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Equine Medicine and Surgery > Lecture 27: Medical diseases of equine renal and urinary systems > Flashcards

Lecture 27: Medical diseases of equine renal and urinary systems Flashcards

1
Q

What is function of renal system

A

Excrete nitrogenous waste and control fluid and ion balances

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2
Q

How much water should horse consume/ day

A

60-65ml/kg/day- 23L or 6 gallons ~5% BW

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3
Q

What is the GFR per day in horse

A

2ml/kg/min-1400L/day- 370 gallons

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4
Q

What does the proximal tubule absorb

A

Glucose, amino acids, electrolytes and water

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5
Q

Urine becomes more ___in Loop of henle

A

Concentrated

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6
Q

What part of LOH is permeable to water, but impermeable to solutes

A

Descending limb

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7
Q

What part of LOH is impermeable to water, but permeable to solutes

A

Ascending

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8
Q

Where does furosemide block

A

NaKCC in ascending loop of henle

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9
Q

What does distal tubule secrete

A

Calcium, potassium and acid

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10
Q

What channel does water leave through in collecting duct and what hormone controls it

A

Aquaporins controlled by ADH

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11
Q

What is USG for hyposthenuria

A

<1.008, very dilute

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12
Q

What is USG for isothenuria

A

1.008-1.014

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13
Q

What is the USG for concentrated urine

A

1.025-1.050

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14
Q

Foals urine should be ___

A

Hyposthenuria

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15
Q

Chronic renal failure produces USG of ___

A

1.008-1.025

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16
Q

What is the normal pH of urine

A

7-9

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17
Q

Paradoxical aciduira is seen with ___

A

Hypokalemia, hypochloremic metabolic alkalosis

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18
Q

What urine protein: creatinine ratio is too high

A

> 2:1

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19
Q

Glucose should be ___in urinalysis

A

Negative

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20
Q

What test can you run for myoglobin

A

Ammonium sulfate precipitation

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21
Q

What is bilirubin associated with

A

Intravascular hemolysis, hepatopathy

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22
Q

Pyrua has a WBC > ___

A

10

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23
Q

Hematuria has a RBC > __

A

5

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24
Q

What tests do you run if PU/PD patient signlament is consistent with PPID or EMS

A

ACTH, insulin, glucose

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25
Q

What challenge/test can you run for PU/PD diagnostic, how does it work and what are some possible results

A

Water deprivation test
Normal renal function USG>1.045
Concentrated urine- psychogenic polydipsia
Noncentrated: run vasopressin tests

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26
Q

What is acute renal failure classified by

A

abrupt decrease in GFR associated with failure to excrete nitrogenous wastes causing azotemia, electrolyte imbalances, acid base disturbances

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27
Q

What are some causes of acute renal failure

A
  1. Decreased renal perfusion- hypovolemia (Pre renal, or ischemic)
  2. Acute tubular necrosis (NSAIDS)
  3. Interstitial nephritis or glomerulonephritis
  4. Post renal- elevated creatinine
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28
Q

What condition in foals can cause post-renal ARF, elevated creatinine in peritoneal fluid

A

Bladder rupture

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29
Q

What is anuria

A

No urine

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30
Q

What is oliguira

A

Decreased urine

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31
Q

What are some clinicopathologic findings associated with ARF

A

Increase BUN, creatinine

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32
Q

What % of nephrons have lost function before azotemia is noticing

33
Q

What test is a sensitive early maker or declining GFR

34
Q

What electrolyte imbalances are seen with ARF

A

Hyponatremia, hypochloremia, hypocalcemia, hyperphosphatemia, metabolic acidosis

35
Q

What is tx for ARF

A
  1. Fluids- saline or balanced electrolyte solution
  2. Furosemide
36
Q

If hypernatremic in ARF what can you give

37
Q

What is the most important prognostic indicator for ARF

A

Duration of ARF and if continue oliguria

38
Q

What is prognosis for creatinine <5 and >10

A

Less than 5- good
>10 grave

39
Q

What are some characteristics of CRF

A

Loss of ability to concentrate urine, retain metabolic waste, alterations in electrolytes, acid-base

40
Q

What are some causes of CRF

A
  1. Congenital anomalies
  2. Acquired: glomerulonehrphitis or interstitial nephritis caused by immune complex deposition
  3. Glomerular tubular injury: NSAIDs, hypoperfusion
41
Q

