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Nephrology Flashcards

1
Q

Aldosterone’s main effects on the kidney are:

A) Sodium reabsorption and potassium secretion 
B) Sodium secretion and potassium reabsorption
C) Potassium secretion and hydrogen ion secretion
D) Sodium reabsorption and potassium reabsorption
A

A) Sodium reabsorption and potassium secretion

Source: Stockham and Scott, p. 419

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2
Q

Which of the following is false regarding azotemia in acute versus chronic renal failure?

A) The rates of increase of urea and creatinine are greater in acute renal failure.
B) Animals with acute renal failure often exhibit oliguria or anuria.
C) Acute renal failure presents with a more severe azotemia than chronic renal failure.
D) Acute renal failure is often caused by toxicants, infections, or ischemia.
A

C) Acute renal failure presents with a more severe azotemia than chronic renal failure.

Source: Stockham and Scott, pp. 427-428

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3
Q

In which of the following diseases would blood urea nitrogen (BUN) most likely be increased on a chemistry panel?

A) Hepatic insufficiency
B) Protein-losing enteropathy
C) Central diabetes insipidus
D) Nephrogenic diabetes insipidus
A

B) Protein-losing enteropathy

Source: Stockham and Scott, p. 435

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4
Q

Which of the following regarding polyuria is true?

A) Polyuria in chronic renal disease is more severe than will typically be seen in other diuretic states.
B) Polyuria persists through end stage renal disease.
C) Polyuria appears with azotemia when GFR is 50% of normal.
D) End stage renal disease is characterized by oliguria or anuria.

A

D) End stage renal disease is characterized by oliguria or anuria.

(Fundamentals of Veterinary Clinical Pathology Pg 428)

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5
Q

Which is true regarding the pathogenesis of azotemia?

A) In response to dehydration ADH increases CRT absorption leading to pre-renal azotemia.
B) Azotemia occurring with PLN may be pre-renal due to hypovolemia.
C) Renal perfusion pressure is inversely proportional to GFR.
D) Pre-renal azotemia secondary to GI bleeding is exclusively to hypovolemia.

A

B) Azotemia occurring with PLN may be pre-renal due to hypovolemia.

(Fundamentals of Veterinary Clinical Pathology Pg 429)

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6
Q

Which of the following regarding the BUN: Crt ration is true?

A) This can be used to distinguish between pre-renal, renal, and post renal azotemia.
B) This test has good sensitivity and specificity for renal dysfunction caused by renal disease.
C) If serum Crt is increased proportionally more than BUN azotemia is likely renal or post renal.
D) If serum CRT is increased proportionally more than BUN, azotemia is likely pre-renal.

A

C) If serum Crt is increased proportionally more than BUN azotemia is likely renal or post renal.

(Fundamentals of Veterinary Clinical Pathology Pg 438)

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7
Q

Medullary hypertonicity can be decreased secondary to which one of the following?

a. Chronic hypernatremia
b. Decreased glomerular response to ADH
c. Increased protein catabolism
d. Osmotic diuresis

A

d. Osmotic diuresis

Stockham and Scott (2nd Ed.), Chap. 8, p. 433.

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8
Q

Which of the following can help differentiate chronic renal failure from acute renal failure ?

a. Duration of signs and anemia
b. Hypocalcemia and hyperkalemia
c. Isosthenuria and urine volume
d. Magnitude of the azotemia

A

a. Duration of signs and anemia

Stockham and Scott (2nd Ed.), Chap. 8, p. 427.

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9
Q

Which one of the following will affect urea nitrogen in serum or plasma, in the opposite direction than the others?

a. Diabetes insipidus
b. Gastrointestinal hemorrhage
c. Hypovolemia
d. Urethral rupture

A

a. Diabetes insipidus

Stockham and Scott (2nd Ed.), Chap. 8, p. 431, 435.

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10
Q

Which of the following molecules is conserved (net conservation) by the normal kidney?

a) Phosphate
b) lactate
c) chloride
d) hemoglobin dimers
e) myoglobin

A

d) hemoglobin dimers

Page 417. Source: Stockham, S.L. and M.A. Scott, Fundamentals of veterinary clinical pathology. 2nd ed2008, Ames, Iowa: Blackwell Pub

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11
Q

Which of the following describes a cause of post-renal azotemia?

a) Release of vasoactive substances (prostaglandins and angiotensin) from urinary tract obstruction that dilate glomerular arterioles thus reducing GFR
b) Leakage of urine into the abdomen from a ruptured bladder
c) Sensing of reduced blood flow by the JG apparatus of the afferent arteriole that leads to constriction of the afferent and efferent arteriole by angiotensin II
d) Aldosterone deficiency

A

b) Leakage of urine into the abdomen from a ruptured bladder

Page 429. Source: Stockham, S.L. and M.A. Scott, Fundamentals of veterinary clinical pathology. 2nd ed2008, Ames, Iowa: Blackwell Pub

