Lit Urinary Flashcards

Question 1

Q

Which urinary & serum biomarkers were a) increased at presentation, and b) predictors of AKI development in hospitalised dogs?
What was the overall morbidity rate associated with AKI?

Answer

A

Nivy JVIM 2021
1. a) Biomarkers – uHSP70/uCr, uGGT/uCr, uALKP/uCr, uIL-6/uCr, IL-6, IL-18 were HIGHER in AKI dogs at presentation vs controls.
b) uHSP70/uCr, uGGT/uCr, uIL-6/uCr were higher in dogs that developed AKI. sSDMA was moderately predictive for AKI (discordant with sCr).
2. 18.6% AKI-associated morbidity rate.

Question 2

Q

(2 papers)
What was the association between serum FGF-23 concentration, serum phosphate and CKD progression in dogs?

What variables were negative prognostic indicators based on a 2018 JVIM study?

Answer

A

Miyakawa JVIM 2021
Increased serum [FGF-23] >528 pg/mL was associated with a significantly shorter time to development of hyperphos (>5.0mg/dL), independent of CKD stage, as well as with CKD progression (>1.5x increase in sCr).

Rudinsky JVIM 2018
BCS < 4/9, muscle atrophy, increased crea, hyperphos, increased UPC, increased Ca x P, increased FGF-23.

Question 3

Q

In cats with early (IRIS stage 1-2) CKD, what were the effects of feeding a low-protein, low-phos (LP-LP) diet compared to a moderate-protein, moderate-phos (MP-MP) diet on renal markers?

Answer

A

Schauf JVIM 2021
LP-LP diet - crea decreased to WRI. P did not increase, but tCa and FGF-23 increased long-term.
* Excessive P restriction led to development of hyperCa in early CKD cats.

MP-MP diet: crea, tCa & P remained WRI w/o sig changes, while FGF-23 sig decreased.
* Increasing dietary P and reducing Ca : P ratio maintained renal markers, while improving Ca-P balance. Cats with early CKD could benefit from MP-MP diets.

Question 4

Q

Landmark paper
What was the effect of feeding a moderate phosphate diet (MP 1.5 g/Mcal; Ca:P ratio 1.3) on renal function parameters in cats with azotemic CKD?

Answer

A

Geddes JVIM 2021
Attenuation of dietary phos restriction –> no significant changes in ionized Ca (decreased to <1.4 in some cats), tCa, PTH, FGF-23. P decreased after ~8.8mths. No cats had increased creatinine >25%.

NB: Schauf JVIM 2021 - similar findings
Cats with early CKD developed hyperCa after long-term feeding of a highly P-restricted diet. Increasing dietary P and reducing Ca : P ratio maintained renal markers (crea, tCa, P, decreased FGF-23) while improving Ca-P balance.

Question 5

Q

What was the documented treatment response and adverse effect profile in proteinuric dogs receiving telmisartan?

Answer

A

Lecavalier JVIM 2021
Partial (UPC decr by >/=50%) or complete (UPC <0.5) tx response in 70%, 68%, 80%, and 60% of dogs at 1, 3, 6, & 12 months respectively.
SE: mild self-limiting GI signs occ. Uncommonly azotemia requiring tx cessation.

Question 6

Q

What were the trends in urolith composition & characteristics (location, culture results) in a) dogs and b) cats in a retrospective evaluation?

Answer

A

Kopecny JVIM 2021 (2 papers)
a) Dogs – CaOx (47.0%) > struvite-containing (43.6%) > urate-containing (14.9%) > cystine-containing uroliths (2.7%).
b) Cats – struvite-containing (47.1%) > CaOx-containing (46.2%) > urate (9.2%). Proportion of CaOx-containing uroliths in the upper urinary tract sig higher vs other urolith types. Only 10.9% of struvite-containing uroliths that had bacterial C&S were positive – of which 64.8% yielded urease-producing bacteria.

Question 7

Q

What was the reported outcome of in female dogs with EU that underwent cystoscopic-guided laser ablation?

Answer

A

Hooi JVIM 2021
67.7% dogs became continent after CLA +/- adjunctive medical management. 54.8% (17/31) dogs received adjunctive medical management. Dogs remaining incontinent after CLA may improve with adjunctive medical management.

Question 8

Q

Describe the effects of using telmisartan + ACEI in comparison to either drug alone in the treatment of systemic hypertension & proteinuria in dogs with PLN.

Answer

A

Fowler JVIM 2021
Overall combo more effective than either drug alone.
ACEI + TEL combo significantly reduced SBP by 13mmHg & UPC by 2.5 (vs ACEI alone).
UPC in TEL + ACEI group lower by 3.8 vs ACEI group.
*TEL alone did not sig reduce proteinuria but more effective as combo with ACEI. Similar effects as ACEI+TEL in BP reduction.

NB: retrospective study so TEL group may have been more severe

Question 9

Q

List the following values for a rapid immunoassay (RIA) used to detect bacteriuria in voided urine from dogs when compared to routine urine C&S: a) sensitivity, b) specificity, c) positive predictive value, d) negative PV.

Answer

A

Grant JVIM 2021
a) Sensitivity 89%, specificity 100%, PPV 100%, NPV 92%.

Question 10

Q

What were the patterns of biological variation (BV) in the gut-derived uremic toxins serum indoxyl sulfate (IS), p-cresol sulfate (pCS) & trimethylamine-n-oxide (TMAO) in healthy adult cats, and what was a major factor influencing BV?
What are the clinical utilities of these biomarkers?

Answer

A

Summers JVIM 2021
IS - individual BV was high short-term and low medium term. pCS & TMAO – individual BV were intermediate both short & medium term.
Major influencing factor = feeding. Significantly LOWER [ ] for all toxins at various q2hr intervals (up to 12hr) post prandium –> best to collect samples at same time of day & consistent as fasted/non-fasted state.
Clinical utility - provides info on CKD stage & risk of dz progression. Humans - biomarkers for therapeutic dietary intervention.

Question 11

Q

What was the frequency of renal infarcts in dogs identified on CT and the most common imaging characteristics?

Answer

A

Sutthigran JVIM 2021
Frequency of renal infarcts = 3.15%
Most common - grade 1 (lesions <25% of the kidney),
caudal pole of kidney. Sagittal plane most useful.

Question 12

Q

What 2 risk factors were associated with hypercalcemia after transitioning to a phosphate-restricted diet in IRIS stage 2-3 CKD cats?

Answer

A

Tang JVIM 2021
Lower plasma K+ and/or PO4 concentrations –> increased plasma [tCa] (associated with CKD progression)

Question 13

Q

Which risk factors were associated with Enterococcus spp. bacteriuria in dogs?

Answer

A

Wood JVIM 2020
1) Hx of recurrent bacteriuria (OR 2.07)
2) LUT anatomic abnormalities (OR: 2.94)
3) Urolithiasis
4) LUT neoplasia
(Basically causes for underlying LUT inflammation)

Question 14

Q

Which clinicopathological characteristics were associated with dogs with focal segmental glomerulosclerosis? List 1 common & 4 uncommon characteristics.

Which 2 factors were negatively associated with survival in dogs with FSGS?

Answer

A

Lorbach JVIM 2020

Common - systemic hypertension
Uncommon - azotemia, severe hypoalb (median alb 2.8g/dL), ascites, oedema

Serum crea >2.1mg/dL
Alb <2g/dL

Question 15

Q

a) Which group of disorders (location) were most common in cats with micturition disorders presenting as urinary incontinence?
b) Was there a positive or negative correlation with survival for the answer to a)?
c) Were voiding or storage phase disorders more common?
d) Incidence of UTI in cats with UI?
e) Overall % of cats that regained continence?

