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Equine Medicine > Kidney Disease > Flashcards

Kidney Disease Flashcards

1
Q

What is the normal water intake out urine output in horses?

A

15-20 L (90 L if hot)

5-15 L, difficult to see - owners will likely observe consistently soaked bedding

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2
Q

How can a rectal exam be used in diagnosing kidney disease?

A

can palpate the caudal border of the left kidney

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3
Q

What are the most common ways of obtaining a urine sample from horses? What is important to note about urine appearance in comparison to small animals?

A
  • free catch (horses will likely urinate when put in a fresh stall)
  • feathering
  • catheter

will likely be viscous due to the normal presence of more mucus

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4
Q

What is the expected tonicity of equine urine? How is that measured?

A

USG = 1.025-1.050 on refractometer

  • hyposthenuric = < 1.008
  • isosthenuric = 1.008-1.014
  • hypersthenuric = > 1.014
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5
Q

What is the pH of equine urine? What does this cause? When is glucose seen? How is blood measured on dipstick? Bilirubin?

A

herbivores = alkaline (7-9)

protein trace

usually absent - seen following exercise, sedation (Dex, Xylazine), and with PPID

usually false positive

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6
Q

What sediment is normally seen in horse urine?

A
  • calcium carbonate crystals (circles)
  • mucus
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7
Q

What hematology changes are expected in horses with kidney disease? What is the preferred biochemistry value evaluated?

A

low-grade anemia

  • creatinine is most sensitive to kidney damage
  • BUN (70% lost)
  • electrolytes
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8
Q

What is acute renal injury? What are the 3 major causes?

A

rapid fall in GFR associated with uremia

  1. pre-renal = dehydration, vasomotor issue, septicemia (decreased renal blood flow)
  2. renal = toxic, intrinsic damage to kidney structures
  3. post-renal = obstruction to urine outflow, uroliths
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9
Q

What is the most common finding with acute renal injury?

A

acute tubular necrosis

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10
Q

What 3 drugs cause toxic (renal) damage?

A
  1. aminoglycosides (Gentamycin, Amikacin) and oxytetracycline
  2. NSAIDs - treat laminitis and uveitis
  3. biphosphonate - treats lameness
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11
Q

What 3 diseases are associated with toxic (renal) damage?

A
  1. myopathy, hemolysis - myoglobin and hemoglobin filtration damage tubules
  2. immune-mediated - complexes
  3. leptospirosis
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12
Q

What clinical signs are associated with acute renal damage?

A

often caused by predisposing issue with uremia 3 days later —> more obscure

  • depression
  • anorexia
  • rarely febrile
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13
Q

How do the 2 renal values compare when diagnosing acute renal damage?

A
  1. creatinine = freely filtered, increases with 75% decreased GFR
  2. BUN = less accurate due to reabsorption
    (SDMA?)

urine and serum creatinine, or BUN/Cr are not reliable and cannot differentiate renal vs. pre-renal

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14
Q

What is expected on USG in renal and pre-renal damage?

A

RENAL = 1.008-1.016 (concentration potential is lost)

PRE-RENAL = > 1.025

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15
Q

How is urine cytology used to diagnose renal disease?

A
  • RBC, WBC = infectious
  • casts = tubular damage
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16
Q

What is the most common change in serum electrolytes seen with acute renal damage? What are 3 other possible observations?

A

hyponatremia and hypochloremia

  1. variable changes in potassium - high with anuria/oligura, high and decreases with rehydration is pre-renal, high with rehydration is renal
  2. magnesium changes
  3. metabolic acidosis
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17
Q

What are the 3 general steps in treating acute kidney disease?

A
  1. fluids
  2. Furosemide
  3. pressors
18
Q

What must be done before treating acute kidney damage? What is the first step in treatment?

A

correct pre-renal factors, predisposing disease, and intravascular volume deficit

  • if diuresis is present: give fluids
  • no diuresis (anuric, oliguric): Furosemide, vasopressors (for low BP)
19
Q

What does the prognosis of pre-renal acute kidney damage depend on?

A

(HEMODYNAMIC) ability to resolve predisposing issue

good prognosis = issue resolved, urine produced, creatinine decreased over 24-72 hours

20
Q

When is prognosis of renal acute kidney damage considered favorable, guarded, and grave?

