LA urology (Reuss) Flashcards
1
Q
History
A
- Duration
- relation to other events
- exercise
- parturition
- number animals affected
- Non specific signs
- weight loss
- colic
- decreased performance
- Diet
- Medications
- Water intake: 40-60 ml/kg/day
- Urine output: 5-20 ml/kg/day
- amount
- pattern
- character
- groaning/grunting
2
Q
Abnormal micturation
- Stranguria
- Dysuria
- Pollakiuria
- Polyuria
- Oliguria
- Anuria
A
- Stranguria: straining to urinate
- Dysuria: pain on urination
- Pollakiuria: inc frequency urination
- Polyuria: inc total volume urination
- Oliguria: dec total volume of urination
- Anuria: passing no urine
3
Q
Oral exam
A
- Excessive tartar
- kidney dz
- Ulcers
- Bad breath
4
Q
External genitalia
A
- urethral fossa
- squam
- stones
- Vulva
- crystals
- evidence of bleedings
5
Q
Transrectal palpation
Horse
Cow
Small Ruminant
A
- Horse
- Left kidney
- Bladder
- Ureters -bad news
- Urethra
- Cattle
- Left kidney
- Lobulated
- almost on midline
- Ureters
- Bladder
- Urethra
- Left kidney
- Small ruminant
- digital
- transabdominal
- perineal urethra (urethral pulse if stone)
6
Q
Ruminant urine collection
A
- Females: urethral diverticulum
- stroke vulva
- Males: NOT POSSIBLE to catheterize
- sigmoid flexure
- urethral diverticulum
- stroke preputial hairs
- small ruminants
- suffocate them…lol
7
Q
Lab evals we do
A
- CBC
- CHEM
- UA
8
Q
CBC
Anemia
A
- Cause of renal disease
- hemolysis => pigment nephropathy
- acute blood loss => vasomotor nephropathy
- Effect of renal disease
- Anemia of chronic disease
- Decreased erythropoietin production
- Decreased life span of RBCs
9
Q
Hematology
- Chronic infection or inflammation
- Glomerulonephritis
A
- Chronic infection or inflammation
- Neutrophilia
- Hyperfibrinogemia
- Inc globulins / total protein
- Glomerulonephritis
- hypoalbuminemia
- panhypoproteinemia = almost always GI DZ
10
Q
Serum biochem
Creatinine
A
- waste product from muscle
- Freely filtered
- filtration rate = excretion rate
- increases once 75% nephrons damaged
11
Q
Serum biochem
BUN
A
- LA patients can secrete in sweat
- LA patients can recycle
- Can use urea to inc medullary hyperotonicity
- retain water
12
Q
GFR measurements
A
- Creatinine clearance
- Iohexol Clearance
- Nuclear scintigraphy
13
Q
Serum electrolytes
Acute Kidney Injury
A
- dec Na, Cl
- inc K, Mg
- dec Ca, inc P
14
Q
Serum electrolytes
Chronic kidney dz
Horses
A
- inc Ca, dec P
15
Q
Urinalysis
A
- Color
- horses should have cloudy urine
- ruminants should not be cloudy
- Red urine:
- blood, hemoglobin
- Brown urine:
- myoglobin
16
Q
UA
Hematuria
Hemoglobinuria
Myoglobinuria
A
- Hematuria
- erythrocytes settle out
- Hemoglobinuria
- urine and serum discolored
- Myoglobinuria
- urine stays discolored
- serum clear
*urine dipsticks can’t tell the difference
17
Q
urine pH
A
- herbivores have alkaline urine
- exceptions:
- high protein diet
- anorexia
- neonate
18
Q
USG
A
- Estimates solute concentration
- weight of solution relative to equal volume of distilled water
- Use refractometer
- dipstick not accurate (I think)
- Can be falsly increased if lots of protein or glucose
- use osmolality (# particles/kg water)
19
Q
Hyposthenuria
Isosthenuria
Hypersthenuria
A
- Hyposthenuria
- USG < 1.008
- normal in suckling foals
- Isosthenuria
- USG 1.008 - 1.014
- tubule disease
- high producing dairy cows N: 1.007 - 1.015
- Hypersthenuria
- USG > 1.014
- N: 1.015-1.035
- Dehydration: > 1.025
*Sedation will falsly lower USG
20
Q
Fractional clearances
A
- Reflection of tubular disease
- Urine (electrolyte) % Plasma (x) * P (Cr) % U (Cr) * 100 = % FC
- Na clearance most useful
- should be less than 1
- should be close to 0 in dehydrated horses
- Altered by IV fluids, furosemide, exercise
21
Q
Urine GGT
A
- Biliary and pancreatic tubular GGT production not filtered by kidney
- Proximal tubular brush border enzyme
- early indicator of proximal tubule damage
- increases quickly with aminoglycoside tox
- only released during active destruction
22
Q
Liver dz without tubular dz and GGT
A
no GGT in urine
23
Q
Tubular dz without liver dz and GGT
A
tubular dz will mean GGT in urine, not liver dz
24
Q
Urine GGT will go up before
A
Creatinine
25
Q
Ratios used to get rid of
A
dilutional effect
26
Q
Urine GGT/Creatinine Ratio
A
- (UGGT)/(UCr) * 100
- normal < 25 IU/g
- 25-100 IU/g ???
- > 100 IU/g are clinically relevant
- Follow trends
27
Q
Proteinuria
Normal kidney
Proteinuria
A
- Normal kidney
- glomerulus excludes albumin, globulin
- proximal tubules reabsorb low-molecular weight proteins
- Proteinuria
- kidney
- more pronounced with glomerular disease
- Exudative processes in ureters, bladder, urethra
- vulvar contamination
- kidney
28
Q
Proteinuria
False positives
A
- False positives
- alkaline pH causes trace protein on dipstick
- overcomes citrate buffer
- Hemoglobin
- alkaline pH causes trace protein on dipstick
- Sulfosalicylic acid precipitation (SSA)
- Urine protein: creatinine = 1.0:1
29
Q
Glucosuria
A
- Reabsorbed in proximal tubule
- Renal threshold = 150 mg/dl
30
Q
Glucosuria + normoglycemia =
A
proximal tubular damage
31
Q
Glucosuria + hyperglycemia =
A
systemic disease
32
Q
Sediment
Casts
Crystals
A
- Casts
- dissolve quickly in alkaline urine (LOOK W/IN 1/2-1hr)
- indicates tubular damage
- Crystals (hard to interpret, all can be normal)
- calcium carbonate, phosphate, oxalate
- struvite
33
Q
Sediment
WBC
RBC
A
- WBC > 10/hpf = pyuria
- infection, inflammation
- +/- Bacteria
- RBC > 5/hpf = hematuria
- inflammation, infection, neoplasia, exercise
34
Q
Ultrasound
Kidneys
A
- Transabdominally
- Transrectally
- Assess size, density, structure
- Cortex should be more echogenic than medulla
- Pelvis echogenecity varies
35
Q
Renal biopsy
A
- complications
- hemorrhage
- bowel penetration
- not done often
- doesn’t give etiology, just confirms end stage kidney dz
36
Q
cystoscopy
A
- ureteral openings
- cystoliths
37
Q
Abdominal Radiographs
A
- Retrograde cystogram
- Excretory pyelography
*suspect bladder rupture
38
Q
Nuclear scintigraphy
A
assess renal perfusion