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12
Q

Which of the following is a factor for an unmaintained medullary hypertonicity in chronic renal failure? Select all that apply.

a. Medullary tissue is damaged
b. Medullary blood flow is normal
c. Na+ and Cl- transport is decreased in the ascending loop of Henle
d. Damaged cells in the distal nephron are more responsive to ADH

A

a. Medullary tissue is damaged
c. Na+ and Cl- transport is decreased in the ascending loop of Henle

Stockholm. Clinical Pathology. Urinary System. Pg 427

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13
Q

In a dog with a protein losing nephropathy and marked hypoalbuminemia, azotemia may be due to decreased GFR caused by hypovolemia secondary to:

a. Decreased colloidal oncotic pressure
b. Increased colloidal oncotic pressure
c. Decreased hydrostatic pressure
d. Increased hydrostatic pressure

A

a. Decreased colloidal oncotic pressure

Stockholm. Clinical Pathology. Urinary System. Pg 429

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14
Q

Which statement is most true?

a. The magnitude of azotemia differentiates acute from chronic renal failure
b. Hypercalcemia is not a cause of azotemia
c. Hypovolemia is a trigger for release of ADH
d. Terminal stages of uremia is present with polyuria.

A

c. Hypovolemia is a trigger for release of ADH

Stockholm. Clinical Pathology. Urinary System. Pg 426

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15
Q

Which of the following is a cause of pre-renal azotemia?

a. Glomerulonephritis
b. Hypovolemia
c. Ethylene glycol
d. Hypercalcemia

A

b. Hypovolemia

Stockham and Scott. Fundamentals of Veterinary Clinical Pathology. 2nd ed. Pg. 430 Table 8.3

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16
Q

All of the following can cause decreased urea nitrogen EXCEPT?

a. Hepatic insufficiency
b. Enzyme deficiencies in urea cycle
c. Nephrogenic diabetes insipidus
d. Gastrointestinal bleeding

A

d. Gastrointestinal bleeding

Stockham and Scott. Fundamentals of Veterinary Clinical Pathology. 2nd ed. Pg. 435 Table 8.5

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17
Q

Which of the following is a true statement?

a. Acute renal failure is an irreversible process
b. In acute renal failure, USG is expected to be hyposthenuric
c. The rate of increase in azotemia is greater in acute renal failure
d. A more severe azotemia is seen in acute renal failure

A

c. The rate of increase in azotemia is greater in acute renal failure

Stockham and Scott. Fundamentals of Veterinary Clinical Pathology. 2nd ed. Pg. 427-429

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18
Q

What are the two major factors affecting if a substance will pass through the healthy glomerular filtration barrier?

A.  blood pressure & electrical charge
B.  molecular weight & electrical charge
C.  molecular size & electrical charge
D.  molecular size & blood pressure
A

C. molecular size & electrical charge

pg 417; Stockham and Scott, Fundamentals of Veterinary Clinical Pathology; 2nd Ed.

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19
Q

What is the main cause of glucosuria?

A. damage to the glomerular filtration barrier
B. damage to the Loop of Henle
C. saturation of Na-glucose cotransport system by excessive K+ from the plasma
D. saturation of Na-glucose cotransport system by excessive glucose from the plasma

A

D. saturation of Na-glucose cotransport system by excessive glucose from the plasma

(pg 422; Stockham and Scott, Fundamentals of Veterinary Clinical Pathology; 2nd Ed.)

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20
Q

Nearly all filtrate amino acids are resorbed where within the nephron?

A.  proximal tubules
B.  collecting tubules
C.  Loop of Henle
D.  distal tubules
A

A. proximal tubules

pg 422; Stockham and Scott, Fundamentals of Veterinary Clinical Pathology; 2nd Ed.

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21
Q

Complete the following statement by selecting the best answer from the choices provided:
Approximately (75% or 25%) of sodium is resorbed in the proximal tubules by (a concentration gradient OR active transport).

a. ) 25% & active transport
b. ) 25% & concentration gradient
c. ) 75% & active transport
d. ) 75% & concentration gradient

A

d.) 75% & concentration gradient

Stockham & Scott, Fundamentals of Veterinary Clinical Pathology, 2nd ed., pg. 418

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22
Q

This compound inhibits urease activity, thus confounding the results of a urea assay.

a. Citrate
b. Fluoride
c. Lithium Heparin
d. Potassium EDTA

A

b. Fluoride

Stockham & Scott, Fundamentals of Veterinary Clinical Pathology, 2nd ed., pg. 435

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23
Q

A healthy two year old Collie mix, intact male dog decided to cross a desert for 3 days with only one bowl of water. Describe his azotemia upon presentation to the emergency clinic.

a. Hepatic
b. Post – Renal
c. Pre – Renal
d. Renal

A

c. Pre – Renal

Stockham & Scott, Fundamentals of Veterinary Clinical Pathology, 2nd ed., pg. 429 – 430

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24
Q

Which one of the following is most consistent with a renal azotemia?