Answer

A

Lonc JVIM 2020
a) Spinal cord disorders (>urethral&raquo_space; bladder&raquo_space; ureter)
b) Negative - more guarded prognosis.
c) Both similar frequency. But voiding phase disorders > common in males & younger cats.
d) 39%
e) 42% (spinal cord worse px)

Question 16

Q

a) What is the role of hemojuvelin?

b) How did urine hemojuvelin concentrations (UHJ) & urine-hemojuvenil-to-creatinine ratios (UHCR) in AKI/ACKD/CKD cats compare to healthy cats?
c) Which haemogram & biochemical parameters did UHJ and/or UHCR correlate with in AKI/ACKD/CKD cats? (List 6)

Answer

A

Jing JVIM 2020
a) Membrane protein with key regulatory role in systemic iron homeostasis via the hemojuvelin-hepcidin-ferroportin axis.

b) Sig increased UHJ & UHCR in AKI/ACKD/CKD cats.

c) Both - high BUN, creatinine & phosphate. Low Hct/RBC count, albumin.
UHCR - peripheral WBC count.

Question 17

Q

In non-azotemic dogs being screened for decreased renal function (defined as ≥40% decrease in GFR assessed by iohexol plasma clearance), a cut-off of SDMA >14μg/dL had …..% sens but …. specificity of …..%. In contrast, an SDMA cut-off of 18 μg/dL had similar sensitivity but …. specificity of …..%.

Answer

A

McKenna JVIM 2020

90% sens, 50% spec.

93% spec.

Question 18

Q

a) What was the association between vitamin D metabolites & PLN in dogs?

b) Which two clinicopathological parameters did these vitamin D metabolites significantly correlate with?

Answer

A

Miller JVIM 2020
a) PLN dogs had lower concentrations of all vit D metabolites – calcidiol, calcitriol, 24,25[OH]2D (inactive form), serum vitamin D binding protein (VDBP) & urine calcidiol concentrations.

b) Urine calcidiol-to-creatinine ratio – neg correlation with serum albumin, positive correlation with UPC.
Serum 24,25[OH]2D – neg correlation with UPC.

Question 19

Q

What is liver-type fatty acid binding protein (L-FABP)?

Is L-FABP excretion increased or decreased in cats with renal disease?

Is L-FABP index correlated with current renal biomarkers?

Answer

A

Katayama JVIM 2020
Cytotoxic oxidation product secreted from renal proximal tubules under ischemia (or low capillary blood flow) & oxidative stress.
In health, L-FABP secreted from the liver into the blood crosses the glomerular barrier and then is reabsorbed by the PT cells, so hardly appears in urine.

Weak correlation with crea, BUN & SDMA; but stronger when serum crea >1.6mg/dL.

Question 20

Q

(T/F) UPCR measurements in urine samples collected at home were similar between at-home and in-hospital samples in healthy dogs.
(T/F) UPCR did not correlate with UCCR (reflecting patient stress) in paired urine samples of healthy dogs.

Answer

A

Citron JVIM 2020
True for both

Question 21

Q

What optimal cutoff urine Ca to creatinine ratio (UCa/Cr) was identified to differentiate Ca-Ox forming vs control male Mini Schnauzers?
What was the sensitivity & specificity for this cut-off?
Does feeding affect this value?

Answer

A

Carr JVIM 2020
** UCa/Cr >0.06**
Spec 93%, 56% sens (false negs - possibly fluctuating hypercalciuria missed in urolith-formers)
(PPV 83%, NPV 78%)
No (post-prandial sampling up to 8hrs not critical).

Question 22

Q

1) State the:
a) Prevalence of systemic hypertension (SH) in dogs with AKI on admission
b) Proportion of AKI dogs with fluid overload (FO)
c) Proportion of AKI dogs with hypertensive retinopathy
d) Proportion of AKI dogs with significant proteinuria (UPCR >0.5)

2) Which of the above factors were:
a) Risk factor(s) for SH development?
b) Correlated with non-survival?

3) What associations were identified between SH & IRIS AKI grade, oligo/anuria, survival to discharge, duration of hospitalization & proteinuria?

Answer

A

Cole JVIM 2020

1)
a) 75%; of which 56% had severe SH (≥180 mm Hg)
b) 42% (FO on admission/during hosp)
c) 16%
d) 77%

2) a) FO on admission
b) Development of FO

3) No associations identified

Question 23

Q

(T/F, state positive or negative)
In cats with azotemic CKD, bacteriuria (based on positive urine culture) when treated with appropriate antibiotics, was associated with:
a) CKD progression
b) Survival

Answer

A

Hindar JVIM 2020
a) F - no sig association
b) F - no sig association

Question 24

Q

a) What 3 clinicopathological parameters should prompt submission of quantitative urine culture (QUC) for proteinuric dogs?

b) What proportion of proteinuric dogs had:
i) Bacteria growth in urine?
ii) Bacteria growth + active sediment?
iii) Missed/unidentified bacteriuria when QUC was not performed based on an inactive sediment?

Answer

A

Grimes JVIM 2020
a) Active urine sediment (OR 11.1), pyuria (OR 25.1), LUT disease (OR 6.7)

b)
i) 6.7%
ii) 4% (60% of proteinuric dogs with bacteria growth)
iii) 1.8% (low!)

Question 25

Q

What % of dogs with proliferative urethritis (PU) had urinary tract infections?

Which clinical and/or therapeutic factors were most likely associated with achieving long-term urethral patency?

Answer

A

Emanuel JVIM 2020
73%

Lesion effacement by balloon dilatation or urethral stenting.
Duration of urethral patency was longer with BD +stent vs BD tx alone (843d vs 452d).

Question 26

Q

What were the differences between immediate compared to delayed plating of urine samples for bacterial C&S?

Answer

A

Coffey JVIM 2020
No sig diff as long as urine samples are stored (refrigerated) & transported appropriately.
More discrepancies in plating methods for midstream samples but most were not clinically significant.

Question 27

Q

What are the 2 types of medullary rom sign (MRS) described on renal US in cats?

What was association between each type & presence of kidney disease?

Answer

A

Cordella JVIM 2020
MRS-line (thin hyperechoic line with well-defined margins), MRS-band (thick hyperechoic band with ill-defined margins)

MRS-band was more frequently associated with KD (74% cats), whereas MRS-line may occur with/without KD (40% cats had KD).

Question 28

Q

What were the top 3 most common aetiologies for acute-on-chronic kidney disease (ACKD) in dogs? (note differences with cats)

What following factors significantly associated with short-term and long-term survival?

Mortality rate?

MST for dogs surviving to discharge?

Answer

A

Dunaevich JVIM 2020
Unknown (45%) > inflammatory (30%) > pyelonephritis (15%)
Short-term - IRIS AKI grade & serum crea at presentation; RR & CK activity. NOT aetiology.
Long-term - aetiology & serum crea at discharge NOT predictors (cats opposite)

35% mortality

Poor long term px. MST 105d (35 & 8 dogs survived up to 6 & 12mths respectively).

Question 29

Q

What were the top 3 most common aetiologies for acute-on-chronic kidney disease (ACKD) in cats? (note differences with dogs)

What following factors significantly associated with short-term and long-term survival?

Mortality rate?

MST for cats surviving to discharge?

Answer

A

Chen JVIM 2020
Unknown (66%) > UO (11%) > renal ischemia (9%)/pyelonephritis (8%)

Short term - serum phos
Long term - serum crea & presentation & discharge

42% mortality

66 days

Question 30

Q

The administration of endoscopic-guided cross-linked gelatin (VetFoam) SQ injections was ……(effective/ineffective) in achieving continence in female dogs with USMI refractory/not amenable to medical treatment.

