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Renal > Lab Dx Urinary Dz > Flashcards

Lab Dx Urinary Dz Flashcards

1
Q

What affects GFR?

A

Renal perfusion and plasma flow

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2
Q

Define azotaemia

A
  • increase in non-protein nitrongenous compounds (usually urea nitrogen (UN) and or creatinine or uric acid (birds)) in the blood
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3
Q

Define uraemia?

A

Uraemia = sick from azotaemia (every urea mic animal is azotaemic but NOT vice versa)

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4
Q

Clinical signs of uraemia

A
  • anorexia
  • VD+
  • GI haemorrhage
  • ulcerative stomatitis
  • bruxism in ruminants
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5
Q

What causes loss of kidney function?

A

Loss of number of functioning nephrons (not a decrease function of each individual)

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6
Q

Which biochem parameters are related to renal function?

A
  • UN
  • creatinine
  • phosphorus
  • calcium
  • sodium
  • chloride
  • potassium
  • acid base
  • protein
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7
Q

Which 2 diagnostics are more important for evaluating renal function?

A

Serum/plasma chemistry and urinalysis CONCURRENTLY

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8
Q

Most important biochem results

A

> UN (urea nitrogen)
creatinine
- indicate GFR (^conc in blood if GFR v)

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9
Q

Where is urea produced and where does it travels?

A
  • urea produced in liver from ammonia (ammonia very toxic, urea bit less toxic)
  • excreted by kidney
  • levels affected by liver function and protein levels
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10
Q

What affects creatinine levels

A

Derived from creatine in muscles, influenced by muscle mass

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11
Q

What causes ^ urea

A

Protein meal or decrased filtration (GFR)

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12
Q

Is urea excreted in feaces?

A

NO

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13
Q

How does excretion of urea and creatinine differ?

A

Creatinine not reabsorption

- urea can reabsorb in collecting duct

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14
Q

Does urea equilibrate in body?

A

Once in vascular diffuses through body water in 90mins

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15
Q

How is UN excreted?

A
  • Renal excretion most important route
  • passively filtered by glomerulus (conc filtrate same as blood)
  • passively diffuses with water from tubular luman back into blood
  • amount absorbed inversely proportional to urine flow (v urine flow ^ absoroption and ^ blood levels)
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16
Q

Is Urea measurement reliable in ruminants ?

A
  • NO (Use creatinine)
  • cattle severe renal dz can compensate urea levels as excreted into rumen and used to produce protein
  • if anorectiv all urea will be excreted via GIT not kidneys
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17
Q

Creatinine sources - what influences levels? How easily does this equilibrate?

A
  • non-enzymatic conversion of creatine stores ini muscle
  • constant rate of conversion (influenced by muscle mass and disease)
  • will distribute in body water but very slowly cf. urea
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18
Q

How do creatinine and urea levels change with a ruptured bladder?

A
  • abdo fluid concentrations creatinine > serum levels

- difference with serunm lasts longer cf. differneces in urea levels

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19
Q

Is creatinine a sensitive indicator of kidney function?

A

NO 3/4 nephrons lost before parameters change

  • more sensitive cows and horse
  • not at all sensitive birds
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20
Q

whY IS Creatinine such a poor indicator in birds ?

A
  • uric acid produced instead
  • hyperuriceamia does occour but not very sensitive
  • may also occour during ovulation and after meal
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21
Q

3 types of azotaemia

A

> prerenal azotaemia
- v GFR d/t v renal perfusion (poor BP -> vasoconstriction and ULTIMATELY ischaemia)
- or ^ protein catabolism
renal
- v GFR d/t non functioning nephrons
postrenal
- interference with excretion of urine (obstruction/postrenal leakage)

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22
Q

How can prerenal azotaemia be Dx?

