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Clinical Pathology > Lecture 11: Renal I > Flashcards

Lecture 11: Renal I Flashcards

1
Q

What are the basic functions of the kidney

A
  1. Regulate blood volume
  2. Acid base and electrolyte balance
  3. Excrete waste
  4. Hormone production
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2
Q

what hormones are produced by kidney and what are their functions

A
  1. Renin: blood pressure regulation
  2. Erythropoietin: RBC production
  3. Calcitriol- Ca2+ homeostasis
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3
Q

what is urine composed of

A

glomerular filtration + tubular reabsorption + tubular secretion

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4
Q

what composes glomerular filtration barrier

A
  1. Capillary endothelium
  2. Glomerular basement membrane
  3. Podocytes
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5
Q

glomerular filtration barrier allows only __molecules to pass, depends on molecular __ and __

A

small, size, and charge

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6
Q

__ is the largest threshold size for passing through glomerular filtration barrier

A

albumin

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7
Q

what occurs in PCT

A

Majority of water and solutes reabsorbed

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8
Q

how does fluid volume and concentration change in PCT

A

decrease fluid volume, concentration no change

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9
Q

what occurs in descending LOH

A

resorb water

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10
Q

what happens to volume and concentration of fluid in descending LOH

A

concentrated and volume reduced

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11
Q

what occurs in ascending LOH

A

resorb solutes (Na, Cl, K)

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12
Q

how does concentration change in ascending loop and what is purpose

A

filtrate becomes dilute, establishes medullary concentration gradient

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13
Q

what is resorbed in DCT

A

Na and Cl

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14
Q

what is resorbed in collecting duct

A

urea, water if ADH present, Na Cl

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15
Q

what is secreted in collecting duct and what controls that

A

K and H+ secreted, controlled by aldosterone

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16
Q

describe how the medullary concentration gradient works

A

ascending LOH- resorbed Na and Cl- back into interstitium and CD urea is resorbed creating hypertonic interstitium which then pulls water from filtrate/urine into body to concentrate urine

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17
Q

define renal disease

A

presence of morphological renal lesions of any severity OR any biochemical abnormalities related to renal function

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18
Q

t or f: clinical signs may or may not be present with renal disease

A

true

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19
Q

define renal insufficiency

A

biochemical evidence of renal dysfunction, often without clinical signs

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20
Q

define renal failure

A

when clinical signs +/- laboratory abnormalities are observed that are caused by reduced renal function

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21
Q

define uremia

A

clinical syndrome associated with renal failure

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22
Q

Define GFR

A

rate of fluid moves from plasma to glomerular filtrate

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23
Q

what is estimation of renal functional mass

A

GFR

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24
Q

what is gold standard test to measure GFR but not practical

A

inulin or iohexol clearance test

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25
Q

what are the practical ways to test GFR

A
  1. BUN, creatinine, uric acid
  2. SDMA
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26
Q

what is main source of BUN

A

protein catabolism (urea cycle) in liver

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27
Q

renal extraction of BUN depends on __ and __, therefore the lower the flow the more __

A

renal blood flow and tubular function

The lower the flow the more urea reabsorbed in proximal tubules—> increase urea in blood increase BUN

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28
Q

what are some extra-renal factors that can increase or decrease BUN

A
  1. High protein diet- increase
  2. Liver failure- decrease
  3. Bacterial flora in rumen and equine GI that recycle urea into protein can decrease BUN
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29
Q

What is the main source of creatinine

A

muscle metabolism waste product

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30
Q

which is more sensitive and specific: creatinine or BUN and why

A

creatinine, less affected by extra renal factors

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31
Q

how can low muscle mass affect creatinine

A

decrease serum concentration

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32
Q

define azotemia

A

increased BUN or creatinine

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33
Q

in renal failure azotemia is seen with __% of functional nephron loss

A

75%

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34
Q

how can high protein diet effect BUN: creatinine ratio

A

increase because increase protein catabolism

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35
Q

what diagnostic test is able to predict renal failure earlier then BUN and creatinine

A

SDMA

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36
Q

which dog breed normally have slightly higher SDMA

A

greyhounds

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37
Q

in avian and reptiles what is the product of protein catabolism

A

uric acid

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38
Q

in avian and reptiles what is the best indicator of renal function

A

Hyperuricemia

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39
Q

how does dehydration affect BUN

A

increases

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40
Q

t or f: creatinine is useful to measure GFR function in reptiles and birds

A

false- not produced

41
Q

what test do we use to evaluate urine concentrating ability

42
Q

what are USG indicates hypersthenuria (concentrated) values for dogs, cats and large animals

A

dogs: >1.030
Cats: >1.035
Large: >1.025

43
Q

what USG indicates partially concentrated

44
Q

what USG indicates isothenuria

A

1.008-1.012

45
Q

What USG indicates hyposthenuria

46
Q

If patients BW shows increase BUN, creatinine , and USG >1.025-1.035. 6% dehydrated. what type of azotemia and what does that tell you about kidneys

A

pre-renal azotemia- Dehydration

Hypersthenuria USG- kidneys are working and able to concentrate urine

47
Q

hypersthenuria is expected in __patients with normal __

A

dehydrated with normal renal function

48
Q

isothenuria is abnormal in __ or __ animals. What does that indicate

A

dehdyrated or azotemia animals
Indicates loss of renal concentrating ability

49
Q

partially concentrated USG is abnormal in __ patients. What are some causes

A

azotemic patients
Causes: renal disease, extra renal: DM, hypercalcemia, liver failure