Continence was achieved in ……% dogs after 1 injection, and …..% dogs, with a mean duration of continence for …….. after 1 injection. Adverse effects were …..(common/uncommon) and included ……

Answer

A

Chen JVIM 2020
Effective

13/15 (87%) dogs
100% (7/7)

11.1 months

Uncommon. Self-limiting stranguria, pollakiuria, tenesmus (1 dog)

Question 31

Q

(T/F) Decompressive cystocentesis is a useful method which can reduce time taken & increase ease of urethral catheterisation in cats with urethral obstruction.

Answer

A

Reineke JAVMA 2021
False. DC did not improve time to place urinary catheter or ease of UC in cats with UO.

Question 32

Q

What was the prevalence of vulvar recession in dogs in a study?
What clinical features were associated with a higher risk of vulvar recession?
(T/F) Dogs with recessed vulvas were at a higher risk of LUT disease or perivulvar dermatitis.

Answer

A

Palerme JAVMA 2020
14% (36/250) dogs.
Dogs with significantly higher BCS & BW, spayed status, spayed ≤1yo (3x as likely for vulvar recession).
False.

Question 33

Q

What % of dogs with non-traumatic haemoabdomen due to splenic disease & non-malignant histopath findings suffered an adverse outcome & premature death? MST?

Answer

A

Millar JAVMA 2021
17% (9/53) dogs
MST 49 days.

Question 34

Q

What condition should be screened for in young-middle aged Bracchi Italiani when presented with inappetance?
What is the MST for this condition, and what 3 histologic findings were identified?

Answer

A

Inman JAVMA 2021
Familial proteinuric nephropathy & renal amyloidosis.
50% azotemic (4/8)
Prognosis poor - MST 75d (euthanasia) from time of diagnosis.
Histo - glomerular amyloidosis (75%), nephrosclerosis (12.5%), non-amyloidotic
fibrillar glomerulopathy (12.5%).

Question 35

Q

What biochemical changes were observed in patients with suspect contrast-induced nephropathy post CT angiography?
What was the progression of acute kidney injury & response to treatment in these patients?

Answer

A

Griffin JAVMA 2021
Marked elevation in creatinine (260-720%). Azotemia peaks at 2-3d post CT > improves by 3-4d > resolves by ~7d (up to 13d) post exposure.
Excellent short term prognosis with supportive care.

Question 36

Q

What microRNA was upregulated in the urine of cats with pyelonephritis? And which pathogen?

Answer

A

Jessen JVIM 2020
miR16
E. coli

Question 37

Q

In a antimicrobial susceptibility study in the mid-western USA, what was the susceptibility profile of E. coli UTI to amoxicillin/amoxy clav in dogs vs cats? Resistance rates to other abx?

Answer

A

KuKanich JVIM 2020
Dogs - E. coli mostly susceptible to clav in dogs (92%), much lower for amoxicillin (53%). Amoxy clav may be a better empirical choice in this region.
Cats - not susceptible, attributed to a different breakpoint between species. Higher breakpoints for dog vs cats.
Low resistance rates to other abx (</=7% cats, </=14% dogs)

Question 38

Q

What changes in faecal straight & branched short-chain fatty acids (SCFAs) are seen in cats with IRIS Stage 3 or 4 CKD?

Answer

A

Summers JVIM 2019
Higher isovaleric acid concentrations in CKD cats (esp in late stage disease).
Branched SCFA [ ] correlated weakly with p-cresol-sulfate [ ] & were higher in cats with muscle wasting (reflecting malassimilation of protein in CKD).

Question 39

Q

What were the effects of IVFT and/or intermittent hemodalysis on SDMA in dogs with IRIS Stage 4 CKD? (Hint: is SDMA dialyzable?)

Answer

A

Le Sueur JVIM 2019
SDMA is a dialyzable biomarker. For every 10% increase in urea reduction ratio = 6.2μg/dL decrease in SDMA.

Its clearance is still dependent on renal function & had less post-dialysis rebound effect (cf urea & sCr), so may still be used to monitor renal function in CKD dogs undergoing IH/IVFT.

Question 40

Q

What is the Idexx SediVue highly, moderately vs poorly sensitive for in detecting pathology in cat/dog urine samples?

Answer

A

Hernandez JVIM 2019
Sensitive for RBC, WBC & struvite (sens 85-90%), moderate for CaOx (75%). Moderate-poorly sensitive for epithelial cells (33% for sqEPI, 71% for nsEPI).

Highly specific for CaOx & EPI (99%), moderate for struvite (84%), 87-90% for remaining elements.

Question 41

Q

What is the intra-individual variability in a first AM USG in dogs (mean difference between min & max)?

Answer

A

Rudinsky JVIM 2019
0.015

Question 42

Q

What (primary/secondary) hemostatic disorder can be observed in dogs with >/= IRIS grade III AKI? What hemostatic abnormalities identified support this?

Answer

A

McBride JVIM 2019
Primary
Type II vwD-like phenotype (low [ ] + abnormal structure)
Higher platelet count but decreased collagen-activated platelet aggregation
High vWF:Ag:vWF:CBA (von Willebrand factor antigen : collagen binding activity ratio) - i.e. vWF present but reduced binding/functional activity. Strongly correlated with sCr.

NB: collagen-binding assay is a useful test for measuring the functional activity of VWF. Assay measures the binding of VWF to collagen and preferentially the HMW VWF multimers - therefore reflects reduction/ absence of larger VWF multimers

Question 43

Q

What is indoxyl sulfate?
What other biomarker is it associated with and what can it predict?

Answer

A

Liao JVIM 2019
Derived from breakdown metabolite of dietary L-tryptophan by colonic bacteria. Protein-bound.
Associated with phosphate metabolism & CKD progression in cats. Significantly associated with FGF-23 - both increase concurrently in line with decreasing renal function.
Uremic toxin in excess.

Question 44

Q

What are the faecal microbiome changes that occur in cats with CKD?
Which metabolic biomarker(s) may change?

Answer

A

Summers JVIM 2019
Reduced diversity & richness of faecal microbiome in CKD cats.

Increased indoxyl sulfate (not p-cresol sulfate). No significant differences between stages 2 & 3/4 CKD.

Question 45

Q

What is the optimal needle size to maximize diagnostic yield with renal biopsies?
What other patient & procedural factors influence diagnostic yield?

Answer

A

Crivellenti JAVMA 2018
16G, similar yield with 14G but greater than 18G
Other factors influencing no. of glomeruli per core specimen - dog age, sCr, degree of proteinuria.

Question 46

Q

What percentage of ureterocoeles are ectopic? How effective is laser ablation?

What condition may be associated with stenotic or imperforate ureters Recommended treatment for this condition?
Which breed(s) is/are overrepresented with stenotic ureters?

Answer

A

Rogatko JVIM 2019

71% ectopic.
JVIM 2018. 71% ectopic. 84% (11/13) had resolution of pollakiuria or incontinence after ablation.

Ectopic ureterocele.
Cystoscopic-guided laser ablation (surgical conversion needed if cannot extend opening of ureteral orifice).

Labrador Retrievers (54% study population, 7/13 dogs) *NB: also predisposed to congenital UVJ stenosis but usually w/o ureterocele
*

Question 47

Q

What is the incidence of positive urine cultures post-SUB placement/ureteral stenting in cats, and 2. the most common bacterial isolate?
Why is this a concern?
Describe factors that reduce the risk of post-SUB UTI.