A

Urine SG low shows no functioning nephrons and poor concentration
- if urine SG normal then must be pre renal

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23
Q

Causes of prerenal azotaemia

A
  • ^protein catabolism
  • gastric or SI haemorrhage / necrosis / starvation / corticosteroids / high protein diet
  • reduced renal perfusion == haemoconcentration MOST COMMON CAUSE
  • dz causing pre/post renal azotaemia 2* affect the kidneys -> renal azotaemia
  • USG high d/t ADH response occouring -> concentration of urine
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24
Q

Why dos USG increase with pre-renal azotaemia?

A
  • ADH response -> kidney concentrates urine
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25
Q

Causes of Post renal azotaemia. CLinical signs?

A
  • obstruction/post rental leakage
  • oliguria/anuria clinically
  • USG may vary
  • UN and creatinine return to normal once obstruction releved
26
Q

What is USG compared with?

A

Creatinine and urine on serum /plasma

27
Q

What is USG and what is it a measure of?

A
  • ratio of refractive index urine cf. ater
  • depends on particle size, weight and number
  • refractomter
  • reflects osmolality (very expensive machine needed to measure this!)
  • falsely increased by glucose and protein
28
Q

What is a normal USG?

A

No reference interval

  • based on expectation
  • range 1.001 - 1.065 in healthy animals (1.080 in cats)
  • concentrating ability neonates is poor
29
Q

What may falsely increase USG?

A
  • glucose (some effect on osmolality but not much)

- protein (no effect on osmolality but 3+ increase ~= 0.004 change)

30
Q

With azotaemia, what should USG be?

A 
Minimum
- 1.03 dog
- 1.035 cat
- 1.025 horse or ruminant 
> if less than these = decreased concentrating ability and renal failure
31
Q

Define isosthenuria and hyposthenuria. What implications do these have?

A 
> isosthenuria
- fixed USG 1.010 (1.008-1.012) 
- kidney not concentrating or diluting 
- osmolality = GFiltrate 
> hyposthenuria 
- USG
32
Q

Component of biochem useful for renal function?

A
  • Na, K, Cl
  • P
  • Ca
  • protein/albumin
  • anylase/lipase
33
Q

Where is the majority of Sodium and how are levels regulated/

A
  • main ion ECF
  • 75% filtered Na resorbed PCT
  • aldosterone stimulated Na resortopin in collecting ducts
  • ^ Na may be d/t ^ intake, ^ water loss or v water intake
  • v Na d/t ^ loss or ^ H20 intake
34
Q

What do changes in Chloride usually mirror?

A
  • Na
  • if not mirroring Na, suspect changes in acid/base status
  • interference from bromide and iodine salts
35
Q

WHere is Potassium found? What is it regulated by?

A
  • intracellular space
  • levels regulated by aldosterone (CDs)
    ASSESS ACID BASE CHANGES FIRST
  • ^ d/t renal failure esp with anuria or oliguria present
  • v d/t loss (renal/VD+) or decreased intake,
    also affected by..
    > leakage from cells thombrocytosis, leukaemia, tissue damage
    > hypoadrenocorticism
36
Q

What is potassium linked in with?

A

Acid base balance (can be swapped into cells for H+)

37
Q

How are kidneys related to Acid base balance

A
  • Kidney conseve filtered bicarb
  • renal failure -> metabolic acidosis
  • assessing acid base from serum biochem not reliable, check blood gas
38
Q

What forms of Calcium can be measured? What are Ca levels affected by?

A
  • free ca (50%)
  • bound calcium: albumin (45%)
  • Ca related to albumin, if albumin lost, Ca v)
  • bound ca: nonpretein anions (5%)
39
Q

Calcium levels regulated by…

A
  • PTH, vit D, calcitonin
  • renal failure -> hypo or normocalcaemia in cats, dogs and cows
  • HORSES will be HYPERcalceamic as kidney major excretor of Ca
40
Q

What causes ^/v levels of Phosphorus

A
  • Decreased GFR (so levels will ^ in animals with renal dz)
  • EXCEPT in HORSES phosphorus levels v with renal dz
  • ^ elvels with young growing anmals alongside ^ ca and ^ ALP
41
Q

Outline how Secondary renal hyoerparathyroidism occorus

A
  • v GFR -> ^P
  • v 1,25DHCC (Vit D?)
  • v Ca absorption from intestine and bone, ^ PTH
  • v Ca -> ^ 1,35DHCC -> ^ Ca absorption
  • ^ PTH promotes phosphaturia
    > Ca, P, Vit D all within ref range
    > BUT concurrent ^ PTH
42
Q

How may protein and albumin be affected by renal dz?