A. Oliguria; USG 1.040; normal BUN/creatinine ratio
B. Oliguria; USG 1.012; increased BUN/creatinine ratio
C. Polyuria; USG 1.040; increased BUN/creatinine ratio
D. Polyuria; USG 1.012; normal BUN/creatinine ratio

A

D. Polyuria; USG 1.012; normal BUN/creatinine ratio

Stockham and Scott, Ch. 8 Urinary System, pg. 432, 438

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25
Q

Which one of the following is true regarding acute kidney injury?

A. The level of azotemia is always greater than that of chronic kidney disease.
B. It is always reversible.
C. The patient is typically oliguric or anuric.
D. The urine is typically hyposthenuric.

A

C. The patient is typically oliguric or anuric.

Stockham and Scott, Ch. 8 Urinary System, pg. 428-429

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26
Q

Which one of the following is true regarding normal renal physiology?

A. Aldosterone works at the Loop of Henle to stimulate secretion of NaCl and water.
B. Antidiuretic hormone works at the collecting tubule to increase reabsorption of water.
C. Parathyroid hormone works at multiple locations within the nephron to promote calcium excretion.
D. Parathyroid hormone works at multiple locations within the nephron to promote phosphorous absorption.

A

B. Antidiuretic hormone works at the collecting tubule to increase reabsorption of water.

(Stockham and Scott, Ch. 8 Urinary System, pg. 419-422)

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27
Q

The net function of a nephron is to excrete all of the following except:

a. NH4+
b. Mg2+
c. K+
d. Creatinine

A

b. Mg2+

Stockham, S. L., Scott, M. A. (2008), Fundamentals of Veterinary Clinical Pathology. 2nd ed. Ames, Iowa: Blackwell Publishing, pg. 421

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28
Q

H2O is passively resorbed in which of the following location(s) in the urinary tubules:

i. Proximal tubules
ii. Descending limb of the Loop of Henle
iii. Ascending limb of the Loop of Henle

a. i, ii, & iii
b. i & ii
c. i & iii
d. i only

A

b. i & ii
i. Proximal tubules
ii. Descending limb of the Loop of Henle

Stockham, S. L., Scott, M. A. (2008), Fundamentals of Veterinary Clinical Pathology. 2nd ed. Ames, Iowa: Blackwell Publishing, pg. 424

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29
Q

Chronic renal disease in dogs is often differentiated from acute kidney injury by all of the following except:

a. The presence of anemia
b. The extreme elevation in phosphorus
c. The duration of clinical signs
d. The presence of hypocalcemia

A

b. The extreme elevation in phosphorus

Stockham, S. L., Scott, M. A. (2008), Fundamentals of Veterinary Clinical Pathology. 2nd ed. Ames, Iowa: Blackwell Publishing, pg. 427

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30
Q

Which of the following is a cause for impaired renal concentrating ability?

a. ADH deficiency
b. Solute overload was not present
c. Increased medullary hypertonicity
d. Epithelial cells of distal nephrons are responsive to ADH

A

a. ADH deficiency

Stockholm and Scott. Urinary System. Pg 448

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31
Q

How does liver failure change urine concentrating ability?

a. Decreased urea synthesis
b. Failure of Na and Cl delivery to the loop of henle
c. Collecting tubules are more responsive to ADH
d. Cortisol inhibiting the responsiveness of renal tubules to ADH

A

a. Decreased urea synthesis

Reference: Stockholm and Scott. Urinary System. Pg 451

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32
Q

A group of renal and extra-renal disease in which ADH is present but renal tubules are not responsive to it describes which process?

a. Addison’s disease
b. Nephrogenic diabetes insipidus
c. Central diabetes insipidus
d. Hyperaldosteronism

A

b. Nephrogenic diabetes insipidus

Stockholm and Scott. Urinary System. Pg 451

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33
Q

Horse urine can turn brown during storage or when exposed to snow due to the presence of what compound:

a. Mucoproteins
b. Hemoglobin
c. Pyrocatechin
d. Denatured calcium carbonate crystals

A

c. Pyrocatechin

Stockham, S. L., Scott, M. A. (2008), Fundamentals of Veterinary Clinical Pathology. 2nd ed. Ames, Iowa: Blackwell Publishing, pg. 442

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34
Q

The gold standard for assessing urine solute concentration is:

a. Freezing-point osmometry
b. Boiling-point osmometry
c. Spectrophotometry
d. Refractometry

A

a. Freezing-point osmometry

Stockham, S. L., Scott, M. A. (2008), Fundamentals of Veterinary Clinical Pathology. 2nd ed. Ames, Iowa: Blackwell Publishing, pg. 445

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35
Q

Tumor lysis syndrome is a potential consequence to rapid lysis of tumor cells from chemotherapy and/or tumor debulking. Of the following, which are common biochemical alterations noted in this condition:

a. Hyperphosphatemia, hypercalcemia, hyperkalemia
b. Hyperphosphatemia, hypercalcemia, hypokalemia
c. Hyperphosphatemia, hypocalcemia, hyperkalemia
d. Hypophosphatemia, hypercalcemia, hyperkalemia

A

c. Hyperphosphatemia, hypocalcemia, hyperkalemia

Howard, S. C., Jones, D. P. (2011), The Tumor Lysis Syndrome. N Engl J Med. 364: 1844-1854. DOI: 10.1056/NEJMra0904569

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36
Q

What is the single most useful and most sensitive test of overall renal function?

