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VETM 442 Clin Path > Renal 1 > Flashcards

Renal 1 Flashcards

1
Q

4 renal functions

A

eliminate metabolic wastes, water and electrolyte balance, acid base regulation, and endocrine (RAA, erythropoietin, vit D)

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2
Q

Calcitriol produced from calcidiol by ________ in proximal renal tubular epithelial cells

A

alpha-1 hydroxylase

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3
Q

3 processes that control H2O, electrolyte, and waste excretion are

A

GFR, tubular resorption, tubular secretion

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4
Q

what is the glomerulus? what is the GFR?

A

glom glom = filtration unit of kidney
glom filtration rate = rate at which blood is filtered through all of glomeruli, and thus measure of overall renal function

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5
Q

what are 2 properties of freely filterable substances

A

small <3.4 nm and positive or neutral charge
eg. albumin is negatively charged, so albuminuria indicates subclinical disease

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6
Q

glomerular disease will increase or decrease leakiness

A

increase

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7
Q

renal function: reabsorption occurs in the ________ while secretion occurs in the _________

A

proximal tubules; distal tubules

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8
Q

renal function: what is tubular disease

A

retention of metabolic wastes; acid base and electrolyte disturbances; inability to concentrate or dilute urine

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9
Q

what 3 things does renal concentrating ability depend on (kinda 4 things)

A

renal interstitium (concentration gradient of NaCl and urea is needed for formation of medullary interstitial osmotic gradient), functional tubules, ADH and ADH responsiveness

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10
Q

to dilute urine requires what 2 things

A

sufficient filtered Na+ and Cl- and active transport in ascending limb

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11
Q

concentrate urine requires what 2 things

A

ADH and concentration gradient (NaCl and urea)

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12
Q

what does USG assess?

A

renal concentrating/diluting ability using a refractive index

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13
Q

what is USG range, and what does it depend on

A

1.001-1.065, depends on hydration status

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14
Q

give adequate renal concentrating ability USG values for dog, cat, cow, horse

A

> 1.030 Dog, >1.035/40 Cat, >1.025 Cow and horse

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15
Q

what does isosthenuria indicate?
what is the range on USG?

A

kidney unable to concentrate of dilute urine, classified as renal azotemia (intrinsic renal disease) when azotemia is present.
1.008-1.012

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16
Q

what does hyposthenuria indicate? what is the range on USG?

A

kidney unable to dilute urine, <1.008

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17
Q

what 2 general types of kidney disease exist? can they be differentiated by bloodwork alone?

A

acute and chronic.
no, need C/S and hx, duration of signs, etc.
exceptions exist, eg. anemia of inflammatory renal disease = CKD

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18
Q

if you have pre-renal azotemia, what is USG? what does it mean?

A

USG > 1.030, so adequate concentrating ability, but there is impaired renal blood flow or decreased perfusion (decreased blood volume) and if left untreated can lead to renal hypoxia and renal azotemia

19
Q

with post-renal azotemia, what is the USG value? what does it mean?

A

USG variable
distal to nephron obstruction: increased intracapsular hydrostatic pressure/afferent arteriolar constriction that decreases GFR/decreases delivery of waste

20
Q

what does uremia refer to

A

clinical signs associated with renal failure: V/D, weakness, ammonia smell breath

21
Q

what is the major nitrogenous waste product from mammals? how is is synthesized and excreted?

A

BUN/urea.
synthesized in liver from CO2 and ammonia via the urea cycle
excreted almost exclusively in URINE
EXCEPT in cattle and horses it is excreted in GI system where it is degraded to NH4+ by enteric bacteria with urease, in rumen and cecum, respectively, then passively absorbed into portal blood as AA or excreted into feces

22
Q

BUN/urea is readily filtered by what? is this passive or active?