50
Q

how would osmotic diuresis effect USG

A

decrease- preventing water reabsorption

51
Q

what causes central DI

A

insufficient production of ADH

52
Q

what causes nephrogenic DI

A

kidney not responding to ADH

53
Q

what are some causes of nephrogenic ADH

A
  1. Hypercalcemia
  2. Canine pyometra
  3. Liver failure
  4. Hypokalemia
54
Q

hyposthenuria may be normal in __ and __

A

neonatal cattle and horses

55
Q

hyposthenuria is abnormal in __ but not __patients

A

dehydrated, but not renal failure

56
Q

what type of USG would you expect with Central and nephrogenic DI and why

A

hyposthenuric
Central DI: ADH deficient- can’t pull water in
Nephrogenic DI: kidneys don’t respond to ADH: can’t pull water in

57
Q

with renal azotemia there is a decrease in functional nephrons by __%

58
Q

how would BUN, creatinine, and USG change with renal azotemia

A

increase BUN and creatinine, decrease USG (isothenuria or lower)

59
Q

how does urea production change with pre-renal azotemia

60
Q

what can cause increase in urea production

A
  1. High protein diet
  2. Increase protein catabolism
  3. GI hemorrhage
61
Q

how would BUN, creatinine, and USG change if pre-renal azotemia was caused by increase urea production

A
  1. Increase BUN
  2. No change to creatinine or USG
62
Q

what type of azotemia would decrease renal perfusion/GFR due to dehydration or shock cause. How would BUN, creatinine and USG change

A

pre-renal azotemia
1. Increase BUN
2. Increase creatinine
3. Increase USG (hypersthenuria- kidneys working just dehydrated)

63
Q

how would BUN and creatinine change with high protein diet

A

increase BUN, no change creatinine

64
Q

how would BUN and creatinine change with hepatic insufficiency

A

decrease BUN, no change creatinine

65
Q

how would BUN and creatinine change with GI bleeding

A

increase BUN and no change creatinine

66
Q

how would BUN and creatinine change in ruminating sheep

A

decrease BUN, no change creatinine

67
Q

how would BUN and creatinine change with dehydration

A

increase both

68
Q

how would BUN and creatinine change with starvation

A

BUN increase, creatinine decrease

69
Q

What are some diseases that can cause pre-renal azotemia with extra-renal effect on USG

A
  1. DM
  2. DI
  3. Addisons
  4. Hypercalcemia
70
Q

how would DM, DI, addisons, and hypercalcemia effect BUN, creatinine, and USG

A

increase BUN and creatinine
Decrease USG: partially concentrated (1.013)

71
Q

what are some causes of post-renal azotemia

A
  1. Urethral obstruction
  2. Uroabdomen
72
Q

how does BUN, creatinine and USG change with post-renal azotemia

A
  1. Increase BUN and creatinine
  2. USG variable
73
Q

what bloodwork finding is indicative of glomerular dysfunction. Also what finding in UA

A

hypoalbuminemia, proteinuria

74
Q

hypoalbunemia can lead to __

75
Q

glomerular dysfunction/damage can also lead to lose of __ which can lead to hypercoaguability

A

antithrombin

76
Q

what is nephrotic syndrome and 4 characteristics

A

glomerular disease and protein losing nephropathy
1. Proteinuria
2. Hypoalbunemia
3. Fasting hypercholesterolemia
4. Edema (transudate)

77
Q

besides the 4 characteristics of nephrotic syndrome, what are some other changes seen

A
  1. Hypercoaguability
  2. Azotemia
  3. Hypernatremia
  4. Hypertension
78
Q

what are some signs of defective tubular resorption/secretion

A
  1. Glucosuria
  2. Proteinuria
  3. Acid base abnormalities
  4. Electrolyte abnormalities
79
Q

renal tubular dysfunction can lead to impaired __activation

80
Q

renal tubular dysfunction can lead to decreased __production

A

erythropoietin

81
Q

what acid base abnormality is seen in renal disease

A

metabolic acidosis

82
Q

why is a metabolic acidosis seen with renal disease

A

decrease resorption of bicarbonate, retention of Cl- decreased excretion of hydrogen

83
Q

what electrolyte abnormalities are seen with renal disease

A
  1. Hyper or hypokalemia
  2. Hyponatremia
  3. Hypochloremia
84
Q

when do you see hyperkalemia vs hypokalemia in renal disease

A

hyperkalemia: acute decrease in urine output
Hypokalemia: increase urine output, decrease K+ intake

85
Q

what would cause hyponatremia or hypochloremia in renal disease

A

decreased resorption from tubular disease, increased urine output

86
Q

Acute vs chronic kidney disease: normal to increase PCV

87
Q

acute or chronic kidney disease: non-regenerative anemia

88
Q

acute or chronic kidney disease: hypokalemia or normal

89
Q

acute or chronic kidney disease: severe metabolic acidosis

90
Q

acute or chronic kidney disease: hyperkalemia or normal K

91
Q

acute or chronic kidney disease: quick, marked increase BUN, creatinine

92
Q

acute or chronic kidney disease: active UA sediment possible

93
Q

what could cause hyperphosphatemia in renal disease

A

decrease GFR

94
Q

what could cause hypophosphatemia in renal disease

A

renal failure in horses and post-renal obstruction in goats

95
Q

what could cause hypercalcemia in renal failure

A

renal failure in horses

96
Q

Describe renal secondary hyperparathyroidism

A
  1. Increase phosphate, decrease vitamin D—> decrease Ca2+
  2. Increase PTH
  3. Kidney increase phosphate excretion
  4. Bone increase calcium resorption
97
Q

what type of anemia is seen with renal disease and chronic renal failure and why

A

normocytic, normochromic, non-regenerative anemia due to decrease erythropoietin production

98
Q

RBC fragmentation is seen with __

A

glomerulonephritis

Clinical Pathology (12 decks)

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