A. creatinine serum levels
B. bile acids
C. GFR
D. BUN serum levels

A

C. GFR

(pg 517; Finco, DR, Brown, SA, Brown, CA, Crowell, WA, Cooper, TA, Barsanti, JA. Progression of Chronic Renal Disease in the Dog. JVIM 13: 516-528, 1999)

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37
Q

The urinary clearance of what substance is the gold standard for monitoring changes in GFR in research settings?

A. bilirubin
B. AST
C. insulin
D. inulin

A

D. inulin

. (pg 519; Finco, DR, Brown, SA, Brown, CA, Crowell, WA, Cooper, TA, Barsanti, JA. Progression of Chronic Renal Disease in the Dog. JVIM 13: 516-528, 1999)

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38
Q

Which of the following is not a potential risk factor for development of acute renal damage in dogs and cats?

A. younger age
B. sepsis
C. diabetes mellitus
D. fever

A

A. younger age

(pg 582; Grauer, GF. Early Detection of Renal Damage and Disease in Dogs and Cats. Vet Clin North Am 35:581-596, 2005)

39
Q

In research, urinary clearance of ______ is the gold standard for monitoring changes of GFR.

A) Creatinine
B) Inulin
C) Glucose
D) Potassium

A

B) Inulin

Source: “Progression of Chronic Renal Disease in the Dog,” Finco et al., p. 519.

40
Q

All but which of the following can lead to renal hypoperfusion and increase the risk of acute renal failure?

A) Decreased plasma oncotic pressure
B) Decreased renal prostaglandin synthesis
C) Decreased blood viscosity
D) Decreased cardiac output

A

C) Decreased blood viscosity

Source: “Early Detection of Renal Damage and Disease in Dogs and Cats,” Grauer, p. 583.

41
Q

Microalbuminuria is defined as a urine albumin concentration between _____ and _____.

A) 1 mg/dL and 10 mg/dL
B) 1 mg/dL and 20 mg/dL
C) 1 mg/dL and 30 mg/dL
D) 1 mg/dL and 40 mg/dL

A

C) 1 mg/dL and 30 mg/dL

Source: “Early Detection of Renal Damage and Disease in Dogs and Cats,” Grauer, pp. 590-591.

42
Q

Which of the following regarding the measurement of urine specific gravity is true? Select all that apply.

a. Urine specific gravity is a measurement of the weight of solutes in solution in mg/dl.
b. The refractive index is dependent on temperature, solute concentration, and charge of the ions in solution.
c. In most urine samples there is a linear relationship between USGref and osmolality.
d. USG is measured in particles of dissolved particles in 1L of solution.

A

C and D

c. In most urine samples there is a linear relationship between USGref and osmolality.
d. USG is measured in particles of dissolved particles in 1L of solution.

(Fundamentals of Veterinary Clinical Pathology pg 446)

43
Q

All of the following result in a decreased response to tubular ADH except:

a. Chronic renal disease
b. Post obstructive diuresis
c. Hyperadrenocortisolism
d. Liver failure

A

c. Hyperadrenocortisolism

Fundamentals of Veterinary Clinical Pathology pg 448 Table 8.8

44
Q

Which of the following conditions result in polyuria due to decreased secretion of ADH?

a. Hypercalcemia
b. Psychogenic polydipsia
c. Hypokalemia
d. Liver failure

A

b. Psychogenic polydipsia

Fundamentals of Veterinary Clinical Pathology pg 448 Table 8.8

45
Q

Which of the following can be seen in a free catch UA of a healthy dog and is least likely to indicate a pathologic problem?

a) USG 1.007
b) Hazy-turbid urine
c) pH 8.5
d) 1+ ketones and USG 1.020
e) 1+ proteinuria and USG 1.010

A

a) USG 1.007

Page 442. The USG in dogs can be quite varied throughout the day. B) true for horses C) can be true for vegetarians D and E) do not expect to see this is dilute urine. Source: Stockham, S.L. and M.A. Scott, Fundamentals of veterinary clinical pathology. 2nd ed2008, Ames, Iowa: Blackwell Pub

46
Q

Which of the following will most likely increase USG?

a) Marked number of tubular casts
b) Marked number of transitional carcinoma cells
c) Marked glucosuria
d) Marked crystalluria

