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BVetMed4 - Urinary > Lab Diagnosis Of Urinary Disease > Flashcards

Lab Diagnosis Of Urinary Disease Flashcards

1
Q

What is the endocrine output of the kidney?

A

Erythropoietin
Renin
Active Vit D metabolites

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2
Q

What is the GFR?

How is it investigated?

A

Rate that fluid moves from plasma to glomerular filtrate

Rate of clearance - Createnine, Inulin (injected)

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3
Q

What is GFR proportionally affected by?

A

Renal plasma flow

Affected by renal perfusion

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4
Q

What is Azotaemia?

A

An increase in the non-protein nitrogenous compounds, usually UN and Createnine in the blood (uric acid in birds)

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5
Q

What is uraemia?

A

AZOTEMIA + CLINICAL SIGNS

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6
Q

What pathology is associated with uraemia ?

A

Loss of functional nephrons

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7
Q

What clinical signs are associated with uraemia?

A

Anorexia, V+D, GI haemorrhage, ulcerative stomatitis

Bruxism in ruminants - excessive teeth grinding/jaw clenching

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8
Q

What causes the decrease in renal function in renal failure?

A

Decrease in numbers of functioning nephrons

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9
Q

When should you take urine samples in relation to initiation of IVFT?

A

BEFORE IVFT

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10
Q

When would cytology be indicated ?

A

To investigate the potential for neoplastic processes affecting the kidney.

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11
Q

What elements of a biochem profile are we interested for urinary function?

A 
UN
Createnine 
Phosphorous 
Calcium 
Sodium 
Chloride 
Potassium 
Acid Base 
Protein
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12
Q

What should you look at concurrently when you look at the urine?

A

Serum/plasma chemistry

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13
Q

What affects urea levels?

A

Production in liver
Excretion in kidney
Protein levels
GI bleeding

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14
Q

What affects Createnine levels?

A

Kidney excretion

Muscle mass

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15
Q

What largely causes increased urea nitrogen?

A

Reduced GFR

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16
Q

Why does UN increase in dehydration ?

A

Passive diffusion back into blood increased as decreased urine flow rate

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17
Q

How should renal disease be assessed on biochem in cows?

Why?

A

CREATENINE

Can have severe dz with relatively normal UN as urea excreted into rumen -> ammonia -> aas -> protein production

Therefore urea low even if kidney dz

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18
Q

How long does Createnine take to equilibrate?

A

Around 4 hours

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19
Q

How can you determine if a uroabdomen is present from Abdominocentesis of fluid?

A

CREATENINE higher than serum levels

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20
Q

How much of renal function must be lost before a change in Createnine is seen?

How would you describe this in terms of specificity and sensitivity?

A

3/4

Low sensitivity - low true negatives

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21
Q

What are the types of Azotaemia?

A

Prerenal
Renal
Postrenal

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22
Q

What is prerenal Azotaemia?

A

Result of reduced RENAL PERFUSION

Or increased PROTEIN CATABOLISM

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23
Q

What causes prerenal Azotaemia?

A

Decreased blood pressure -> vasoconstriction -> reduced renal perfusion

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24
Q

What is renal Azotaemia?

A

Azotaemia due to renal disease and nonfunctional nephrons

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25
Q

What is postrenal azotaemia?

A

azotaemia caused by interference with the excretion of urine

—obstruction
— post renal leakage e.g. rupture

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26
Q

What can cause pre-renal azotaemia?

A 
Increased protein catabolism: 
 — GI haemorrhage 
 — necrosis 
 — starvation 
 — corticosteroids

High protein diets
REDUCED RENAL PERFUSION

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27
Q

What would you expect the USG to be in pre-renal azotaemia?

Why?

A

HIGH

ADH response occurs and kidneys concentrate urine

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28
Q

What clinical signs are typically associated with post-renal azotaemia ?

A

Oliguria or anuria

29
Q

How can you determine which type of azotaemia is present?

A

USG
Concentrating ability assessment
Compare urine with serum/plasma Createnine

30
Q

What can falsely increase USG?

A

If there is glucose or protein in the urine

Needs to be calibrated to urine that doesn’t have abnormal constituents

31
Q

What does a low USG indicate WITH azotaemia ?

A

RENAL FAILURE - decreased concentrating ability

32
Q

What is isosthenuria?

A

Fixed USG 1.008-1.012

Osmolality same as plasma, no resorption

33
Q

What is hyposthenuria?

Where is the problem?

A

USG <1.008

DILUTING ABILITY RETAINED

problem is in the collecting duct

34
Q

What can cause normonatraemia?