Answer

A

Kopecny JVIM 2019
1. 25% (5/20) of SUBS had positive urine cultures post-SUB/ureteral stenting pre-discharge.
2. Enterococcus spp. (50%; as mono or polymicrobial infections).
3. Most cats with positive urine C&S had signs of pyelonephritis and/or LUT signs. (rather than subclinical)
4. Post-op antibiotics significantly reduced likelihood of positive urine culture.
Positive cultures NOT associated with CKD, renal implant type, post-op urinary catheterization.

Question 48

Q

When is the recommended age to start screening for CaOx urolithiasis in at-risk canine breeds, based on onset of clinical urolithiasis?

What high risk breeds were identified?

Answer

A

Hunprasit JVIM 2019
Median age was 8.4 +/- 2.8 years for onset of clinical CaOx urolithiasis. Screening recommended from 5-6 yo.

High-risk: all small dog breeds, total 12.
Mini Pin, Pom, Cairn Terrier, Brussels Griffon (OR >3) > Maltese, Lhasa Apso, Chihuhua, JRT, Mini Schnauzer, Yorkie (OR 2-3) > Bichon Frise, Jap Chin (OR 1-2)
(Low-risk: medium-large dog breeds)

Question 49

Q

What abnormalities in vitamin D metabolism can be seen in a subset of CaOx stone forming dogs?

Answer

A

Groth JVIM 2019
Decreased conversion of 25(OH)D to 24,25(OH)2D
–> increased 25(OH)D:24,25(OH)2D ratio - moderate positive correlation with urinary Ca:Cr.

Recap:
25(OH)D = calcidiol.
1,25OH2D = calcitriol.
24,25(OH)2D = less active metabolite of calcidiol & calcitriol.

Question 50

Q

What % of cats with FIC will have recurrent urethral obstruction within 6 months after discharge? Is this incidence improved by meloxicam administration?

Answer

A

Nivy JVIM 2019
24%.
No (not in this study) - NB: meloxicam dose used was low dose @0.025mg/kg PO SID for 2 wks post discharge, in addition to phenoxybenzamine & alprazolam.

Question 51

Q

Which cytokines/chemokines were increased in cats with acute idiopathic cystitis compared to healthy controls?

Answer

A

Parys JVIM 2019
All pro-inflammatory: CXCL12, IL-12, IL-18, Flt3L (fms-related tyrosine kinase 3 ligand)

May be potentially useful non-invasive biomarkers for diagnosis, staging & tx outcome monitoring of FIC cats - but more studies needed.

Question 52

Q

What is an alternative to cross-linked collagen injections for USMI in dogs? What is the reported success rate?

Answer

A

Lüttmann JSAP 2019
Dextranomer/hyaluronic acid copolymer injection (another urethral bulking agent).
58% success rate at 6mths (71% for X-linked collagen)
Median duration of continence ~20mths (vs 48mths for X-linked collagen)

Question 53

Q

What factors are associated with duration and severity of post-obstructive diuresis (POD) in cats with ureteral obstruction undergoing stenting or SUB placement?

Overall survival rate?

Answer

A

Balsa JAVMA 2019
- Pre-sx renal values (sCr, BUN), K+ & PO4 - associated with POD intensity & duration.
- Absolute change pre & post-op of BUN/crea & K - associated with POD duration.
- Anuria pre-sx associated with longer period of POD.
- (No diff in POD duration/severity with uni vs bilateral UO)

92% survived to discharge (50% of this had resolved azotemia by then)

Question 54

Q

What are the clinical consequences of high dietary phosphate intake in cats?

Answer

A

Laflamme JVIM 2020 (Review)
High amt of soluble P (in particular inorganic P) & low Ca:P ratio (<1:1) in diet have been associated with progressive renal damage in cats.

Question 55

Q

What is the impact of a) HCM & b) diabetes mellitus on SDMA in cats?

Was there an association between DM & CKD in cats?

Answer

A

Langhorn JVIM 2018

a) No changes for HCM compared to healthy controls.

b) DM cats significantly lower SDMA - caution when interpreting renal function in this population of cats.

Pérez-López JVIM 2019
Yes. CKD cats had increased assocation with DM (OR 4.47)

Question 56

Q

What differences in RAAS are there between greyhounds & non-greyhound breeds?

Answer

A

Martinez JVIM 2017

Greyhounds had no difference in basal RAAS activation (plasma renin, ACE activity) vs other breeds.
BUT did have lower aldosterone concentration, likely an appropriate response to higher BP & Na concentration (where ATII effects in the renal tubules predominate over aldosterone).

Also have higher creatinine & SDMA vs other breeds.

Question 57

Q

SDMA & creatinine:
- Which is more reliable for sequential patient monitoring?
- What about use of population RI?

Answer

A

Kopke JVIM 2018

Creatinine was recommended to be used with sequential measurements.

SDMA better suited to population based RI. (False-negatives could occur when comparing a single test result from an individual to such RIs).
An individual’s homeostatic set point is derived from the mean & CI of the test variable with repeat measurements.

Question 58

Q

What is the association between cTnI & BNP with GFR in dogs? How does this affect clinical interpretation in healthy vs stable CKD dogs?

Answer

A

Pelander JVIM 2017

No independent associations between either parameter with GFR.
Increased circulating cTnI & NT-proBNP [ ] can be interpreted similarly in stable CKD vs non-CKD dogs.

Question 59

Q

How is plasma FGF-23 concentration associated with CKD severity?
What are the strongest predictors of FGF-23 concentration in dogs?

Answer

A

Harjes JVIM 2017

FGF-23 increases with CKD severity (sig higher in stages 3/4 vs 1/2).
Creatinine & phosphorus.

Question 60

Q

Can SDMA differentiate between CKD & AKI in dogs?

Answer

A

Dahlem JVIM 2017

No, but SDMA/creatinine ratio is higher in CKD cf AKI dogs.

Question 61

Q

Is urine/serum Cystatin C a useful biomarker in cats with CKD?
What is it trying to predict?

Is serum cystatin C reliable in assessing renal function in hyperT cats?

Answer

A

Ghys JVIM 2016
Proteinase inhibitor, produced in all nucleated cells at a constant rate (responsible for intracellular protein catabolism). Biomarker for tubular damage in people & dogs.

To predict GFR.
Not useful as insensitive - could not reliably distinguish healthy from CKD cats or reduced GFR.
Also uCysC not detectable in 100% CKD cats in this study.

Williams JVIM 2016
No.

sCysC did not change significantly pre & post hyperT tx. Also not sig diff between non-hyperT CKD cats & healthy older cats, or hyperT cats that rmained non-azotemic vs developed azotemia 4mths post tx.

Question 62

Q

How did the diagnostic performance of serum cystatin C compare to sCr & SDMA to detect GFR reductions in clinically stable dogs?

Answer

A

Pelander JVIM 2019
Overall diagnostic performance of sCr (Sp 90%) & SDMA (Sp 87%) were similar (Sn 90% for both), but cystatin C was inferior to both (lower Sp 72% for similar Sn 90%).

Question 63

Q

Are UPCs on single, averaged, or pooled measurements (over 3 days) comparable in PLN dogs?

Answer

A

Shropshire JVIM 2018

Overall methods are comparable.
More variability at UPC 4+ but clinical relevance unknown.
At UPC <4, there was variability but according to authors, was not considered a true difference (change must >80% to be clinically relevant).

Question 64

Q

Are there significant differences in renal pelvis widths amongst cats with CKD, pyelonephritis & ureteral obstruction on US?