A

(NEPHROTOXIC)

FAVORABLE = diuresis, normalized creatinine and maintained w/o fluids

GUARDED = anuria, oliguria

GRAVE = uremic encephalopathy

21
Q

What does the prognosis of post-renal acute kidney damage depend on?

A

(OBSTRUCTIVE)

  • obstruction relief
  • hyperkalemia correction
22
Q

How is acute kidney damage prevented?

A
  • hydrate patient receiving potentially nephrotoxic drugs
  • monitor creatinine, urine output, and enzymuria closely
23
Q

What is chronic kidney disease? What horses most commonly are affected? What disease is associated?

A

chronic, irreversible, slowly progressing ( > 3 months) structural and functional reduction in GFR

older horses

primary, immune-mediated glomerulonephritis

24
Q

What are the 3 most common signs of CKD in horses? What else is seen?

A
  1. weight loss
  2. PU/PD
  3. ventral edema
  • inappetence and depression
  • fetid breath, gingivitis, tartar
  • oral and intestinal ulcers
  • decreased performance
  • hematuria, encephalopathy
25
Q

What is commonly seen on hematology in patients with CKD?

A
  • anemia
  • hypoalbuminemia
26
Q

What are kidney values like in patients with CKD? What 3 values are seen on biochemistry?

A

azotemia - BUN/Cr > 10:1

  1. hyponatremia, hypochloremia
  2. hyperkalemia, hypercalcemia
  3. metabolic acidosis
27
Q

What is seen on UA in patients with CKD?

A
  • isosthenuria
  • proteinuria
  • sediment
28
Q

What diet is recommended in patients with CKD? What should be added?

A

good quality pasture and carbohydrates (C-H)

  • fat
  • salt
  • omega 3 fatty acids
29
Q

What treatments are recommended in patients with CKD?

A
  • treat inciting cause
  • replace fluids, electrolytes, nutrients, and protein
  • treat hypertension with Benazepril
  • vitamin B
  • anabolic steroids
30
Q

In what horses with CKD is there a poor prognosis?

A
  • USG < 1.015
  • creatinine > 10 mg/dL
31
Q

What is characteristic of renal tubular acidosis?

A

renal injury leading to metabolic acidosis and hyperchloremia

32
Q

What horses may have a genetic disposition to develop renal tubular acidosis? How do they present?

A

Friesians

  • depression, anorexia
  • tachycardia +/- arrhythmia
  • weakness, ataxia
  • intermittent abdominal pain
33
Q

How is renal tubular acidosis diagnosed? How is UA affected?

A
  • metaboilc acidosis = bicarbonate < 10 mmol/L, or pH < 7.25
  • hyperchloremia = Cl > 110 mmol/L

urine pH will be alkaline despite acidosis

34
Q

How is renal tubular acidosis treated?

A
  • correct acidosis with initial IV isotonic sodium bicarbonate, then maintenance oral sodium bicarbonate
  • correct hypokalemia
35
Q

What is the top differential diagnosis for PU/PD horses?

A

psychogenic water drinking due to boredom

ALSO:

  • iatrogenic
  • PPID, EMS
  • ARF, CKD
  • endotoxemia, sepsis
  • DI, DM
  • psychogenic salt consumption
36
Q

What is the most common cause of ectopic ureters? What is the most common presentation?

A

abnormal embryonic development

filly with lifelong history or urinary incontinence and hindlimb/tail urine scalding (tend to smell)

37
Q

How are ectopic ureters diagnosed? Treated?

A
  • speculum, endoscopy
  • contrast studies
  • ultrasound
  • UA, blood work

surgical reimplantation or nephrectomy

38
Q

How is the treatment of ectopic ureters determined?

A
  • unilateral vs. bilateral
  • presence of UTIs
  • impaired kidney function
39
Q

What is a urachus?

A

fetal connection of the bladder and allantoic fluid that closes and regresses at birth

40
Q

What are the 3 most common clincial signs associated with patent urachus?

A
  1. urine leaking from umbilicus
  2. moist umbilicus
  3. pollakiuria
41
Q

What are 3 treatments for patent urachus? What needs to be monitored?

A
  1. antimicrobial topicals
  2. Gomez method
  3. surgical removal of the infected navel structures (removing source of further infection) and closure of the opening between the urachus and the bladder

presence of navel imfection

Equine Medicine (33 decks)

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