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Clinical Pathology Exam 3 > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Function of the glomerulus- what things get filtered

A

Water/solute excretion

Small, neutral or positive molecules are filtered

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2
Q

Does abnormal glomerular filtration correlate to abnormal GFR?

A

NO

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3
Q

If the glomerular barrier is compromised, what leaks?

A

Albumin and antithrombin III

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4
Q

What does GFR depend on?

A

Renal plasma flow (blood volume, cardiac output, number of functional glomeruli, constriction/dilation of relevant arterioles)

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5
Q

What might decrease GFR

A

Dehydration, hypovolemia, cardiac disease, vascular disturbances (shock)

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6
Q

What are the functions of the renal tubules

A

Ion exchange
water, mineral, and acid/base balance
Glucose/protein reabsorption

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7
Q

Clinical signs of renal disease

A 
Nonspecific
Vomiting/dehydration
Halitosis/oral ulcerations
Palpable abnormalities
Changes in water intake/urination
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8
Q

What is the earliest and most significant indicator of UTI

A

Disturbances in water intake/urination

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9
Q

Ways to become PU/PD

A

Loss of medullary gradient/medullar washout

Decreased ADH

ADH resistance

Iatrogenic

Psychogenic

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10
Q

How might you lose the medullary gradient

A

Osmotic diuresis from CKD, diabetes mellitus, fanconi syndrome, or post-obstructive diureis

Medullary washout from chronic PU/PD or liver failure

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11
Q

Decreased ADH secretion

A

Rare cause of PU/PD

Central diabetes insipidus or inciting cause such as congenital, surgery, infection, inflammation, tumor/injury to brain

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12
Q

Central diabetes insipidus urine findings

A

No elevated glucose concentration

USG is usually hyposthenuric

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13
Q

ADH resistance

A

Common cause of PU/PD

Primary nephrogenic diabetes insipidus

Secondary nephrogenic diabetes insipidus

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14
Q

Primary nephrogenic diabetes insipidus

A

Rare

USG is isosthenuric

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15
Q

Secondary nephrogenic diabetes insipidus

A

Common
USG is hyposthenuric
Can be caused by pyometra, pyelonephritis, cystitis, hypercalcemia, hypokalemia, Cushings, Addisons, hyperthyroidism

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16
Q

Anuria/oliguria- pre renal, renal, post renal

A

Total lack of or reduced urine output

Pre-renal= dehydration

Renal= acute or chronic

Post-renal= obstruction

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17
Q

Dysuria

A

Difficulty urinating

Clinical sign of lower urinary tract disease

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18
Q

What are the markers fo GFR

A

BUN and creatinine- need to be evaluated simultaneously

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19
Q

Azotemia vs uremia

A

Azotemia- increased BUN/creatinine due to decreased GFR

Uremia- condition of azotemia plus clinical signs of disease

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20
Q

In what animals is BUN not a reliable indicator of renal disease

A

Ruminants and hind gut fermenters

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21
Q

Describe prerenal azotemia

What is it?

What causes it?

What will you see on chem profile?

A

Problem not involving the kidneys

Results from decreased blood flow to the kidneys caused by dehydration/hypovolemia

Will see high USG, increases in PCV, RBC, Na, Cl, and plasma proteins

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22
Q

Describe renal azotemia

What is it?

What will you see on chem profile?

A

Decreased GFR caused when 75% of functional nephrons are lost

Will see low USG (inadequate or isosthenuric), but NOT hyposethenuric

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23
Q

Describe post renal azotemia

What is it?

What will you see on chem profile

A

Problem of UT but passed the kidneys

Azotemia with hyperkalemia and hyponatremia
USG not helpful

24
Q

When would you see renal disease without azotemia and how would you diagnose it

A

When more than 25% of nephrons are functional

Would see proteinuria, glucosuria without hyperglycemia, casts, and reduced ability to concentrate urine in a dehydrated animal

25
Q

When will you see increased creatinine

A

When GFR is decreased
Affected by same diseases that affect BUN
Not affected by GI hemorrhage or diet
May increase in severe muscle damage or wasting

26
Q

When would you see decreased creatinine

A

Artifact of increased bilirubin
Pregnancy- because of increased CO and GFR
Significant loss of muscle mass