Answer

A

Quimby JFMS 2017

Between CKD & pyelo: no significant differences in renal pelvis widths, but sig diff proximal ureteral widths.

Between UO & CKD: UO had greater renal pelvic & proximal ureteral widths.

Between UO & pyelo: no sig diff in renal pelvis & proximal ureteral widths.

Answer 65

A

Lemieux JVIM 2021

Feline UO may be associated with minimal RP dilation (8% cats had RP dilation </=2mm). The severity of RP &
ureteral dilation can be highly variable. So absence of significant RP dilation does not rule out UO.

Wormser JAVMA 2019
US highly Sn (98%) to detect ureteroliths, but much less Sn (44%) for ureteral strictures. High Sp for both (96-98%).

Lamb JFMS 2017
US is inaccurate cf pyelography. US may be useful to identify azotemic cats at greatest risk of UO, but did not reveal sig diff between obstructed vs non-obstructed ureters, but paired pyelography was positive for UO in 71% cases.

Answer 66

A

Hulseboch JVIM 2016

AKI did not consistently change these parameters (did not correlate with sCr elevations); though in some dogs there were variable increases.

Answer 67

A

Troia JVIM 2018

FE (Na) was:
- Higher in I-AKI cf VR-AKI - good for early differentiation. (in this study FE(Na) was actually not sig diff between VR-AKI & contorl non-AKI dogs)
- Higher in non-survivors (along with other risk factors: AKI IRIS grade, UOP)
- In another paper, was predictive of renal recovery (as it reduces)

Answer 68

A

Kelly JVIM 2016

Significantly increased GFR & FeNa (cf D5W).
No AE recorded in this study.

Answer 69

A

Segev JVIM 2018

Dopamine 1 receptor agonist. Theoretically increases GFR & renal blood flow via direct vasodilation.

No to both a) and b).
No sig diff in UOP, GFR & NaFE between tx & placebo groups.
No sig diff in mortality rates between tx & placebo groups (30-40%).

Answer 70

A

Takada JVIM 2018

High prevalence (62%), but no sig associations with survival or IHD-dependency at 30 days (though study could be underpowered).

Answer 71

A

Parker JVIM 2017

Sig lower in stages 3 & 4 (no sig diff in 1 vs 2).

PTH, FGF-23 & phosphorus concentrations.

Answer 72

A

Van den Broek JVIM 2018

Calcitonin is released by C-cells of the thyroid gland response to increased serum iCa. Role in preventing hyperCa by inhibiting bone turnover (Ca release) & renal reabsorption.

No. (no apparent impt role in Ca metabolism in CKD cats)

Answer 73

A

Javard JVIM 2017

Overall CKD results in functional iron deficiency (altered metabolism due to systemic inflammation).

CKD cats had:
- Increased hepcidin & SAA (positive correlation with sCr)
- Decreased TIBC & total iron.
- CKD cats that were anemic (37%) had sig lower TIBC.

No association between survival time & APP, iron status, or EPO concentrations.

Answer 74

A

Matos JFMS 2017

Resistive index (only need evaluation of 1 kidney).
Increased, cut off 0.639 for preliminary diagnosis of CKD.

Tipisca JFMS 2016
Found in contrast that RI can differ between 2kidneys, but did not change with age. Found increased RI with CKD, AKI, PCKD, renal neoplasia.

Answer 75

A

Geddes JVIM 2016

Sig effect of diet on plasma PTH, FE(PO4) & iCa (not crea, plasma PO4 or FGF-23).
Stable PTH levels (PTH levels increased over time in control diet).
No treatment effect on the onset of azotemic CKD in this study.

Answer 76

A

Diniz JVIM 2018

No difference in AKI markers between groups.

Tetrastarch dogs had less extravascular lung water but no difference in ppO2 between both groups.

Answer 77

A

Hokamp JVIM 2016

**Urine IgM:Cr & urine NAG:Cr (Sn 75%, Sp 78% within population of proteinuric dogs). **

Neutrophil gelatinase-associated lipocalin (NGAL) & urine N-acetyl-b-D-glucosaminidase (uNAG) are markers of renal tubular damage

FE (IgG) & FE (IgM) correlated best with glomerular damage based on LM.
sCr correlated best with tubular injury.

SCr, FE (IgM) & glomerular damage based on transmission electron microscopy (TEM).

Answer 78

A

Sigrist JVIM 2017 (dogs)
Colloid - increases colloid osmotic P, SBP, blood volume. Indications - hypovolemia, hypotension, peri-op IVFT, low colloid osmotic P, hypoalbuminemia.

HES treated dogs were not significantly more likely to develop AKI or have a different AKI grade. But** no. of days HES treatment was given was associated with increase in AKI grade within 10 days.** So duration of HES tx should be kept short.

Sigrist JVIM 2017 (cats)
Non-azotemic critically ill cats.
HES treated cats not more likely to develop AKI or have development of more severe serum creatinine increases. HES dose & duration (# days) did not appear to be risk factors for AKI development in this study.

Answer 79

A

McCallum JVIM 2018

Enveloped, single-stranded, negative RNA, paramyxovirus.

Tubulointerstitial nephritis.

In this study, seropositivity was not different between azotemic vs non-azotemic cats.

Answer 80

A

Van Den Broek JVIM 2018

Inverse association. Hypomagnesemia was associated with higher plasma FGF-23 & increased risk of death. OR 2.74.
12%

NB: study measured tMg not iMg

Answer 81

A

Takenaka JVIM 2018

Beraprost = prostacyclin analogue (vasodilator & platelet aggregation inhibitor).
(Prostacyclin is primarily produced by vascular endothelial cells. Impt role in maintaining cardiovascular & renal vascular homeostasis. Used to treat PAH in humans.)

Theoretical benefit is renoprotection, inhibition of inflammatory mediators & renal endothelial & tubular apoptosis (addresses renal hypoxia in the pathogenesis of CKD development).

BPS treated cats:
- Didn’t experience increased sCr over 180d (whereas placebo cats did) - indicating inhibition of reduced GFR.
- Did not have increased PO4/Ca ratio (whereas placebo cats did).

Answer 82

A

Sargent JVIM 2019
More cats with increased SDMA had higher FGF23 cf cats with normal SDMA –> suggests alteration in phosphate homeostasis.
Potential utility of FGF23 in influencing management of cats with early CKD.

Answer 83

A

Fiocchi JVIM 2017

85% dogs achieved 30%+ PCV (~29 days to reach target PCV).
Minimum q21 days to maintain response to tx.
Systemic hypertension (36%), seizures (15%), V+ (9%), D+ (9%), suspected PRCA (6%).

Answer 84

A

Mariano JAVMA 2018

50% of dogs in this study had persistent thickening of the cystotomy site up to 12wks post-sx (but were subclinical).

61% had reoccurrence of hyperechoic foci within the bladder (~17d post sx).

Answer 85

A

Grimes JAVMA 2018

79%.
Development of intra/post-op complications (hypotension most common intra-op, 53% post op complications)
No pre-op factors (esp sCr at admission)

Answer 86

A

Kennedy JAVMA 2016

No; CaOx urolith cases infrequently had either of these two variables present.
Hematuria & proteinuria.

Answer 87

A

Wormser JAVMA 2016
1. a) 14% (stent) vs 3% (sx)
b) Similar (8-9%); also similar MST

Chronic LUT signs & LUTI significantly more common in stent cats.
Neither for reobstruction; similar incidence in both groups (22%).

Culp JAVMA 2016
Benign UO cats undergoing stenting more likely to have sig decreases in sCr & BUN at 1days post op; and resolution of azotemia before discharge (vs ureterotomy alone).

