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Renal > Laboratory Diagnosis of Renal Patients > Flashcards

Laboratory Diagnosis of Renal Patients Flashcards

1
Q

What are the functions of the kidney?

A

> Excretion of nitrogenous waste (urea and
creatinine)
Regulate body water and solute concentration
in the urine
Regulate electrolyte composition
– sodium, chloride, potassium, calcium, magnesium, sulphate and phosphate ions
Regulation of acid-base balance
– Excretion of H+ and conservation of HCO
Endocrine function
– Produce erythropoietin, renin and active
metabolites of vitamin D.
Elimination of toxic substances
– The kidneys may eliminate and
concentrate chemicals, pollutants, food
additives and drugs within the urine.

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2
Q

What is glomerular filtration rate (GFR)?

A

Rate fluid moves from plasma to the glomerular filtrate

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3
Q

Define azotemia

A

An increase in the non-protein nitrogenous compounds, usually urea nitrogen (UN) and/or creatinine or uric acid (birds) in the blood

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4
Q

What is uremia?

A

Complex of clinical signs and biochemical abnormalities (azotemia) associated with the loss of functional nephrons

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5
Q

What are the clinical signs associated with uremia?

A 
> Anorexia
> Vomiting
> Diarrhoea 
> GI haemorrhage
> Ulcerative stomatitis
> Bruxism in ruminants
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6
Q

What is the relevant biochemistry in regards to renal disease?

A 
> UN
> Creatinine
> Phosphorus 
> Calcium 
> Sodium
> Chloride
> Potassium
> Acid base
> Protein
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7
Q

Where is urea produced and excreted?

A

Urea is produced in the liver via the urea cycle and excreted by the kidney thus levels will be influenced by liver function and protein levels.

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8
Q

Where is creatinine created?

A

Derived from creatine in muscles, and thus will be influenced by muscle mass

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9
Q

What is UN?

A

Urea nitrogen

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10
Q

Where goes UN come from?

A

Synthesised from ammonia (waste product of protein catabolism) via the urea cycle in the liver

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11
Q

What influences UN levels?

A

Protein intake

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12
Q

Explain the physiology of UN..

A

Passively filtered by the glomerulus and concentration in the filtrate is the same as blood. Increased UN is largely by result of decreased filtration.

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13
Q

In cattle, which is the better indicator of renal disease, creatinine or urea and why?

A

Creatinine. In cattle, urea is excreted into the rumen and converted to ammonia and then amino acids. If the animal is anorexic, all urea will be excreted via the GIT and not the kidneys and thus anorexic ruminants with renal failure may have a normal UN.

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14
Q

How can you tell if you have a ruptured bladder?

A

Abdominocentesis, test the fluid for creatinine levels. If creatinine is higher than serum levels then consistent with uroabdomen.

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15
Q

What are the three types of azotemia?

A

Prerenal
Renal
Poster all

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16
Q

What is the underlying mechanism for prerenal azotemia?

A

As a result of reduced renal perfusion or increased protein catabolism

17
Q

What is the underlying mechanism of renal azotemia?

A

Due to renal disease and presence of nonfunctional nephrons

18
Q

What is the underlying mechanism for postrenal azotemia?

A

Caused by interference with excretion of urine (obstruction or postrenal leakage)

19
Q

Give some example of causes of pre-renal azotemia..

A

Increased protein catabolism which may be secondary to gastric or small bowel haemorrhage, necrosis, starvation or corticosteroids

High protein diets

Reduced renal perfusion with haemoconcentration MOST COMMON

20
Q

What should the USG be in prerenal azotemia and why?

A

High because ADH response occurs and the kidneys can concentrate urine

21
Q

What would you clinically see with post-renal azotemia?

A

Oliguria or anuria

22
Q

What may falsely increase USG?

A

Glucose or protein in the urine

23
Q

If urea and creatinine are increase in the serum then USG should be at least…

A
  1. 030 in the dog
  2. 035 in the cat
  3. 025 in the horse or ruminant
24
Q

Define isosthenuria

A

Fixed USG 1.008-1.012, kidneys are not concentrating or diluting urine so osmolality is the same as glomerular filtrate

25
Q

What is hyposthenuria?

A

USG <1.008, diluting ability is retained

26
Q

Give the physiology of sodium and reasons for increased and decreased levels..

A

The main ion in extracellular fluid. Along with water, levels are regulated by the kidney. 75% filtered sodium reabsorbed in the proximal tubule. Aldosterone stimulated Na restoration in the collecting ducts.

Increased sodium may be due to diuresis, drugs, diabetes mellitus, GI losses, renal failure, panting, hyperaldosteronism

Decreased sodium may be due to hypoadenocorticism, vomiting/diarrhoea, renal failure, water retention (heart failure/effusions).

27
Q

Give the physiology of chloride and reasons for increase or decreased levels..

A

Coincide with changes in sodium.

Increased: acidosis/hypernatraemia
Decreased: alkalosis/hyponatraemia

28
Q

Give the physiology of potassium and reasons for increased and decreased levels..

A

Main ion in intracellular space, levels are regulated by intake in the collecting ducts under the influence of aldosterone.

Increased: reduced excretion, renal failure, hypoadrenocorticism
Decreased: persistent loss, vomiting/diarrhoea, diuresis, insulin therapy, renal failure, chronic anorexia, metabolic alkalosis

29
Q

Give the physiology of calcium and the reasons for increased and decreased levels..

A

Free calcium - active (50%)
Bound calcium - to albumin (40-45%)
Bound calcium - to non-protein ions (5-10%)

Levels are regulated by PTH, vitamin D and calcitonin. Most dogs and cats with renal failure are hypo or normocalcemic. Horse will be hypercalcaemic as the kidney is the major execratory route for calcium in the species.

Increased: HARDIONSG
Decreased: hypoalbinaemia, alkalosis, milk fever, chronic renal failure, pancreatitis, ethylene glycol toxicity, dietary

30
Q

What would you expect phosphorus levels to be in renal failure?

A

Hyperphosphatemia is associated with decreased GFR so levels would be increased in renal disease in the dog and cat. Horses show decreased phosphorus though an unknown mechanism.

31
Q

What happens to amylase and lipase levels in renal disease?

A

Increased as they are cleared by the kidney.

32
Q

Why might you have glucose in urine?

A

Via diabetes mellitus, renal glucosuria or very stressed cats.

33
Q

What might you find on urine sediment exam and why?

A

WBCs - inflammation or infection
RBCs - trauma, cystitis, renal blending, genital tract
Transitional cells
Ammonium biurate cystrals - Neutral-alkaline pH, PSS
Bilirubin crystals - Lows numbers not significant. Often in cats and horses
Calcium oxalate - any pH
Struvite - Most common type in dogs and cats neutral - alkaline pH
Calcium carbonate - found normally in horses
Tubular casts - High number indicate tubular damage

Renal (12 decks)

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