A
  • 1* glomerular dz severe hypoproteinaemia d/t hypoalbumenaemia
43
Q

What may be affected concurrently with protein changes (hypoproteinaemia)?

A
  • hyperlipidaemia and hypercholesterolemia

- proteinuria and very high protein:creatinine ratio

44
Q

Which enzymes may be affected by renal dz?

A
  • amylase and lipase
  • pancreatic enzymes cleared by kidney so ^ moderately with renal dz
  • TLI also ^ with v GFR
45
Q

What may be seen on haematology with renal disease?

A

> anaemia

  • mild (HCT >30%)
  • normovytic, normochromic, non regeneratice
  • 2* to lack of EPO and complicated by haemorrhage and direct BM suppression
46
Q

What is cytology useful for with kidneys? When is cytology not useful and what is performed instead?

A
  • lymphoma renal
  • bladder neoplasia (histopath or urine cytology, not sediment)
    > biopsy for all other diseases (assess architecture)
47
Q

What can be used to monitor GFR?

A

Creatinine, inulin

48
Q

What affects urine pH?

A

> diet
- protein (and fasting in ruminants) v pH
- vegetables ^ pH
will become alkaline on standing
cystitis ^ pH (urease producing bacteria -> ammonia)

49
Q

What does urine pH affect?

A

types of crystals that form

50
Q

4 types of proteinuria?

A
  • prerenal
  • glomerular
  • tubular
  • haemorrhagic or inflammaotry (post renal)
51
Q

What are the threshold levels of glucose reabsorption?

A

> 9mmol/L dogs

> 14mmol/L cats

52
Q

What may glycosuria be seen?

A
  • hyperglycaemic glucosuria (DM)
  • renal glucosuria
  • stressed cats
53
Q

What do ketones indicate? Ketones in the urine?

A
  • excessive fat degradation rather than using glucose as an energy source
    > ketone bodies
  • acetoacetate, B-hydroxybutyrate, acetone
  • reagant strip detects mainly acetoacetate
    > ketones in the urine
  • poorly controlled diabetics
  • starvation
54
Q

When is bilirubin seen in the urine? How may this be noted?

A
  • overspill in haemolytic anaemia
  • liver dz with cholestasis, gall bladder/bile duct obstruction
    > threshold lower in dogs cf. cats
  • small amount in dogs not a concern but any in cats concerning
    > urine may be bright yellow and stain things
55
Q

Normal no. red and white cells per 40x high power field?

A
56
Q

When are ammonium biurate crystals seen?

A
  • neutral - alkali pH

- Portosystemic shunt

57
Q

When are bilirubin crystal seen?

A
  • most common dogs
  • in low numbers not clinically significant in dogs
  • often significant in cats and horses
58
Q

When are calcium oxalate crystals seen?

A 
- any pH 
> 2 forms
- monohydrate (ethylene glycol toxicity) 
- dihydrate (found in normal urine) 
> horses have low numbers normally
59
Q

When are struvite crystals seen?

A
  • most common crystal in cats and dogs
  • may be seen in normal urine
  • neutral - alkaline pH
60
Q

When are calcium carbonate crystal seen?

A
  • normal horse urine
61
Q

Where are all casts derived from?

A

Renal tubular epithelium

  • appearance depends on transit time down tubule
  • in high numbers indicate tubular damage

Renal (23 decks)

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