PU/PD Flashcards

1
Q

Polydipsia definition (PD)

A

water intake is greater than 100ml/kg/day
- >50 in cats

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2
Q

polyuria definition

A

urine output is >50ml/kg/day compared to a normal output of 1-2ml/kg/hour

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3
Q

USG < __ confirms PU while USG >__ is unlikely PU

A

1.020, 1.030

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4
Q

Antidiuretic Hormone

A

produced in the hypothalamus then stored/released from the posterior pituitary targeting V2 receptors and creating increased aquaporins

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5
Q

central diabetes insipidus is __ ADH deficiency while nephrogenic is a lack of__ to ADH

A

partial/complete, responsiveness

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6
Q

what is the most common cause of PU/PD in small animals?

A

secondary nephrogenic DI

primary is rare

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7
Q

primary polydipsia is __ while primary polyuria is __

A

behavioral, impaired renal concentrating capacity

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8
Q

psychogenic polydipsia

A

behavioral disorder of unknown cause, anxiety is speculated

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9
Q

non-pathologic polydipsia

A

pain, stress, hyperthermia, heat, exercise

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10
Q

Hyperadrenocorticism

A

glucocorticoids inhibit ADH release and renal response to ADH

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11
Q

Hepatic Disease

A

unknown; behavorial secondary to encephalopathy vs decreased urea concentration in medullary insterstitium

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12
Q

hyperthyroidism

A

unclear, decreased medullary solute washout from increased renal blood flow vs thyrotoxicosis- induced psychogenic polydipsia

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13
Q

primary polydipsia differentials

A

psychogenic polydipsia
non-pathologic polydipsia
hyperadrenocorticism
hepatic dz
hyperthyroidism

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14
Q

primary polyuria - extra renal causes

A
  • central DI
  • hypercalcemia
  • hypokalemia
  • pyometra
  • hypoadrenocorticism (hyponatremia)
  • DM
  • Hypersomatotropism (acromegaly)
  • pheochromocytoma
  • hyperviscosity syndrome/polcythemia
  • neoplasia
  • low protein diet
    -splenic hemangiosarcoma
  • drug induced secondary nephrogenic DI
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15
Q

Central DI

A

absent or decreased ADH production

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16
Q

hypercalcemia

A

downregulation of aquaporin, impaired ADH action, impaired NaCl transport in loop of henle, decreased GFR from vasoconstriction, and eventually tubular dysfunction from nephrocalcinosis

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17
Q

hypokalemia

A

downregulation of aquaporin/decreased ADH response

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18
Q

pyometra

A

bacterial endotoxin competitively inhibits and damages ADH receptors and decreases NaCl transport into medullary interstitium

19
Q

hypoadrenocorticism

A

decreased medullary osmolarity from sodium loss which also impairs normal stimuli for ADH release in dehydration

20
Q

Diabetes mellitus

A

osmotic diuresis from glucosuria

21
Q

pheochromocytoma

A

catecholamine- induced inhibition of ADH release and response

22
Q

hyperviscosity syndrome/polycythemia

A

decreased ADH secretion from inhibition from ANP

23
Q

neoplasia (intestinal leiomyosarcoma)

A

paraneoplastic secondary nephrogenic DI

24
Q

low protein diet

A

loss medullary gradient from decreased urea nitrogen

25
Q

splenic hemangiosarcoma

A

paradoxical: compensatory polyuria following ADH release from hypovolemia in addition to stimulated thirst mechanism

26
Q

drug induced secondary nephrogenic DI

A

impaired renal ADH response. Vasopressin, ofloxacin, amp b, aminoglycosides, cisplatin, etc.

27
Q

primary polyuria - renal causes differentials

A
  • Primary/congenital nephrogenic DI
  • CKD
  • AKI
  • pyelonephritis
  • fanconi syndrome
28
Q

primary/congenital nephrogenic DI

A

mutation of V2 receptors or aquaporin

29
Q

CKD

A

decreased number of functional nephrons -> osmosis diruesis of remaining nephrons + distortion of medullary architecture -> disruption of counter-current mechanism

30
Q

AKI or post- obstructive diuresis

A

osmotic diuresis

31
Q

Pyelonephritis

A

loss of medullary gradient from interstitial inflammation + impaired ADH action from endotoxemia

32
Q

fanconi syndrome

A

osmotic diuresis from renal glucosuria

33
Q

> 100ml/kg/day __ PD and 80-100 is __

A

confirms, suggestive

34
Q

if you see hyperglycemia on a chem what do you think of first?

A

DM

35
Q

elevated ALP and hypercholesterolemia is suggestive of what?

A

hyperadrenocorticism

36
Q

hypoalbuminemia , hypocholesterolemia, low BUN, hypoglycemia +/- elevated liver enzymes indicates what?

A

liver disease

37
Q

differentials for azotemia

A

CKD, AKI, pyelonephritis

38
Q

differentials for hypothenuria (USG <1.008)

A

central DI
primary nephrogenic DI
primary psychogenic PD
hypercalcemia
hyperadrenocorticism
liver disease
pyelonephritis or pyometra
hemangiosarcoma/hemorrhage

39
Q

lack of app concentration (USG 1.008 -1.030) differentials

A

CKD
Hypercalcemia
cushings
liver disease
DM
pyelonephritis or pyometra
hyponatremia
hypokalemia

40
Q

concentrated urine (USG > 1.030) differential

A

NOT PU
intermittent PU
DM
Fanconi syndrome

41
Q
A
42
Q

what additional dx tests can be performed for pu/pd?

A
  • abdominal ultrasound
  • urine culture (pyelonephritis)
  • MAT+ PCR (lepto)
  • Bile acid stimulation Test (liver dz)
  • endocrine testing
43
Q

when is the water deprivation test indicated?

A

when the remaining dx’s are primary/psychogenic polydipsia (most commoon) and central and nephrogenic DI

44
Q

desmopressin is a synthetic form of __ that if after administered the patient decreases water intake and increases USG indicates __ while an absent/decreased response would indicate __

A

ADH, central DI, primary nephrogenic DI or primary polydipsia