A

glomerulus
passive diffusion to excrete into urine (or in cattle and horses, into GIT then passive diffusion into portal blood as AA or excreted into feces)

23
Q

3 conditions you would see INCREASED BUN/urea

A

decreased GFR (any reason), increased protein digestion (more in diet or hemorrhage into GIT), protein catabolism due to fever

24
Q

3 conditions you would see DECREASED BUN/urea

A

decreased production (liver failure or PSS), decreased protein diet/malnutrition, increased excretion, urea cycle enzyme deficiencies, but rare

25
Q

creatinine is produced where (at a constant rate, as a result of normal muscle metabolism)

A

skeletal muscle. not the same as CK which is a leakage enzyme in cytoplasm of myocytes

26
Q

which enzyme is produced in skeletal muscle at a constant rate as a result of NORMAL muscle metabolism and not reabsorbed (is excreted unchanged by renal tubules or collecting ducts)? which is a LEAKAGE enzyme in cytoplasm of myocytes (not a marker of kidney disease, but a marker of either muscle damage or liver disease)

A

creatinine; creatine kinase

27
Q

what is azotemia

A

increased BUN and creatinine. markers of kidney disease

28
Q

***renal failure (aka renal insufficiency or preferred term kidney disease/injury) occurs when ____% of functional renal mass is lost and ______ develops

A

66-75%; azotemia

29
Q

acute vs chronic kidney disease or injury: which is reversible?

A

acute is potentially reversible, chronically irreversible. again, can’t be diagnosed with lab tests alone definitively because there is considerable overlap

30
Q

assessing kidney disease with creatinine and BUN: what should you consider with increased BUN?

A

other causes of increased BUN are:
- intestinal hemorrhage
- increased protein catabolism (generates increased NH4+ this increased BUN production by hepatocytes) (creatinine will be normal and BUN increase will be mild)

31
Q

assessing kidney disease with creatinine and BUN: what should you consider with creatinine?

A

consider muscle mass

32
Q

assessing kidney disease with creatinine and BUN: what should you consider with creatinine?

A

consider muscle mass

33
Q

compare serum creatine and serum SDMA: which increases at earlier % function loss? which is more specific? which is more sensitive? which is affected by

A

both are specific (serum creatinine 100%, serum SDMA 91%)
serum creatinine: increase at 75% function loss, NOT sensitive (17%), decreases with age and hyperthyroidism in cats, variable reference ranges
serum SDMA: increases at only 40% loss, 100% sensitive, not affected by age, muscle mass, or hyperthyroidism, ONE reference range

34
Q

***can you interpret azotemia properly without USG?

A

no

35
Q

three components of urinalysis are

A

physical, chemical, microscopic

36
Q

cylinduria (casts in urine) can be seen with what condition

A

tubular disease

37
Q

crystalluria can be potential cause of what disease, (but is not a reliable indicator for presence of uroliths/nephroliths)

A

kidney disease

38
Q

glucosuria in a normoglycemic patient is indicative of what disease

A

tubular disease

39
Q

is proteinuria in dilute urine a cause for concern that should be investigated

A

always!
(in some healthy dogs in dilute urine can be microalbuminura (small amounts albumin))

40
Q

***hypoalbuminemia in blood is most often associated with what kind of proteinuria?

A

renal proteinuria

41
Q

what are 3 types of proteinuria? (kinda 4, one please give the two subtypes)

A

pre-renal (overflox proteinuria) = more small blood proteins get filtered through the glom glom
renal proteinuria: glomerular = damage to the glom glom so decreased selective permeability and passage of larger proteins
renal proteinuria: tubular = damage to tubules, so smaller proteins that should be resorbed are not
post-renal (hemorrhagic and inflammatory proteinuria) = hemorrhage or inflammation in LUT, eg. UTI

42
Q

what is UPC ratio? what does it help to conform?

A

evaluates loss of protein relative to creatine (since creatinine filtration is relatively constant in healthy animals)
helps confirm a renal proteinuria

43
Q

tell me the normal UPC ratio in dogs? what is abnormal (hint: think what the UPC ratio is used to help confirm)

A

normal is <0.5
remember they help to confirm a renal proteinuria
- tubular proteinuria will be >0.4 (if azotemic) or 1-2 (if not azotemic)
- glomerular proteinuria >2.0 (more dramatic)

VETM 442 Clin Path (3 decks)

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