Cats more likely to develop abdominal effusion post-ureterotomy (vs stent) - associated with non-survival in this study.

Answer 88

A

Deroy JAVMA 2017

UB device placement was associated with
- Shorter duration of sx & hospitalisation
- Lower complication rate - LUT signs (hematuria, pollakiuria, stranguria), risk of device occlusion (4% UB vs 26% stent)
- Lower risk of requiring additional procedures to treat complications (9% in UB - UB occlusion & urethral obstruction; vs 44% in stents - uroabdomen, stent occlusion, refractory cystitis).
- Longer survival time
Similar peri-op mortality rates (18% stent, 13% UB).

Berent JAVMA 2018
(concluded SUB device placement is a viable option for cats with benign UO, with 94% survival to discharge.

Catheter mineralisation most common long-term complications (24%) at ~460days post SUB placement.

High post-op iCa significantly associated with SUB device occlusion.

NB:
Cray JAVMA 2018
Case series (4 cats). Renal pelvis lavage with SUB device placement successful to treat cats with obstructive pyonephrosis.

Borchert JAVMA 2018
Bilateral SUB placement + mass resection successful for treating bilateral UO secondary to retroperitoneal paraganglioma in a cat.

Answer 89

A

Petrovsky JAVMA 2019
Endoscopic nephrolithotomy (ENL).
93% (15/16) were nephrolith free post procedure.

Renal puncture-associated hemorrhage (required transfusion), renal capsule tear, ureteral puncture - all managed without complications/deaths.

Answer 90

A

Duffy JAVMA 2017

Pleural effusion (transudate, non-chylous lymphatic effusion documented in a cat). Resolved after removal of hydronephrotic kidney.

Answer 91

A

Cléroux JAVMA 2017

Positive association with CKD presence - should evaluate for CKD in cats with urolithiasis.
But no associations between urolithiasis & CKD stage; or between CKD presence & location of nephroliths.

Answer 92

A

Byron JVIM 2017

Heavier BW (25kg+)
Neutering
For dogs >25kg - age at neutering (decrease in hazard for every month of delay in neutering)

Median time from neuter to incontinence = 3.7yrs.

Answer 93

A

Seitz JAVMA 2018
LOWER recurrence with indwelling U-cath (11%) cf outpatient (31%).

Increasingly abnormal urine colour at time of U cath removal was associated with recurrence.

Answer 94

A

Pavia JAVMA 2018

Yes (either endoscopic or surgical).
Success rates: endoscopic 82% (45/55), surgical 100% (10/10)
UTI (pre-stent 59%, post stent 26%)

Answer 95

A

Cooper JVECC 2018

0% pre & 13% post (at 24hrs). Streps > Pasteurella.
No.

Answer 96

A

Fages JFMS 2017

Renal pelvic distension is at least partially reversible after SUB placement. Pelvic width 3.5mm+ may indicate post-SUB obstructive complications.

Answer 97

A

Jepson VCNA 2019

Cutaneous & renal glomerular vasculopathy (CRGV)
Form of thrombotic microangiopathy (TMA) on histo. Initial vascular lesions that include endothelial cell swelling, detachment, and microthrombosis –> microangiopathic hemolytic anemia.
Ddx for TMA = hemolytic uremic syndrome (but no skin lesions). Other ddx = thrombotic thrombocytopenic purpura (TTP), neoplasia, drug-induced (chemo vs others), renal transplant, sepsis, DIC.

Pathogenesis:
- Unknown! No infectious cause identified to date.

Risk factors:
- Seasonal outbreaks (UK) - Nov-May in the UK.
- Woodlands/lowland areas?
- Hounds (esp Greyhounds), gun dogs, pastoral dogs.
- Flat-coated retriever, Hungarian Vizsla, Manchester terrier, Saluki, Whippet, English springer spaniel, Bearded collie
- Females, neutered

CSx:
- Typically **ulcerated skin lesions affecting distal limb (77%) **esp interdigital spaces, body (20%), face/muzzle (7%), tongue (4%).
- Skin lesions usually apparent before systemic signs.
- Range from small superficial abrasions (0.5 cm) to large full-thickness ulcerated & necrotic lesions (>30 cm), with surrounding bruising & oedema.
- Progression to oligoanuric AKI within ~4 days. Subclinical possible.
- Classified into 4 groups
a) Skin lesions w/o systemic signs, non-azotemic (?%)
b) Skin lesions + pyrexia, followed rapidly by azotemic AKI (19% cases)
c) Skin lesions + azotemic AKI within 10 days (60% cases)
d) Azotemia before skin lesions (1%)

Dx
- Histo of renal bx gold standard - TMA (usually PM diagnosis)
- Routine bloodwork + UA
- Blood smear may show microangiopathic hemolysis (Burr cells, acanthocytes, schistocytes)
- Biochem: +/- azotemia, elevated LE, TBIL, CK
- Elevated spec CPL (79%)
- UA: usually NSF; +/- proteinuria, Hb/RBC, glucosuria, granular/hyaline casts
- Oligoanuria (70% cases)
- AUS: usually non specific (may reflect AKI), peritoneal effusion (if vol overloaded or bleeding)
- Skin bx histo: may be helpful, but usually non-specific ischemia/ ulceration, may see evidence of TMA.

Answer 98

A

Jepson VCNA 2019

Tx
- Manage as per AKI - limit further damage, enhance cell recovery (correct fluid/electrolyte/AB disorders, maintain normotension (hypertension common, maintaining UOP).
- Immunosuppressive tx - successful in 1 dog but needs more research; used in people.
- Anti-platelet tx - not if clinical bleeding, severe thrombocytopenia
- Wound management - avoid sedation/GA. Sterile dressing. Debridement rarely needed. Analgesia. Sample skin for cytology & culture - however systemic abx is contraindicated if no clincial signs indicating infection even if cyto/culture positive.
- Renal replacement therapy - may extend tx for several weeks but not shown to improve survival w/o other specific tx.
- Eculizumab (monoclonal antibody) - no evidence in dogs, successful as immunomodulator in atypical HUS in humans but $$$$. Binds to C5 to impair hydrolysis & subsequent complement activation.
- TPE: Successful in improving survival rates in people with TTP & anti-ADAMTS13 autoantibodies, best in EARLY disease. Trialled in dogs with severe CRGV (case series) but lack of controlled study design so unknown if truly beneficial (2/6 dogs did survive though).

Prognosis
- Excellent for NON-AZOTEMIC CRGV
- Fair with intensive management (83% survival in USA study), 100% survival in dogs with development of azotemia BEFORE skin lesions.
- Poor - 100% mortality in dogs with dvpt of azotemia AFTER skin lesions (multiple studies; US & UK).
- High mortality once develop oliganuric AKI, but survival possible with intensive care.

Answer 99

A

Stock JVIM 2018
Longer time to peak & shorter mean transit times for the renal cortex –> indicate decreased blood velocity & shorter total duration of enhancement, likely due to increased vascular resistance.
Contrasting findings for renal medulla - a shorter time to peak. In theory indicates increased blood velocity; unclear cause but authors propose different regulatory factors in medulla vs cortex.

Answer 100

A

Segev JVIM 2018
ASB = asymptomatic bacteriuria (E coli). Live biotherapeutic product.
Reported to have anti-infective & visceral analgesic effects in rodent models & people.
Administered as infusion via U cath into the bladder (10^10 CFU/mL).
Did not cause LUT signs in research dogs. In dogs with recurrent UTI, 4/9 had complete clinical cures, of which 3 had microbiological cure at D14.
No major AE, 2 dogs had mild self-limiting hyporexia.

