroliths do urinary tract infections predispose to?

A

strivite

108
Q

why do urinary tract infections predispose to struvite uroliths?

A

bacteria produce urease that converts urea to ammonia and bicarbonate, this ammonia then binds with magnesium and phosphorus in the diet to form struvite

109
Q

how are struvite stones treated?

A

feed a reduced protein, phosphorous and magnesium diet that promotes acidic urine to dissolve them
treat UTI as well

110
Q

when do animals need monitoring for struvite dissolution?

A

every 4-6 weeks after the start of treatment until there has been radiographic cure for at least 2-4 weeks

111
Q

what are some possible reasons for failure of struvite treatment?

A

UTI isn’t controlled
core of urolith is oxalate
diet not followed

112
Q

what is the best way to prevent struvite stones?

A

rapid treatment of bacterial UTIs

113
Q

what pH urine to calcium oxalate crystals form in?

A

neutral to acidic

114
Q

what condition predisposed to calcium oxalate stones?

A

hypercalcaemia

115
Q

are calcium oxalate uroliths visible on radiographs?

A

yes - they are radiodense

116
Q

are calcium oxalate crystals more common seen in males or females?

A

males

117
Q

how are calcium oxalate uroliths treated?

A

removal (often reoccur)

118
Q

how can calcium oxalate crystals be prevented?

A

rule out underlying cause - hypercalcaemia, metabolic acidosis, excess vitamin D
increase urine volume - dilute solute

119
Q

what pH urine do urate stones form in?

A

acidic

120
Q

are urate stones visible on radiographs?

A

no - they are radiolucent

121
Q

what are the two situations in which dogs get urate stones?

A

inherited alteration of rate transporter
portosystemic shunts

122
Q

how are urate stones treated?

A

low protein and purine diet that produce alkaline urine to dissolve them
allopurinol (only with diet)

123
Q

are cystine stones visible of radiographs?

A

no - they are radiolucent

124
Q

what uroliths can be prevented by neutering?

A

cystine

125
Q

which urolith is more commonly seen in females?

A

struvite

126
Q

what intervention is important when treating/preventing all uroliths?

A

increase water intake (dilutes the urine solution)

127
Q

what is feline idiopathic cystitis?

A

abnormal voiding behaviour after exclusion of other disorders
persistent, chronic or recurrent with no obvious cause

128
Q

what are the two forms of feline lower urinary tract disease?

A

non-obstructive (mainly female)
obstructive

129
Q

what is FLUTD?

A

feline lower urinary tract disease

130
Q

what is the most common cause of non-obstructive FLUTD?

A

idiopathic cystitis

131
Q

what is the most common cause of obstructive FLUTD?

A

urethral plug

132
Q

are non-obstructive or obstructive FLUTD more common in males?

A

obstructive more in males
non-obstructive more in females

133
Q

what age cats is FLUTD most commonly seen in?

A

2-6 year old neutered cats

134
Q

what predisposes cats to FLUTD?

A

obesity
indoor/sedentary cats
dry diet
multi-cat household (stress)

135
Q

what are the clinical signs of FLUTD?

A

dysuria (difficulty)
pollakiuria (increased frequency)
haematuria
inability to urinate (obstruction)
behavioural changes
appear to lose letterbox training (periuria)

136
Q

what is periuria?

A

urinating in inappropriate places

137
Q

what is done to treat non-obstructive FLUTD?

A

nothing - self-limiting and resolves in around a week

138
Q

what are the features of a bladder of cats with non-obstructive FLUTD?

A

small, firm, painful

139
Q

how does the bladder appear in cases of cats with obstructive FLUTD?

A

large, painful

140
Q

what is FIC?

A

feline idiopathic/interstitial cystitis

141
Q

what pathology is seen with cases of FIC?

A

increased mast cells and oedema on submucosa
neurogenic inflammation leading to increased sensitivity
reduced glycosaminoglycan layer - reduced protection

142
Q

what is the main predisposing factor of feline idiopathic/interstitial cystitis?

A

stress (can’t deal with it properly)

143
Q

what are the main constituents of a urethral plug due to FLUTD?

A

mucus and glycoprotein matrix (weeping from bladder)

144
Q

is struvite associated with UTIs in cats?

A

no - they are usually sterile

145
Q

is blood sampling more important for obstructed or non-obstructed FLUTD cats?