A

Normal blood Na/normal blood water

Increased/increased

Decreased/decreased

35
Q

What is the main ion in extracellular fluid?

A

Sodium

36
Q

Where is most sodium resorbed?

A

Proximal tubule

37
Q

What causes hypernatraemia?

A

Increased sodium intake

Reduced water intake or increased water loss

38
Q

What causes hyponatraemia?

A

Reduced sodium intake
Increased sodium loss

Increased water intake

39
Q

What usually coincides with changes in sodium?

A

Changes in chloride

40
Q

When might you see changes in chloride without changes in potassium?

A

VOMITING

Acid/base status alteration

41
Q

When does potassium increase ?

A

Acidosis - H+ swapped for K+ in blood

ACUTE Renal failure — ESPECIALLY if anuria and oliguria are present

Hypoadrenocorticism

42
Q

When does potassium decrease?

A

Chronic kidney disease - PD/PU

43
Q

Why do dogs and cats with renal failure often have a metabolic acidosis?

A

Kidneys usually conserve filtered bicarbonate

44
Q

What makes up total calcium?

A

Free
Bound to albumin
Bound to anions

45
Q

What can cause a decrease in albumin bound calcium?

A

Albumin loss - PLN

46
Q

What can mask a decrease in free calcium on total calcium in renal failure?

A

Increased amount bound to anions

47
Q

Which animals get all their calcium from their diet?

Where is it ALL excreted?

A

Horses and rabbits

Kidneys

48
Q

What will calcium levels be in the following animals in renal failure:

Dog
Cat
Cow
Horse

A

Dog cat cow - hypo

Horse - Hyper

49
Q

How does decreased GFR affect phosphate levels?

How may this differ in horses?

A

Hyperphosphataemia

HypO

50
Q

What changes may be seen normally on biochem in normal growing animals ?

A

Hyperphosphataemia
Hypercalcaemia
Increased ALP

51
Q

How does increased phosphate affect 1 alpha - hydroxylase ?

A

DECREASES

52
Q

Outline secondary renal hyper parathyroidism.

A

Decreased GFR

Increased phosphate

Decrease 1a-hydroxylase activity

Decrease active vit D3

Decrease Calcium absorption and Calcium conc

Increase PTH

Phosphaturia + Increase 1 a-hydroxylase + increase calcium absorption

53
Q

Describe the biochem seen in secondary renal hyperparathyroidism.

A

Initial damage
Slight PTH increased

Additional damage
Further PTH increase

Renal failure

Hyperphosphataemia
Reduced D3
Hypocalcalcaemia
High PTH

54
Q

How does kidney disease affect amylase and lipase?

A

Normally cleared by kidney so INCREASE

55
Q

Why is anaemia associated with renal disease?

A

DECREASED EPO

56
Q

Describe the anaemia of renal disease.

A

Mild (HCT not lower than 30)

Normocytic and normochromic

NON-REGENERATIVE

57
Q

When might cytology be indicated

A

investigate potential RENAL LYMPHOMA
- If both kidneys enlarged

BLADDER NEOPLASIA

58
Q

What diets are associated with lower pH urine?

A

High protein

Fasting

59
Q

What diet is associated with a higher pH urine?

A

Vegetable

60
Q

What pH would you expect in urine of patient with cystitis?

A

Higher

Urea converted to ammonia by bacteria

61
Q

What are the types of proteinuria ?

A

Prerenal
Glomerular
Tubular
Haemorrhagic or inflammatory (postrenal)

62
Q

When might you see glucosuria?

A

Hyperglycaemic glucosuria (e.g. DM)

Renal glucosuria

Stressed cats

63
Q

When might you see ketonuria?

A

Poorly controlled diabetics

64
Q

When might you see bilirubinuria?

A

Haemolytic anaemia

Liver disease with cholestasis

Gall bladder/bile duct obstruction

65
Q

How would you interpret bilirubinuria in dogs and cats?

A

Dogs - small amount not a concern

Cats - ALWAYS significant

66
Q

What is haematuria?

What causes?

A

Intact blood cells in urine

Trauma, cystitis, renal or genital bleeding

(Can see intact RBCs in spun sample)

67
Q

What can you see in sediment?

A

Cells, crystals, casts, bacteria

68
Q

What do white blood cells in sediment indicate?

A

Inflammation or infection

69
Q

Why might there be RBCs in urine sediment?

A

Haemorrhage

Contamination from cystocentesis

BVetMed4 - Urinary (15 decks)

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