A

c) Marked glucosuria

Page 443 and 447. Source: Stockham, S.L. and M.A. Scott, Fundamentals of veterinary clinical pathology. 2nd ed2008, Ames, Iowa: Blackwell Pub

47
Q

Decreased medullary hypertonicity can cause PU/PD. Which of the following causes of PU/PD does not mainly decrease medullary hypertonicity?

a) IV fluids during a 3 hour long surgery
b) Furosemide
c) Hypercalcemia
d) Uncontrolled Cushing’s disease
e) Liver failure

A

Page 433. Hypercalcemia causes ADH antagonism and thus causes nephrogenic diabetes insipidus. Source: Stockham, S.L. and M.A. Scott, Fundamentals of veterinary clinical pathology. 2nd ed2008, Ames, Iowa: Blackwell Pub

48
Q

Which one of the following statements is true regarding acute kidney injury (AKI)?

A. AKI only occurs if there is pre-existing renal disease.
B. The onset of renal damage in AKI is always associated with oliguria.
C. Patients with AKI are always hypotensive or normotensive.
D. Nephrotoxic drugs that cause AKI typically do so by damaging the tubules.

A

D. Nephrotoxic drugs that cause AKI typically do so by damaging the tubules.

(Grauer, Early Detection of Renal Damage and Disease in Dogs and Cats pg. 581-587)

49
Q

Which one of the following serum chemistry results is most consistent with chronic renal azotemia?

A. Hyperphosphatemia; hyperkalemia
B. Hyperphosphatemia; hypokalemia
C. Hypophosphatemia; hyperkalemia
D. Hypophosphatemia; hypokalemia

A

B. Hyperphosphatemia; hypokalemia

Stockham and Scott, Ch. 8 Urinary System, pg. 439-440

50
Q

Which one of the following diseases would be most likely to cause a dog to have polyuria with a USG of >1.020?

A. Acute kidney injury
B. Hyperadrenocorticism
C. Diabetes mellitus
D. Hyperaldosteronism

A

C. Diabetes mellitus

Stockham and Scott, Ch. 8 Urinary System, pg. 448-451

51
Q

These two compounds falsely indicate glycosuria by the reagent strip method:

a. Hydrogen peroxide & sodium hypochlorite
b. Quaternary ammonia & hydrogen peroxide
c. Sodium hypochlorite & urine ketones
d. Urine ketones & lipidemia

A

a. Hydrogen peroxide & sodium hypochlorite

Stockham & Scott, Fundamentals of Veterinary Clinical Pathology, 2nd ed. pg #463

52
Q

Ketonuria occurs because the body mobilizes lipids for energy when a shift in energy production from carbohydrates to lipids is required. What are the 3 ketone bodies produced and which is/are detected by assay methods?

a. Acetate, β-hydroxybutyrate, lactate; acetate and lactate
b. Acetate, β-hydroxybutyrate, toluidine; Acetate and β-hydroxybutyrate
c. Acetoacetate, β-hydroxybutyrate, acetone; acetoacetate and acetone
d. Acetone, lactate, propylene glycol; acetone and lactate

A

c. Acetoacetate, β-hydroxybutyrate, acetone; acetoacetate and acetone

Stockham & Scott, Fundamentals of Veterinary Clinical Pathology, 2nd ed. pg #464-645

53
Q

Which is more sensitive on the urine dipstick analysis between heme and protein detection pads?

a. Heme
b. Protein
c. Neither

A

a. Heme

Stockham & Scott, Fundamentals of Veterinary Clinical Pathology, 2nd ed. pg. #465

54
Q

In dogs, the reported maximum renal glucose transport is

A. 120-160 mg/dL
B. 140-180 mg/dL
C. 180-220 mg/dL
D. 220-260 mg/dL

A

C. 180-220 mg/dL

Stockham and Scott pg 463

55
Q

Aciduria could be expected in all of the following EXCEPT:

A. Hyperkalemia
B. Carnivore diet
C. Furosemide therapy
D. Hypochloremic metabolic alkalosis

A

A. Hyperkalemia

Stockham and Scott pg 457

56
Q

Bence Jones proteinuria has been reported in dogs in each of the following EXCEPT:

A. Leishmaniasis
B. Ehrlichiosis
C. Babesiosis
D. Borreliosis

A

D. Borreliosis

pg 462 of Stockham and Scott

57
Q

All of the following are risk factors for developing acute renal failure EXCEPT?

a. Dehydration
b. Fever
c. Metabolic alkalosis
d. Hypotension

A

c. Metabolic alkalosis

Grauer, Gregory; Early Detection of Renal Damage and Disease in Dogs and Cats; Pg. 582, Box 1

58
Q

Which of the following would cause polyuria due to a decreased tubular response to ADH?

a. Central diabetes insipidus
b. Hypercalcemia
c. Diabetes mellitus
d. Liver failure