What are some signs of CRF

A

Ill-thrift, weight loss, ventral edema, PU/PD, poor athletic performance, excess dental tartar, uremic breath

42
Q

What is the USG of CRF

A

Isothenuria 1.008-1.012

43
Q

What are the classic electrolyte disturbances associated with CRF

A

Hyponatremia, hypochloremia, hyperkalemia, hypercalcemia, hypophosphatemia

44
Q

How can you manage CRF

A
  1. Short term IV fluids
  2. Avoid alfalfa
  3. Encourage appetite
  4. Vitamin E and C
  5. Omega 3 fatty acids
45
Q

T or F: diuretics are useful in CRF

46
Q

What is the expected lifespan in CRF for creatinine <5, 5-10 and >10

A

<5: >18 months
5-10 <18 months
>10 days to weeks

47
Q

Case example: 20yr Morgan gelding presented with urine dribbling for weeks to months, 8/9 BSC what are some differentials

A

Neurological disease, urolithiasis/cystitis, congenital, trauma, tail injections, neoplasia

48
Q

What does the pudenal nerve innervate

A

Striated muscle of urethra

49
Q

What does hypogastric nerve supply

A

Sympathetic nerve supply

50
Q

What does pelvic nerve supply

A

Parasympathetic nerve supply

51
Q

Contraction of bladder is controlled by __nerve supply

A

Parasympathetic

52
Q

What are some signs of lower motor neuron bladder

A

Loss of detrusor function, dribbling, large easily expressible bladder, loss of anal and tail tone

53
Q

What are some signs of upper motor neuron bladder

A

Initially increased urethral resistance, turgid bladder (colic)

54
Q

What are 2 causes of sabulous urolithiasis

A
  1. Secondary to neurogenic bladder
  2. Primary sabulous accumulation secondary failure to empty
55
Q

What is prognosis for sabulous urolithiasis

56
Q

Patients with sabulous urolithiasis usually prevent with ___

A

Incontinence/dribbling

57
Q

What is tx for sabulous urolithiasis

A

Removal with 0.25% acetic acid, bethanecol, phenoxybenzamine

58
Q

What does bethanecol do to tx incontinence

A

Improve destrusor function

59
Q

What does phenoxybenzamine do to tx incontinence

A

Decrease urethral tone

60
Q

What is the top differential diagnosis for Hematuria

A

Urolithiasis/cystourolithaisis- usually associated with exercise

61
Q

What are some clinical signs of urolithiasis/ cystourolithiasis

A

Hematuria with exercise, normal renal function with chemistry and urinalysis

62
Q

What urinary stones are yellow-green speculated, easily fragmented

A

Calcium carbonate

63
Q

What urinary stones are gray white smooth, resistant to fragmentation

A

Calcium carbonate phosphate

64
Q

Renal idiopathic Hematuria is common in what breed

65
Q

What are some signs of renal idiopathic Hematuria

A

Clots of blood in urine, endoscopic exam reveals clots of blood in 1 or both ureters

66
Q

What is the most common urinary tract neoplasms

A

Urethral and external genitalia tumors

67
Q

What is the tx for renal neoplasms

A

Remove kidney

68
Q

What is the most common complaint for bladder neoplasms

69
Q

What is the most common bladder neoplasm in horses

A

Squamous cell carcinoma

70
Q

Pyelonephritis and ureteritis are associated with upper or lower urinary tract infections

A

Upper urinary tract

71
Q

Which is a life threatening urinary tract infection: upper or lower

72
Q

Is cystitis and urethritis associated with upper or lower urinary tract infections

73
Q

What breed is genetically predisposed to renal tubular necrosis

74
Q

What is the inciting cause of renal tubular necrosis

A

Drugs- SMZ, antibiotics

75
Q

What clinical pathologies are associated with renal tubular acidosis

A

Decreased bicarbonate, hyperchloremia, metabolic acidosis

76
Q

What is the distal type I renal tubular acidosis

A

Can’t secrete H+

77
Q

What is the proximal type II renal tubular acidosis

A

Can’t reabsorb bicarbonate

78
Q

What is tx for renal tubular acidosis

A

Bicarbonate IV, potassium supplementation, sodium bicarbonate PO (baking soda)

Equine Medicine and Surgery (27 decks)

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