27
Q

What is PD/PU

What does it mean

How would you diagnose it

A

Production of urine and consumption of water in excess of normal

Means renal tubules have lost the ability to concentrate urine

Consistently low specific gravity, measuring water intake and urine output

28
Q

What would you see in an animal with uroabdomen

A

High BUN/creatinine, low sodium, high potassium

29
Q

What would you see in an animal with ethylene glycol toxicity

A

High BUN/creatinine, low calcium, high anion gap, seizures, crystalluria, anuria/oliguria 1-4 days after ingestion

30
Q

How would you differentiate between UMN and LMN when diagnosing a neurological cause of dysuria

A

UMN= tight distended bladder that is difficult to express

LMN= large flaccid bladder that is easy to express

31
Q

What does increased BUN mean

A

Decreased flow rate in the kidney so there is increased reabsorption

Could also be increased protein catabolism (GI hemorrhage)

32
Q

If there is a high BUN but normal creatinine, what should you consider?

A

High protein diet or GI hemorrhage

33
Q

What are some examples of post renal azotemia?

A

Obstruction of urine outflow as in FLUTD, neoplasia, calculi

Leakage of urine into abdomen as in trauma or newborn foal

Other causes of obstruction

34
Q

What will see in the abdominal fluid when looking for a uroabdomen

A

Low protein

2x amount of creatinine as what is in serum

35
Q

What is creatinine? What are levels affect by? Who has higher levels of creatinine?

A

Product of skeletal muscle not reabsorbed by renal tubules

Levels can be influenced by muscle wasting

Greyhounds

36
Q

When might you see hyperkalemia

A

Renal and post-renal azotemia:

anuric/oliguric renal failure
Chronic kidney disease (horses)
Uroabdomen
Hypoadrenocorticism
Hypoaldosteronism
37
Q

When would you see hypokalemia

A

Polyuric renal failure except in horses

Increased aldosterone, increased distal tubular flow rate, renal tubular disease

38
Q

When would you see elevated sodium

A

Prerenal azotemia- dehydration

Renal retention with hyperaldosteronism

Hypotonic fluid loss: Osmotic/ chemical diuresis, renal failure

39
Q

When would you see low sodium

A

Volume overload: Advanced renal failure

Hypertonic fluid loss: proximal renal tubule dysfunction, hypoadrenocorticism, hypoaldosteronism, osmotic diuresis (diabetes mellitus)

40
Q

When is chloride decreased?

A

Horses and cattle with renal disease

41
Q

When is chloride elevated

A

Prerenal azotemia

42
Q

When is bicarbonate decreased and why

A

Dogs and cats with renal disease because they become acidotic

43
Q

Two types of metabolic acidosis

A

Loss of bicarbonate (kidneys conserve Cl, normal anion gap)

Build up of acids (bicarb not lost and Cl not conserved, increased anion gap)

44
Q

When would you see loss of chloride in excess of sodium

A

Renal disease esp in cattle

Sweating in horses

Lots of GI problems

45
Q

When would you see hyperphosphatemia

A

Renal disease because of decreased P excretion EXCEPT in cattle and horses

46
Q

What’s a potential consequence of hyperphosphatemia

A

Secondary hyperparathyroidism with bone resorption and renal mineralization

47
Q

When would you see hypercalcemia

A

Renal disease of horses-common

Rarely in renal disease of other species

48
Q

When would you see metabolic acidosis and why

A

Renal disease of cats and dogs because of decreased excretion of H+ and inability to conserve bicarb

49
Q

Ruminants with renal disease will have which acid base status?

A

Either no abnormalities or metabolic alkalosis due to rumen stasis and sequestration of HCl

50
Q

What are albumin levels in prerenal azotemia

A

Increased

51
Q

What are albumin levels in renal azotemia

A

Normal or decreased

52
Q

Prognosis of AKI vs CKD

A

AKI- guarded short term prognosis but good long term

CKD- good short term diagnosis but poor long term

53
Q

What are clinical findings of AKI vs CKD

A

AKI- initially anurica and oliguric, later polyuric; good BCS

CKD- usually PU/PD but will become anuric or oliguric at end stage; anemia due to low EPO production

54
Q

Lab findings of AKI vs CKD

A

AKI- anuric/oliguric, hyperkalemia, metabolic acidosis with high anion gap, normal Na and Cl or might be high, not anemic, high P

CKD- polyuric, Low Na and K, high Cl, metabolic acidosis with normal anion gap, non regenerative anemia, high P

55
Q

What is the UP:C ratio used for

A

Magnitude and significance of proteinuria

Ratios higher than 0.5 indicate protein losing glomerular nephropathy

Clinical Pathology Exam 3 (8 decks)

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