Answer 101

A

White JVIM 2016
Prevalence 10-13% in cats 7yo +. Being female was a risk factor (OR 21.2).
No association with survival.

Answer 102

A

Rafatpanah Baigi JVIM 2017
74% 1+ positive urine culture, 27% recurrent bacteriuria.
Uncommonly caused pyrexia. Positive cultures associated with pyuria, but not cloudiness.
No association with survival.

Answer 103

A

Olby JVIM 2017
Contains PACs (proanthocyanidins), which inhibit adhesion of type I & P-fimbriated uropathogenic bacteria (esp E coli) to uroepithelium.

No benefit of oral cranberry in preventing bacteriuria. Did not impact urine anti-adhesion activity, BUT UAAA was associated with lower risk of E coli UTI in these dogs.

Answer 104

A

Courtice JVIM 2021
20%. Resistance to ampicillin most common (14.9%).
Mechanisms:
- β-lactamases (12 isolates)
- Extended spectrum beta-lactamase (ESBLs) (7 isolates) - 3rd gen cephalosporin resistance
- Plasmid-mediated quinolone resistance (PMQR) gene (1 isolate)
- ST131 strain (1 isolate) - commonly associated with MDR

Answer 105

A

Kern JVIM 2018
Crystal violet assay.
52.6%.
None identified in this study. Impt to consider potential biofilm formation in all E coli UTI cases.
Biofilm-forming E. coli had a lower likelihood of MDR.

Answer 106

A

Bouillon JVIM 2018
0.4-1.3% prevalence (PM exams).
CSx inappetence (57%), lethargy (51%), vomiting (36%), dehydration (25%). 75% had co-morbidities.
Could be acute (26%), subacute (19%) or chronic (55%).
Mild (15%) to severe (61%).
Fever was associated with subacute pyelonephritis. E coli most common isolate.
38% had no UTI signs.

Answer 107

A

Thornton JVIM 2018
Favours neutral to acidic & dilute urine. Lowest growth in concentrated, alkaline urine. Need to assess impact of non-alkalizing diluting diets on incidence of E coli LUTI.

Answer 108

A

Maurey JSAP 2019
Alkaline urine, urease-producing so struvite crystalluria.
Risk factors: pre-existing urinary disorders (previous urologic sx, LUT or prostatic disease, neurogenic UI), urethral catheterisation.
Can be associated with encrusted cystitis.
MDR resistance common.

Negative routine urine culture (fastidious bacteria) - need overnight incubation with blood agar + culture 72hrs+ to improve yield.

PO L-methionine for urine acidification.

Answer 109

A

Melgarejo JVIM 2021
Low presence of bacteria and/or fungi, identified on next-generation sequencing molecular diagnostics but not routine culture.
Struvite crystals.

Answer 110

A

Patterson JAVMA 2016
When stored at 4degC for 24hrs, urine samples from silicon coated tubes (STT) had higher bacterial yield.
When stored at room temp for 24hrs, urine transport tubes (UTT) were superior.
STT at room temp for 24hrs reduced to less than the cutoff for significant infection (>1000CFU/mL for cysto samples). Thus when prolonged storage 24hrs+ is anticipated at room temp, UTTs should be used.

Acierno JAVMA 2018
Recc immediate submission of urine samples for bacterial culture. CFU counts for refrigerated and immediately processed samples were stat similar in this study, but sample refrigeration in enrichment broth resulted in imperfect sensitivity for UTI detection (sig lower CFU counts & lower Sn of 89% vs 95% without broth), thus not recommended.

Answer 111

A

Uhl JAVMA 2017
Sn 93%, Sp 100%.
Limitations of the CCSP method included inaccuracy of some abx susceptibility test results (matched with reference cultures for only 39% isolates) & failure to correctly identify bacteriuria in 7% dogs.

Answer 112

A

Yoon JVIM 2018
Discordance between the XX karyotype, gonad & genital phenotypes.
Urogenital anomaly (in this case hypoplastic testes without spermatozoa, a uterus & ambiguous external genitalia).
Urinary incontinence.

Answer 113

A

Biomarker of oxidative stress/injury. Formed by non-enzymatic, free radical-catalyzed lipid peroxidation of arachidonic acid. Measure in urine - more stable cf plasma.

Whitehouse JVIM 2017
Yes, urinary IsoPs are significantly higher in EARLY CKD (stage 1) cats, and decreased with advancement of each stage. Inverse correlation with sCr. Studies needed to determine whether early antioxidant treatments have a protective effect on CKD progression.

Woolcock JVIM 2020
Urinary IsoPs not useful in differentiating UC from other LUTD, but were higher in dogs with all causes of urinary dz cf healthy dogs.

Answer 114

A

Wang JVIM 2017
Glycoprotein expressed by neutrophils (usually found within granules), many epithelial cells & tubular cells of PT, LOH & CDs. Primary function possibly binding of extracellular iron.

Yes, both urinary NGAL & urinary NGAL to creatinine ratio (UNCR) are useful markers to predict CKD progression in cats. Both sig higher in CKD cats (cf healthy) & highly correlated with sCr.
UNGAL cut-off of 2.06ng/mL had 76% Sn & 75% Sp. UNCR cut-off of 4.08 x10^(-6) had 76% Sn & 79% Sp. Cats with UNCR > cut-off had faster deterioration (median 19d),

Answer 115

A

Kim JVIM 2019
Yes, UNGAL higher in progressive CKD vs stable CKD dogs. No sig diff between pre-renal azotemia & stable CKD dogs.

Answer 116

A

Palm JVIM 2016
UNCR = early marker of gentamicin-induced AKI (based on 7x increase by D16) vs >50% incr in sCr. uNGAL incr earlier than UNCR (D11 vs D19) but changes overall paralleled UNCR.
UNCR also decreased 2d earlier cf sCr at onset of renal recovery.

Answer 117

A

Van den Broek JVIM 2017
Sp 100%, low Sn (9.1% non-azotemic, 27% azotemic)
CKD cats had 4.29 HR for total hyperCa vs non-azotemia cats.
Lower venous HCO3- associated with underestimation.
- Higher HCO3 expected to increase tCa by stimulating tubular Ca reabsorption & increased protein binding.

Answer 118

A

Tolbert JVIM 2017
No sig diff in both.
CKD cats may not need acid suppression - need more studies to determine if there is clinical benefit.

Answer 119

A

Thomson JVIM 2019
MSCs have a ‘homing’ ability - travel via circulation to sites of inflammation, attracted by cytokines and chemokines
released from injured tissue –> create anti-inflammatory,
pro-angiogenic, anti-fibrotic, and anti-apoptotic effects within the
local tissue environment by releasing growth factors, cytokines, and
chemokines –> provide trophic support for damaged tissue, helps regeneration and differentiation of injured cells –> tissue recovery.
Adipose tissue harvested from individual cats to grow MSCs. Delivered into renal artery via femoral/carotid a. under fluoroscopic guidance.
Study is in phase I clinical trial, only had FU of 3 months. Variable changes in renal parameters at D90 (but small sample no & short FU). No AE noted.

Answer 120

A

Bradley JVIM 2019
Crea, BUN, USG, age.
Higher Sn near point of diagnosis (90%), decreased to 63% 1 yr before & 44% 2 yrs before dx.
Sp remained simlar 98-99% throughout different timepoints.

