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Tobias full > Kidneys > Flashcards

Kidneys Flashcards

1
Q

How often are multiple renal arteries reportedly found?
In which kidney is this most common?

A
  • 13% of dog kidneys
  • 10% cat kidneys
  • Left kidney is more common

Right kidney more commonly has multiple renal veins

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2
Q

Where do the capsular arteries commonly arise from?

A
  • Phrenicoabdominal and adrenal arteries
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3
Q

What is the role of the vasa recta capillaries?

A
  • Extend from the cortec into the medulla, reabsorbing water from the collecting ducts and returning it back to systemic circulation
  • Help to maintain hypertonicity of the renal medulla through countercurrent exchange system
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4
Q

What structure helps to maintain renal autoregulation of blood flow?

A

Macula densa (between glomerulus and afferent arterioles)

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5
Q

What cells within the glomerulus are responsible for filtration?

A
  • Podocytes - water and small particles under 60,000 daltons can freely pass through the filtration slits
  • Inherent negative charge of the glomerulus basement also enhances the selective nature of filtration
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6
Q

What is normal urine production?

A

20-45ml/kg/d

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7
Q

What is the osmolality of the glomerular filtrate and of the medullary interstitial fluid?

A
  • Glomerular filtrate - 300mOs/L
  • Medullary interstitial fluid - 1200-1400mOs/L
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8
Q

What is normal renal blood flow?

A
  • Approx 25% of CO
  • 4ml/min/g of renal tissue

Calculated as renal perfusion/renal vascular resistance

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9
Q

How does GFR relate to blood flow?

A

GFR is roughly 20% of renal plasma flow

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10
Q

What determines the concentrating ability of the kidney?

A

Based on renal medullary hyperosmolarity which is maintained by the vasa recta through a counter-current mechanism

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11
Q

What can cause decreased concentrating ability of the kidney?

A

Increased blood flow through the vasa recta
- Vasodilation
- Increased arterial pressure
- Increased fluid volume

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12
Q

What mechanisms create medullary interstitial hyperosmolarity?

A
  • Faculative diffusion of large molecules (urea) into the interstitium
  • Limited ability of water to diffuse into interstitium
  • Active transport of Na, K, Cl and other electrolytes into the interstitium from the thick portion of the proximal loop of Henle

Urea contributes 40-50%. Absorbed in the collecting ducts UT-A1, stimulated by ADH. It is then recycles by moving to thin limb of Loop of Henle

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13
Q

What suture pattern caused increased renal parenchymal damage?

A

Horizontal mattress
- parenchymal necrosis, fibrosis, scarring and atrophy

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14
Q

List some indications for renal surgery

A
  • Unresponsive pyelonephritis
  • Perinephric abscess or cyst
  • Unilateral renal neoplasia
  • Severe renal trauma
  • Ureteral consitions causing severe irresolvable hydronephrosis
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15
Q

What factors increase the risk of haemorrhage during renal surgery?

A
  • Hypertension
  • Thrombocytopaenia
  • Azotaemia - inhibits platelet adhesion and aggregation. Should perform BMBT
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16
Q

What is the rate of pulmonary metastasis with primary renal neoplasia?

A
  • Dog: 16-48%
  • Cat: 43%
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17
Q

Which lateral radiographs is better for viewing both kidneys?
What is the normal kidney size?

A
  • Right lateral
  • Dogs: 2-2.5x length of adjacent vertebra
  • Cats: 2-3x length of adjacent vertebra
18
Q

What imaging modality of best for determining the GFR (and therefore function) of the kidneys?

A

Nuclear scintigraphy

Plasma clearance tests are more accurate but more difficult to perform and time consuming

19
Q

What radiopharmaceuticals can be used for scintigraphy of the kidney?

A
  • Technitium 99m - DTPA (diethylenetriaminepentaacetic acid)
  • Technetium 99m - MAG3 (mercaptoacetyltriglycine) - better for patients with very limited renal function and for performing renal perfusion studies to evaluate transplant patients
20
Q

Where is the most common location of renal ectopia?

A

Pelvis

21
Q

What breeds are predisposed to polycystic kidney disease?