A

very important in obstructed
unremarkable in non-obstructed

146
Q

what are possible features of a haematology of obstructed FLUTD cats?

A

hyperkalaemia
hyperphosphataemia
metabolic acidosis
azotaemia

147
Q

how common are crystals in cat urine?

A

very - don’t over interpret

148
Q

what uroliths in cats require surgical removal?

A

calcium oxalate

149
Q

how often does FIC reoccur?

A

chronically reoccurring but self-resolving

150
Q

what is the main way to reduce/prevent FIC?

A

reduce stress - environment, household, pets, neighbours

151
Q

what needs to be done to assess stress in FIC patients?

A

multimodal environmental modification

152
Q

what drugs can be used to treat FIC?

A

glycosaminoglycan supplements
analgesics - buprenorphine, NSAIDs
tricyclic antidepressant - amitriptyline (reduce stress??)

153
Q

if using amitriptyline to treat FIC what needs to be monitored closely?

A

bloods

154
Q

what is the most important thing to check in a cat presenting with LUT signs?

A

bladder size

155
Q

what are the three layers of the glomerular filtration barrier?

A

fenestrated endothelial cells
glomerular basement membrane
podocytes

156
Q

what is the hallmark sign of a glomerulopathy?

A

proteinuria

157
Q

are glomerulopathies more common in dogs or cats?

A

dogs

158
Q

what are the two main categories of the pathogenesis of glomerulopathies?

A

immune mediated
non-immune mediated

159
Q

what is the cause of immune mediated glomerulopathies?

A

type 3 hypersensitivity reactions - immunoglobulin complexes get stuck in-between the barriers causing inflammation due to complement

160
Q

how fast do familial glomerulopathies progress?

A

rapidly (present at a young age)

161
Q

what is the main breed associated with glomerulopathy due toamyloidosis?

A

shar-pei

162
Q

what are the clinical signs of amyloidosis in shar-peis?

A

shar-pei fever - swollen joints. hyperthermia

163
Q

when would a glomerulopathy be suspected?

A

unexpected proteinuria on urinalysis
differential for renal disease
unknown hypertension
hypoalbuminaemia/hypercholesterolaemia
thromboembolic diseases

164
Q

what needs to be done when suspecting a glomerulopathy to confirm diagnosis?

A

confirm proteinuria (dipstick)
quantify proteinuria - protein creatinine ratio (UPCR)
determine if proteinuria is pre-renal, renal, post-renal
confirm proteinuria is persistent - 3 tests 2 weeks apart

165
Q

what is the gold standard for confirming a renal proteinuria?

A

renal biopsy - needs specific sample and pathologist centres (rarely performed)

166
Q

what is the marker used to assess if a proteinuria is a renal or not?

A

UPCR >2 is probably renal
UPCR <2 is problem tubulointerstital

167
Q

what is the standard treatment used for proteinuria?

A

RAAS blockade - ACE inhibitor or angiotensin receptor blockers

168
Q

what is the most common ACE inhibitor used for proteinuria treatment?

A

benazepril (then telmisartan if ineffective)

169
Q

can steroids (immunosuppressives) be used as a treatment for glomerulopathies?

A

yes but needs a biopsy to confirm it is an immune mediated glomerulopathy so is rarely used

170
Q

what are some complications of glomerulopathies that need treating?

A

thromboembolism
azotaemia (CKD)
systemic hypertension
oedema

171
Q

what is used to treat thromboembolism in glomerulopathy cases?

A

antiplatelets - clopidogrel
anticoagulants - apixaban or rivaroxaban

172
Q

what needs to be monitored closely if using a anti-coagulants in the treatment of glomerulopathies?

A

signs of bleeding

173
Q

what is used to treat hypertension in glomerulopathy cases?

A

dogs - benazepril (then amlodipine)
cats - amlodipine or telmisartan

174
Q

what is nephrotic syndrome?

A

a combination of hypoalbuminaemia, proteinuria, hypercholesterolaemia and oedema

175
Q

what is usually the reason for oedema formation in glomerulopathy cases?

A

associated with renal sodium retention

176
Q

what is used to treat oedema associated with glomerulopathies?

A

furosemide (pulmonary oedema)
spironolactone (pleural/abdominal oedema)

177
Q

what is the major disadvantage of using diuretics to treat oedema associated with glomerulopathies?

A

can cause severe azotaemia

Small animal (fourth year) (26 decks)

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