Answer 121

A

Boyé JVIM 2019
Marker of cellular proliferation; increases markedly after G1-S transition of cell cycle > declines rapidly in G2.
sTK1 activity >20Du/L in 88% dogs with LSA; sig lower in dogs with CR vs PR.
Also useful to detect relapse/dz progression (5x increase in sTK1 when monitored q4wks had Sp 94% but Sn 50%)

Answer 122

A

Chik JVIM 2019
Infusion of 1-2mL 2% tetrasodium ethylenediaminetetraacetic acid (tEDTA) solution into SUB after drainage & irrigation using sterile saline. 100% (8/8) had resolution of mineralisation with 1st flush. 2/8 cats reobstructed but resolved after additional tEDTA, 1 cat needed SUB replacement.

Answer 123

A

Finch JVIM 2016
Annual/frequent vax, moderate-severe dental disease (more studies needed to explore pathophys)

Answer 124

A

Finch JVIM 2018
Pelvic circumference, reciprocal of creatinine.
No, not reliable.

Answer 125

A

Freeman JVIM 2018
Weight loss noted up to 3 years before CKD diagnosis, accelerated within 1 yr before CKD dx.
Yes, shorter survival.

Answer 126

A

Hu JVIM 2016 Review
Carbachol - similar to bethanechol. Parasympathomimetic drug (Pelvic n.). Tx bladder atony –> promote detrusor contraction & urine voiding.

Alfuzosin - similar to prazosin - bind to alpha receptors in bladder wall s.m. (alpha-sympatholytic drug). Tx bladder atony, promote relaxation of IUS, assist urine voiding. AE -

Baclofen - GABA-derived striated muscle relaxant. Tx bladder atony, promote relaxation of EUS. Narrow therapeutic index. GI signs, salivation, pruritus, weakness; seizures & hallucinations (reported with abrupt withdrawal)

Answer 127

A

Hu JVIM 2016
Sacral neuromodulation (ventral root stimulation). Involves surgical isolation and placement of silicon-insulated platinum electrodes around S2 spinal nerves bilaterally. Electrodes are attached to a SQ receiver coil, which can be activated transcutaneously with an external stimulator that triggers S2 firing and subsequent detrusor contraction & bladder emptying “on demand”.
8/9 dogs had voiding efficiency of >90%; dogs still using the system 5 years after implantation.

Answer 128

A

Kabatchnick JVIM 2016
38% cats, 20.5% dogs. Temp sig lower vs non-uremic patients.
Yes.
Lower BW (cats <5kg), timing (pre-dialysis vs post).

Answer 129

A

King JVIM 2017
BZP sig reduced proteinuria, but insufficient sample no. to draw conclusions on survival time.

Answer 130

A

Lamoureux JVIM 2019
32% prevalence overall (common even in IRIS stage 1 CKD 28%). Only 8% symptomatic.
Risk factors - female (OR 3.2), isosthenuria (OR 2.48), positive leukocyte esterase test & microorganisms on urine sediment.

Answer 131

A

Vessieres JSAP 2019
27% (glomerulosclerosis most common; 35%)
Mycophenolate, myco + chlorambucil.
53% IMGN dogs were alive at study end point (652d). All dogs treated with myco were alive at 712d, successful tx in 4/6.

Answer 132

A

Vessieres JSAP 2019
Membranoproliferative GN (26-60%).
Mainly 2’ to infectious dz with immune complex accumulation on sub-endothelial side of glomerular BM. Agents - D. immits, L. infantum, Babesia spp, tick borne dz, systemic mycosis (coccidiodes), Bb (controversial)

Answer 133

A

Lulich JVIM 2017
Dystrophic mineralisation > ectopic bone arising from the urothelium.

Answer 134

A

Liu JVIM 2018
All these biomarkers have a wide range of long-term intra-dog variability (8% for sCysC, up to 87-88% for uNGAL & uLgG). Ideally need to establish RIs for healthy vs CKD dogs.

Answer 135

A

Moyle JVIM 2018
Not in this study. Urine samples kept in 24C for 4hrs, 4C for 12hrs, or −20C for 72hrs.

Answer 136

A

Meindl JVIM 2018
No

Answer 137

A

Marynissen JVIM 2017
11% overt (UPC >0.5), 14% borderline (0.2-0.5). 19% persistent proteinuria.
Not in this study.

Answer 138

A

Pocar JVIM 2019
Yes.
Plasma iohexol was measured 5, 15, 60, 90 & 180 minutes after injection. Simplified GFR protocols were based on 1-3 samples (vs 5) - all gave reliable GFR measurements, with best GFR measures including the 180-min sampling.
Gray zone may corerspond to early kidney dysfunction.

Answer 139

A

Segev JVIM 2016
Higher scores > decreased 30d survival probability.
Overall Sn 71-75%, Sp 75-86%.

Answer 140

A

Shipov JVIM 2018
Reduces bone quality (smaller lacunae size), but changes noted were mild & not likely to cause CSx.
Authors commented short duration of CKD for dogs in this study (6mths+) likely accounting for subtle changes.

Answer 141

A

Sørensen JVIM 2018
62%. Performing in-house urine microscopy (accuracy 64.5%) but not culture (accuracy 77%; only done in 56% cases).

Answer 142

A

Francey JVIM 2018
Heparin most commonly used.
Regional citrate anti-coagulation in thist study showed to be safe, adv: doesn’t systemically anti-coagulate the patient, good for patients at risk of bleeding. Cause hypoCa (mild in this study).

Answer 143

A

Rosenthal JVIM 2019
27% dogs developed AKI, severity of sCr increase was dose dependent.
TPE = effective tx, 100% (11 dogs) survived to discharge.
54% complication rate, did not affect patient outcome.

Answer 144

A

Francey JVIM 2021
No sig diff, even with bias towards refractory cases in the TPE group.
TPE had good response rate (83% in IMHA vs 65% med), 80% in IMTP (vs 70% med). 82% TPE dogs survived to discharge (controls 69%). 71% TPE achieved CR, 14% PR, 18% died/euthanised.

Answer 145

A

Adelman JAVMA 2017
Povidone iodine sclerotherapy (5% solution instilled via ureteral stent).

Kortum JSAP 2021
ACE-Is or ARBs.
Px good; MST 1482d regardless or tx/clinical response.
With ACEI/ARB, complete response 42%, partial 26%, no improvement 31%.

Answer 146

A

Foster JAVMA 2018
18% dogs.
Subclinical bacteriuria.

Answer 147

A

Etedali JAVMA 2019
94% diagnostic rate. No.
24% minor, 2% major

Answer 148

A

Ogilvie JAVMA 2018
Not in this study, ass with earlier development of CAB but not CAUTI, but larger prospective studies needed to assess benefits.

Answer 149

A

Park JAVMA 2016
Vesicoureteral reflux (common in people).
Sx intervention involving ureteral reimplantation with an extravesicular technique incorporating a long submucosal tunnel resolved hydronephrosis & recurrent UTI episodes in the case report.

Answer 150

A

Meler JAVMA 2018
CDUOS (congenital distal ureteral orifice stenosis). Tx with cystoscopic laser ablation (CLA) to open the ureteral orifice. Intramural EU.

Answer 151

A

Hartmann VCNA 2018
ESBLs = group of enzymes that inactivate most β-lactam antimicrobials by hydrolyzing the β-lactam ring.
So ESBL-producing bacteria are resistant to most β-lactams, potentiated sulfonamides & FQs.
Susceptible to cephamycins (cefoxitin and cefotetan) & carbapenems. Also most susceptible to fosfomycin but not routinely reported on lab panels.

Answer 152

A

Aresu JVIM 2017
ICGN esp MPGN - most severe hypoalb

Morphological dx - amyloidosis, membranous GN, MPGN & mixed GN
(Vs minimal change dz, 1’/2’ focal glomerulosclerosis, juvenile nephropathies).

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