A

b. Hypercalcemia

Stockham and Scott. Fundamentals of Veterinary Clinical Pathology. 2nd Ed. Pg. 448, Table 8.8

59
Q

Which of the following may be a normal finding on a routine urinalysis in a dog?

a. Bilirubinuria
b. Glucosuria
c. Alkalinuria
d. Proteinuria

A

a. Bilirubinuria

Stockham and Scott. Fundamentals of Veterinary Clinical Pathology. 2nd ed. Pg. 456, Table 8.11

60
Q

What is the approximate renal tubular transport maximum for glucose in horses and calves ?

a. 100 mg/dL
b. 150 mg/dL
c. 200 mg/dL
d. 290 mg/dL

A

b. 150 mg/dL

Stockham and Scott (2nd Ed.), Chap. 8, p. 463.

61
Q

Which one of the following can be seen in the urine of healthy herbivores ?

a. Bilirubin
b. Calcium carbonate crystals
c. Ketones
d. Hemoglobin

A

b. Calcium carbonate crystals

Stockham and Scott (2nd Ed.), Chap. 8, p. 442.

62
Q

You examine a sick cow, 10 days post-partum, and perform a urinalysis with the reagent pad method on a voided sample. Which one of the following is a pathologic finding ?

a. Blood +++
b. Leukocytes +++
c. Trace proteins
d. pH 5.5

A

d. pH 5.5

Stockham and Scott (2nd Ed.), Chap. 8, p. 455. (blood and leukocytes on a voided sample can come from the genital tract, p. 441 ; protein can be falsely increased in alkaline urine, p. 458)

63
Q

Which of the following assays is not a method for detecting urine protein levels:

a. Coomassie Brilliant Blue
b. Benzethonium Chloride
c. Trichloroacetic Acid
d. Ethylenediaminetetraacetic Acid

A

d. Ethylenediaminetetraacetic Acid

Stockham, S. L., Scott, M. A. (2008), Fundamentals of Veterinary Clinical Pathology. 2nd ed. Ames, Iowa: Blackwell Publishing, pg. 477-478

64
Q

Bence Jones proteins have unique thermal properties that allow them to precipitate out of solution, then redissolve when heated and cooled to certain temperatures. Which of the following is false regarding Bence Jones proteins:

a. The variable portions of light-chain proteins dictates the thermal properties of these proteins
b. pH of urine must be alkaline in order for precipitation to occur
c. Bence Jones proteins should precipitate out between 40°C and 60°C
d. The concentration of Bence Jones proteins should be >145 mg/dL in order to note a positive result

A

b. pH of urine must be alkaline in order for precipitation to occur

Stockham, S. L., Scott, M. A. (2008), Fundamentals of Veterinary Clinical Pathology. 2nd ed. Ames, Iowa: Blackwell Publishing, pg. 460-462

65
Q

An alternative name for the SSA turbidity assay is:

a. Trichloroacetic acid
b. Ponceau S/TCA
c. Bumintest
d. Microalbumin

A

c. Bumintest

Stockham, S. L., Scott, M. A. (2008), Fundamentals of Veterinary Clinical Pathology. 2nd ed. Ames, Iowa: Blackwell Publishing, pg. 482

66
Q

Which of the following is not a cause of falsely increased proteinuria using the reagent strip method?

A) Alkaline urine
B) Acidic urine
C) Urine that contains quaternary ammonium salts
D) Urine that contains chlorhexidine

A

B) Acidic urine

Source: Stockham and Scott, p. 458.

67
Q

Which type of urolith would you expect to see in a patient that has a urinary tract infection caused by urease-producing bacteria?

A) Calcium oxalate dihydrate
B) Struvite
C) Calcium carbonate
D) Urate

A

B) Struvite

Source: Stockham and Scott, pp. 489-490.

68
Q

Which type of protein would be most easily filtered by the glomerulus?

A) Small, positively charged
B) Small, negatively charged
C) Large, positively charged
D) Large, negatively charged

A

A) Small, positively charged

Source: “Measurement, Interpretation, and Implications of Proteinuria and Albuminuria” Grauer, pp. 283-284.

69
Q

All of the following are causes of physiologic proteinuria EXCEPT?

a. Fever
b. Cystitis
c. Exercise
d. Seizures

A

b. Cystitis

Source: Grauer,G. Measurement, Interpretation, and Implications of Proteinuria and Albuminuria; Veterinary clinics of North America; pg. 288, Table 1

70
Q

Which of these would be expected to cause the highest magnitude of proteinuria?

a. Tubulointerstitial disease
b. Fever
c. Glomerulonephritis
d. Urinary tract infection

A

c. Glomerulonephritis

Source: Grauer,G. Measurement, Interpretation, and Implications of Proteinuria and Albuminuria; Veterinary clinics of North America; pg. 287

71
Q

Which proteins are more readily filtered by the glomerulus?

a. Small and positively charged
b. Large and positively charged
c. Small and negatively charged
d. Large and negatively charged

