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Endocrine > Lecture 1 - PU/PD > Flashcards

Lecture 1 - PU/PD Flashcards

1
Q

Where is the thirst center?

A

Hypothalamus

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2
Q

What monitors plasma volume and blood pressure in the thirst center?

A

osmoreceptors and baroreceptors

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3
Q

What are the triggers for thirst?

A

hypERosmolality and decreased vascular volume/plasma volume

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4
Q

Plasma osmolality is primarily determined by _______ and is tightly regulated.

A

sodium

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5
Q

The thirst center is mediated primarily by?

A

hypothalamic osmoreceptors

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6
Q

What is ADH?

A

anti-diuretic hormone; vasopressin

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7
Q

Where is ADH produced?

A

hypothalamus

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8
Q

What does ADH do?

A

tells distal renal tubule to increase aquaporins and water reabsorption and increase urine concentration

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9
Q

Where is ADH stored?

A

posterior pituitary

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10
Q

What is the range for hyposthenuria?

A

<1.008

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11
Q

What are the release triggers for ADH?

A

hypER osmolality and hypovolemia

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12
Q

What is the range for isosthenuria?

A

1.008-1.012

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13
Q

What is the range for minimally concentrated in dogs?

A

1.013-1.030

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14
Q

What is the range for minimally concentrated urine in a cat?

A

1.013-1.040

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15
Q

What is the range for fully concentrated urine in a dog?

A

> 1.030

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16
Q

What is the range for fully concentrated urine in cats?

A

> 1.040

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17
Q

Appropriate or Inappropriate:
Dog is a run with its owner and has a USG of 1.008.

A

inappropriate because it should be concentrating its urine

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18
Q

Appropriate or Inappropiate?
Puppy is it the crate all day and has a USG of 1.039 when you get home.

A

appropriate

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19
Q

Appropriate or Inappropriate?
Your cat is eating dog food and has a USG of 1.040.

A

appropriate

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20
Q

Appropriate or Inappropriate?
Your cat is eating wet cat food and has a USG of 1.023.

A

appropriate

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21
Q

Appropriate or Inappropriate?
dog is playing outside on a hot day and drinks out of a kiddie pool. Has a USG of 1.006.

A

appropriate

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22
Q

Appropriate or Inappropriate?
Older patient is on furosemide or glucocorticoids and has a USG of 1.012.

A

appropriate

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23
Q

What are the four things needed to produce concentrated urine?

A
  1. functioning nephrons
  2. hypertonic medullary gradient intact
  3. ADH
  4. response to ADH
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24
Q

Decreased renal perfusion activates?

A

RAAS

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25
Q

What are the thresholds for polydipsia and polyuria?

A

PD: >100mL/kg/d
PU: >50mL/kg/d

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26
Q

How many nephrons do you need to concentrate urine?

A

at least 1/3

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27
Q

What two things are important for hypertonic medullary gradient?

A

sodium and urea

28
Q

What are the mechanisms for primary polyuria?

A
  1. osmotic diuresis
  2. reduced/absent ADH production
  3. reduced/absent ADH-receptor function
  4. medullary washout
29
Q

Types of Primary Polydipsia.

A
  1. psychogenic
  2. neurologic
  3. GI disease
  4. hepatic encephalopathy
30
Q

T/F: Primary Polydipsia is a diagnosis of exclusion.

31
Q

T/F: Primary Polyuria is most common compared to PD.

32
Q

What are the mechanisms for primary PU?

A
  1. osmotic diuresis
  2. reduced/absent ADH production
  3. reduced/absent ADH-receptor function
  4. medullary washout
33
Q

What are the three components of medullary washout?

A
  1. urea
  2. sodium
  3. blood flow
34
Q

Describe how osmotic diuresis is a mechanism for PUPD.

A

Impaired fluid reabsorption in the proximal tubule because of poorly reabsorbed solutes such as mannitol, urea, glucose or excessive salt. It all overwhelms the capacity to reabsorb water, even in the face of ADH.