A
  • Persians (37-38% of breed)
  • Bull Terriers
22
Q

What breeds are overrepresented with renal calculi?
What is the most common calculi?
List potential causes of renal calculi

A
  • Siamese cats, Bichon Frise
  • Calcium oxalate

Oversaturation of the urine with calculogenic substances
- Organ dysfunction
- neoplasia
- Increased Ca intake
- Drugs
- Increased intestinal absorption
- Impaired renal reabsorption
- Excessive skeletal mobilisation

23
Q

List options for stone removal

A
  • Extracorporeal shockwave lithotripsy
  • Nephrotomy
  • Pyelolithotomy
  • Endoscopic nephrolithotomy (intracorporeal lithotripsy)
24
Q

What are the most common renal neoplasias in cats and dogs?

A

Cats: Lymphome
Dogs: Carcinoma

25
Q

What inherited neoplastic condition of the kidneys can effect young GSD?

A

Renal cystadenocarcinoma with nodular dermatofibrosis
- Bilateral multifocal renal tumours
- Firm nodules of dense collagen in the skin and SQ
- Feline common also have uterine leiomyoma
- Mutation of FLCN gene, affecting folliculin (a potentially tumour suppressing portein)
- 50% mets

26
Q

List paraneoplastic syndromes which can be seen with renal neoplasis

A
  • Polycythaemia and thrombocytosis in cats
  • HyperCa
  • Hypoglycaemia
  • Leucocytosis
  • Peripheral neuropathy
27
Q

What is the rate of bilateral renal neoplasia?

A

4-32%

28
Q

What is the MST for renal neoplasia?

A
  • Carcinoma - 16m
  • Sarcoma - 9m
  • Nephroblastoma - 6m
  • HSA - 278d (haemoperitoneum has significantly shorter survival 62d
29
Q

List some DDx of abnormal appearance of the kidney

A
  • Developmental abnormalities
  • Calculi
  • Neoplasia
  • Acquired renal cyst
  • Perirenal pseudocyst
  • Renal abscess
  • Trauma
  • Kidney worms (Dioctophyma renale)
30
Q

List some treatment options for severe renal trauma?

A
  • Ureteronephrectomy
  • Wrap in semielastic polyglactin mesh
  • Wrap in polyglycolic acid mesh
  • Sterile, nonabsorbable cyanoacrylate for small lacerations

When comparing mesh to partial nephrecomy, creatinine clearance ratio was 0.93 for mesh and 0.58 for partial nephrectomy

31
Q

List some contraindications for renal biopsy
What needle can be used?

A

Contraindications:
- Uncontrolled coagulopathy
- Hypertension
- Large or multiple renal cysts or abscesses
- Extensive pyelonephritis
- Ureteral obstruction
- Severe hydronephrosis

Monopty biopsy needle

32
Q

What is the complication rate of surgical renal biopsy?
What factors have been associated with increased complications?

A
  • Complications 1-21.7% (Major in 8.9%
  • Mortality rate less then 3%

Factors associated with complications:
- Thrombocytopaenia
- Prolonged clotting times
- Creatinine above 5mg/dL
- Patient older than 4yo
- BW less than 5kg

33
Q

List some indications for nephrotomy

A
  • Biopsy
  • Removal of nephroliths or other obstructive lesions
  • Chronic infection
  • Persistent haematuria of renal origin
  • Persistent hydronephrosis
34
Q

What are the 2 options for nephrotomy?

A
  • Bisectional nephrotomy (sharp dissection of the renal parenchyma)
  • Intersegmental nephrotomy (Blunt dissection)

Bisectional recommended - faster, easier, no difference in post-op GFR between the 2 techniques

35
Q

What should be the maximum occlusion time of the renal vessels?

A

20min

36
Q

How do you close a partial nephrectomy?

A
  • Overlapping mattress sutures through the parenchyma and apposition of the overlying capsule
  • If cannot be apposed, can tack omentum to exposed surface
37
Q

List potential complications following a partial nephrectomy

A
  • Haemorrhage
  • Urine leakage
  • Urine fistula
38
Q

What is the expected orientation of the renal vessels?

A
  • When in normal orientation, renal vein is ventral to renal artery
  • When the kidney is rotated ventromedially, renal artery is lateral to renal vein
39
Q

How many ports are required for a laparoscopic nephrectomy?

A
  • 3 to 4 port technique (1 caudal to umbilicus, 1 caudal to last rib and 1 cranial to pelvic limb for triangulation)
40
Q

List some DDx of abnormal appearance of the kidney

A
  • Developmental abnormalities
  • Calculi
  • Neoplasia
  • Acquired renal cyst
  • Perirenal pseudocyst
  • Renal abscess
  • Trauma
  • Kidney worms (Dioctophyma renale)

Tobias full (110 decks)

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