A

a. Small and positively charged

Source: Grauer,G. Measurement, Interpretation, and Implications of Proteinuria and Albuminuria; Veterinary clinics of North America; pg. 233

72
Q

What concept is described by the ratio of a solution’s weight to the weight of an equal volume of water?

a. Specific gravity
b. Osmolarity
c. Osmolality
d. Freezing point osmometry

A

a. Specific gravity

Reference: Clinical Pathology. Stockholm and Scott pg 445

73
Q

Which of the following statements is true?

a. Overflow proteinurias produce hypoproteinemia
b. In tubular proteinuria, the glomerular filtration barrier is damaged
c. Bence Jones proteins are part of a routine urinalysis
d. Glomerular disease damages the filtration barrier and decreases selective permeability

A

d. Glomerular disease damages the filtration barrier and decreases selective permeability

Reference: Clinical Pathology. Stockholm and Scott. Pg 458 – 460

74
Q

Hyaline casts form from the conglutination of which protein?

a. Tamm-Horsfall mucoprotein
b. Bence Jones proteins
c. Albumin
d. Hemoglobin

A

a. Tamm-Horsfall mucoprotein

Reference: Clinical Pathology. Stockholm and Scott. Pg 473

75
Q

Tamm-Horsfall proteins are ______1________ secreted by _________2_______; and are considered the major component of these two types of casts: __________3_______.

a. 1 = albumin degradation products, 2 = the proximal renal tubules, 3 = hyaline and granular
b. 1 = Immunoglobulins, 2 =podocytes, 3 = hyaline and granular
c. 1 = mucoproteins, 2 = the ascending loop of Henle, 3 = hyaline and granular.
d. 1 = myoglobin by products, 2 = Distal renal tubule, 3 = waxy and lipid

A

c. 1 = mucoproteins, 2 = the ascending loop of Henle, 3 = hyaline and granular.

Stockham & Scott, Fundamentals of Veterinary Clinical Pathology, 2nd edition, pg. 457.

76
Q

On a reagent urine test strip, proteinuria may be a false positive result in which situation?

a. A carnivore with acidotic urine.
b. An herbivore with alkalotic urine.
c. A ruminant with a paradoxical aciduria.

A

b. An herbivore with alkalotic urine.

Stockham & Scott, Fundamentals of Veterinary Clinical Pathology, 2nd edition, pg. 458.

77
Q

Bence Jones proteinuria is typically associated with __________________, and has been documented in dogs with _______________________.

a. B - lymphocyte or plasma cell neoplasia; leishmaniasis, ehrlichiosis, & babesiosis.
b. Hepatocellular adenocarcinomas; IMHA, DIC, & IMT.
c. Transitional Cell Carcinomas; Urinary Tract Infections, cystitis, & renal tubular dysplasia.
d. Uterine Adenocarcinomas; No other diseases cause Bence Jones proteins.

A

a. B - lymphocyte or plasma cell neoplasia; leishmaniasis, ehrlichiosis, & babesiosis.

Stockham & Scott, Fundamentals of Veterinary Clinical Pathology, 2nd edition, pg. 462.

78
Q

A urine albumin concentration greater than what value is considered overt albuminuria?

A. 50 mg/dL
B. 500 mg/dL
C. 30 mg/dL
D. 1 mg/dL

A

C. 30 mg/dL

(pg 289; Grauer GF. Measurement, Interpretation, and Implications of Proteinuria and Albuminuria. Vet Clin Small Anim 37: 283-295, 2007)

79
Q

Which of the following cases would be most consistent with glomerular disease?

A. 7 y/o Doberman with casts noted on UA currently on gentamicin antibiotics
B. 4 month old Yorkie with portosystemic shunt and ammonium biurate crystals
C. 2 y/o DSH with UPC 2, evidence of hematuria 4+, & stranguria
D. 10 y/o Westie with UPC 10 with clean sediment

A

D. 10 y/o Westie with UPC 10 with clean sediment

(pg 291; Grauer GF. Measurement, Interpretation, and Implications of Proteinuria and Albuminuria. Vet Clin Small Anim 37: 283-295, 2007)

80
Q

Persistent proteinuria of renal origin is defined as which of the following?

A. positive proteinuria results on 3+ occasions 2 weeks or longer apart
B. negative proteinuria results on 3+ occasions 2 weeks or longer apart
C. positive proteinuria result on 1 occasion
D. positive proteinuria results on 3+ occasions each a day apart

A

A. positive proteinuria results on 3+ occasions 2 weeks or longer apart

(pg 291; Grauer GF. Measurement, Interpretation, and Implications of Proteinuria and Albuminuria. Vet Clin Small Anim 37: 283-295, 2007)

81
Q

Which of the following statements is true regarding microalbuminuria?