35
Q

What are some disease examples for osmotic diuresis for PUPD?

A

Fanconi syndrome, lepto, jerky treats, diabetes mellitus, mannitol

36
Q

What disease do you have if there is reduced/absent ADH production?

A

central diabetes insipidus

37
Q

What disease do you have if there is reduced/absent ADH-receptor function?

A

nephrogenic diabetes insipidus

38
Q

Can a central diabetes insipidus patient concentrate urine when given exogenous ADH?

39
Q

Causes of central diabetes insipidus

A
  • idiopathic
  • congenital/primary
  • acquired/secondary from neoplasia, trauma, radiation
40
Q

Can a nephrogenic diabetes insipidus patient concentrate urine when given exogenous ADH?

41
Q

Causes of nephrogenic diabetes insipidus

A

primary/congenital
secondary/acquired

42
Q

Describe primary nephrogenic diabetes insipidus.

A

it’s rare, congenital, and usually in male dogs

there’s a defect in the cellular mechanism that opens the water channels

43
Q

Which condition will the pet die if not given water?

A

primary nephrogenic diabetes insipidus

44
Q

What interferes with the ADH receptor?

A

cortisol; cushing’s, exogenous
endotoxin; infection
electrolytes; hypercalcemia

45
Q

If you have an impaired medullary gradient and a low urea, what is it from?

A

liver insufficiency

46
Q

If you have an impaired medullary gradient and low sodium, what is it from?

A

either:
- addison’s
- loop diuretics
- electrolyte loss / diarrhea

47
Q

Alterations in blood or urine flow cause?

A

medullary solute washout

48
Q

Most common causes of PUPD in dogs?

A

CKD
Cushing’s
Diabetes mellitus

49
Q

Most common causes of PUPD in cats?

A

CKD
Hyperthyroidism
Diabetes mellitus

50
Q

If you have inappropriately dilute urine, what are your main DDx?

A

Central or nephrogenic DI
Primary polydipsia
Sometimes Cushing’s

51
Q

If you have inappropriately isosthenuric urine, what are your DDx?

A

CKD
Secondary causes of nephrogenic DI
Partial central DI
Sometimes Cushing’s

52
Q

T/F: Urine culture is recommended for all PUPD animals.

53
Q

T/F: Impaired concentration can predispose an animal to UTI.

54
Q

Steps for DX A CAUSE FOR PUPD

A
  1. Hx and PE
  2. USG
  3. UA
  4. Urine culture
  5. Minimum database
  6. Endocrine screening
  7. Imaging
  8. Serum sodium
55
Q

Less common causes of PUPD

A

bile acids
SDMA
lepto

56
Q

How to interpret serum sodium?

A

Decreased –> psychogenic
Normal to increased –> central DI

57
Q

What test is next after you do serum sodium and want to confirm psychogenic?

A

modified water deprivation test

58
Q

What test is next on your list after you do serum sodium and want to confirm central DI?

A

desmopressin trial

59
Q

Desmopressin trial does what?

A

looks at ADH response

60
Q

We’re doing a Desmopressin trial. Your patient can concentrate their urine after given ADH. What is it?

A

central DI

61
Q

We’re doing a Desmopressin trial. Your patient can partially concentrate their urine after given ADH. What is it?

A

Either partial DI or secondary NDI

62
Q

We’re doing a Desmopressin trial. Your patient canNOT concentrate their urine after given ADH. What is it?

A

Either primary NDI or psychogenic

63
Q

How does the desmopressin trial work?

A

Monitor water intake for 2-3d, do 3x USGs, give eyedrops BId-SID for 5-7d then reassess USGs and watch water intake.

64
Q

T/F: Desmopressin has a long term risk of hyponatremia.

65
Q

NEVER PERFORM A WATER DEPRIVATION TEST IF:

A
  • CAN CONCENTRATE >1.030
  • DEHYDRATION
  • AZOTEMIC
  • HYPONATREMIC
  • UNABLE TO MONITOR

Endocrine (4 decks)

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