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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
What is postrenal azotaemia?
azotaemia caused by interference with the excretion of urine —obstruction — post renal leakage e.g. rupture
26
What can cause pre-renal azotaemia?
``` Increased protein catabolism: — GI haemorrhage — necrosis — starvation — corticosteroids ``` High protein diets REDUCED RENAL PERFUSION
27
What would you expect the USG to be in pre-renal azotaemia? Why?
HIGH ADH response occurs and kidneys concentrate urine
28
What clinical signs are typically associated with post-renal azotaemia ?
Oliguria or anuria
29
How can you determine which type of azotaemia is present?
USG Concentrating ability assessment Compare urine with serum/plasma Createnine
30
What can falsely increase USG?
If there is glucose or protein in the urine Needs to be calibrated to urine that doesn’t have abnormal constituents
31
What does a low USG indicate WITH azotaemia ?
RENAL FAILURE - decreased concentrating ability
32
What is isosthenuria?
Fixed USG 1.008-1.012 Osmolality same as plasma, no resorption
33
What is hyposthenuria? Where is the problem?
USG <1.008 DILUTING ABILITY RETAINED problem is in the collecting duct
34
What can cause normonatraemia?
Normal blood Na/normal blood water Increased/increased Decreased/decreased
35
What is the main ion in extracellular fluid?
Sodium
36
Where is most sodium resorbed?
Proximal tubule
37
What causes hypernatraemia?
Increased sodium intake Reduced water intake or increased water loss
38
What causes hyponatraemia?
Reduced sodium intake Increased sodium loss Increased water intake
39
What usually coincides with changes in sodium?
Changes in chloride
40
When might you see changes in chloride without changes in potassium?
VOMITING | Acid/base status alteration
41
When does potassium increase ?
Acidosis - H+ swapped for K+ in blood ACUTE Renal failure — ESPECIALLY if anuria and oliguria are present Hypoadrenocorticism
42
When does potassium decrease?
Chronic kidney disease - PD/PU
43
Why do dogs and cats with renal failure often have a metabolic acidosis?
Kidneys usually conserve filtered bicarbonate
44
What makes up total calcium?
Free Bound to albumin Bound to anions
45
What can cause a decrease in albumin bound calcium?
Albumin loss - PLN
46
What can mask a decrease in free calcium on total calcium in renal failure?
Increased amount bound to anions
47
Which animals get all their calcium from their diet? Where is it ALL excreted?
Horses and rabbits Kidneys
48
What will calcium levels be in the following animals in renal failure: Dog Cat Cow Horse
Dog cat cow - hypo Horse - Hyper
49
How does decreased GFR affect phosphate levels? How may this differ in horses?
Hyperphosphataemia HypO
50
What changes may be seen normally on biochem in normal growing animals ?
Hyperphosphataemia Hypercalcaemia Increased ALP
51
How does increased phosphate affect 1 alpha - hydroxylase ?
DECREASES
52
Outline secondary renal hyper parathyroidism.
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
Describe the biochem seen in secondary renal hyperparathyroidism.
Initial damage Slight PTH increased Additional damage Further PTH increase Renal failure Hyperphosphataemia Reduced D3 Hypocalcalcaemia High PTH
54
How does kidney disease affect amylase and lipase?
Normally cleared by kidney so INCREASE
55
Why is anaemia associated with renal disease?
DECREASED EPO
56
Describe the anaemia of renal disease.
Mild (HCT not lower than 30) Normocytic and normochromic NON-REGENERATIVE
57
When might cytology be indicated
investigate potential RENAL LYMPHOMA - If both kidneys enlarged BLADDER NEOPLASIA
58
What diets are associated with lower pH urine?
High protein | Fasting
59
What diet is associated with a higher pH urine?
Vegetable
60
What pH would you expect in urine of patient with cystitis?
Higher Urea converted to ammonia by bacteria
61
What are the types of proteinuria ?
Prerenal Glomerular Tubular Haemorrhagic or inflammatory (postrenal)
62
When might you see glucosuria?
Hyperglycaemic glucosuria (e.g. DM) Renal glucosuria Stressed cats
63
When might you see ketonuria?
Poorly controlled diabetics
64
When might you see bilirubinuria?
Haemolytic anaemia Liver disease with cholestasis Gall bladder/bile duct obstruction
65
How would you interpret bilirubinuria in dogs and cats?
Dogs - small amount not a concern Cats - ALWAYS significant
66
What is haematuria? | What causes?
Intact blood cells in urine Trauma, cystitis, renal or genital bleeding (Can see intact RBCs in spun sample)
67
What can you see in sediment?
Cells, crystals, casts, bacteria
68
What do white blood cells in sediment indicate?
Inflammation or infection
69
Why might there be RBCs in urine sediment?
Haemorrhage Contamination from cystocentesis

BVetMed4 - Urinary (15 decks)

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