A. Microalbuminuria only occurs with glomerular disease.
B. Microalbuminuria may occur from pre-renal causes.
C. Microalbuminuria assays are not affected by hematuria or pyuria.
D. Microalbuminuria always occurs alongside tubular loss of globulins.

A

B. Microalbuminuria may occur from pre-renal causes.

Stockham and Scott, Ch. 8 Urinary System, pg. 480-483

82
Q

Which of the following statements is true regarding urine protein:creatinine (UPC)?

A. Normal UPC in dogs is <1.5
B. Tubular proteinuria usually causes a larger increase in UPC than glomerular disease.
C. UPC is used to standardize proteinuria based on the amount of water excretion by the kidneys.
D. A UPC of >2.0 is suggestive of glomerular disease.

A

C. UPC is used to standardize proteinuria based on the amount of water excretion by the kidneys.

(Stockham and Scott, Ch. 8 Urinary System, pg. 479-480)

83
Q

Protein is primarily resorbed in the _______________ of healthy animals.

A. Glomerulus
B. Proximal tubules
C. Distal tubules
D. Collecting ducts

A

B. Proximal tubules

Stockham and Scott, Ch. 8 Urinary System, pg. 457

84
Q

Which one of the four major types of proteinuria is most likely to cause hypoalbuminemia?

a. Overflow
b. Glomerular
c. Tubular
d. Hemorrhagic and inflammatory

A

b. Glomerular

Stockham and Scott (2nd Ed.), Chap. 8, p. 459.

85
Q

Which one of the following best characterizes the proteins that are readily filtered through the normal glomerular capillary?

a. Neutral or negatively charged ; molecular weight the size of albumin and smaller
b. Neutral or negatively charged ; molecular weight smaller than the size of albumin
c. Neutral or positively charged ; molecular weight the size of albumin and smaller
d. Neutral or positively charged ; molecular weight smaller than the size of albumin

A

d. Neutral or positively charged ; molecular weight smaller than the size of albumin

Grauer GF. Measurement, interpretation, and implications of proteinuria and albuminuria. Vet Clin North Am Small Anim Pract. 2007 Mar;37(2) :283-95. (p. 283-284)

86
Q

Among these quantitative urine total protein assays, which one is most affected by the albumin to globulin ratio in the sample?

a. Benzethonium chloride assay
b. Coomassie brilliant blue assay
c. Spectrophotometric SSA method
d. Trichloroacetic acid method

A

c. Spectrophotometric SSA method

Stockham and Scott (2nd Ed.), Chap. 8, p. 458, 477-478.

87
Q

Which of the following regarding proteinuria is TRUE?

a. UP/C of less than <1 is considered unremarkable for a dog
b. Strenuous exercise can result in persistent renal proteinuria due to increases in GFR.
c. Congestive heart failure may result in proteinuria.
d. A UPC is indicated in all cases of proteinuria.

A

c. Congestive heart failure may result in proteinuria.

PG 288, Grauer

88
Q

Which of the following is true regarding screening rests for proteinuria?

a. Dipsticks are highly sensitive for urine albumin.
b. False positives may occur in alkaline urine.
c. False positives may occur in dilute urine.
d. False positives are more common in dogs than cats.

A

b. False positives may occur in alkaline urine.

PG 285: Grauer

89
Q

Which of the following causes of microalbuminuria are true?

a. MA is an accurate predictor of subsequent renal disease in human beings with hypertension and hyperadrenocortisolism.
b. MA seems to be a good indicator of early renal disease in dogs.
c. Corticosteroid administration has been shown to cause significant increases in proteinuria in cats.
d. Strenuous exercise does not affect albuminuria in dogs.

A

b. MA seems to be a good indicator of early renal disease in dogs.

(PG 291: Grauer)

90
Q

The collecting tubules are permeable to water when:

a) ANP is present
b) ADH is present
c) Aldosterone is present
d) Never
e) Always

A

b) ADH acts on the collecting ducts to insert aquaporins

91
Q

Which of the following is a cause of azotemia in the case of a urethral obstruction?

a. Increased hydrostatic pressure causing a decrease in GFR
b. Inflammation causing renal tubular damage and impaired clearance of BUN and creatinine
c. Release of vasoactive substances that constrict the glomerular arterioles and decrease GFR
d. Both A and B
e. Both A and C
f. All of the above

A

e. Both A and C

Stockham and Scott (2nd Ed.), p. 431

92
Q

Which of the following electrolytes is not primarily absorbed in the proximal tubules?

a. Sodium
b. Chloride
c. Magnesium
d. Calcium

A

c. Mg - mostly absorbed in the thick LOH

93
Q

Urine composition is determined by several different factors. Which of the following does not affect the composition of the urine?

a) Renal tubular absorption
b) Quantity of plasma presented to the kidneys
c) Material added to the glomerular filtrate
d) Altered blood/aqueous barrier

A

D. Altered blood/aqueous barrier

Stockham and Scott (2nd Ed.), p. 441

Advanced Clinical Pathology (8 decks)

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