Renal

Question 1

Which kidney is more cranial?

Answer 1

Right

Question 2

What is the nephron?

Answer 2

• The structural and functional unit of the kidney
• Each nephron includes a filter, glomerulus, Bowmnan’s capsule, proximal tubule, loop of Henle, and distal tubule

Question 3

How many nephrons do dogs and cats have?

Answer 3

Dogs: 415,000
Cats:: 190,000

Question 4

What is the glomerulus?

Answer 4

A capillary bed fed by afferent arterioles that arise from the renal artery. Blood enters, circulates quickly, and exits via efferent arteriole, which continues to supply blood to remainder of nephron and carry away reabsorbed solutes and water from tubules

Question 5

What is Bowman’s capsule?

Answer 5

A hollow structure that surrounds the glomerulus that is comprised of epithelial cells. Its thin epithelial enables rapid movement of ultrafiltrate into the B/C. Fluids absorbed into the B/C moves into the lumen of the proximal tubules

Question 6

Where does the loop of Henle go?

Answer 6

• From the cortex to the medulla then back to the cortex
• The distal tubule terminates at the collecting duct

Question 7

What is urine?

Answer 7

It is what is leftover after the kidneys reabsorb 99% of the plasma water filtered by the tubules

Question 8

Oliguria is characterized by?

Answer 8

• UOP 0.27-0.5ml/kg/hr
• Low USG (<1.020)
• Indicates the kidney has lost the ability to concentrate urine

Question 9

Why is it OK to give UO cats IVF that already contain K in them?

Answer 9

These are physiolgoical concentrations of K that don’t affect K clearance and also act as an alkalinizing isotonic solution (most UO pts will be in metabolic acidosis)

Question 10

What is the most common stone type?

Answer 10

Struvite
- Urine must be saturated with Mg, NH3, Phos for them to form
- Usually associated with urease producing microbes in UTI which alkalinize the urine
- Sx preferred but can be medically managed

Question 11

What type of stone are Dalmations prone to?

Answer 11

Ammonium urate
- Diet should be purine restricted
- Urine should be alkalinized

Question 12

How long can a urine sample be refrigerated for?

Answer 12

Up to 8 hours in a sterile container without a substantial change in results

Question 13

What are the most common uropathogens?

Answer 13

AEROBIC bacteria
- Escherichia
- Staph
- Proteus
- Streptococcus
- Klebsiella
- Entero
- Pseudomonas

Question 14

Where is peripheral edema usually noticed first?

Answer 14

The hocks

Question 15

What creates the osmotic gradient required in PD?

Answer 15

Dextrose

Question 16

What is the most common complication of PD?

Answer 16

Peritonitis

Question 17

What is Intermittent Hemodialysis?

Answer 17

• Planned treatment
• For patients with CKD that require long term management of uremia
• Typically lasts 3-4 hours and is performed several times a week
• Rates are higher
• Uses principle of diffusion

Question 18

What is Continuous Renal Replacement Therapy?

Answer 18

• Typically chosen for AKI or toxin exposure
• Tx are longer with slower flow rates designed to mimic native kidney function
• Uses a combo of convection and diffusion

Question 19

The arterial access catheter carries blood from ___ to ____?

Answer 19

• From the patient to the dialyzer
• Connects to proximal port

Question 20

The venous access catheter carries blood from ___ to ___?

Answer 20

• From the dialyzer to the patient
• Connects to distal port

Question 21

Why is sodium citrate beneficial to use?

Answer 21

• Bacteriostatic
• Prevents biofilm
• Cheaper than heparin

Question 22

What are the four dialysis techniques?

Answer 22

• Ultrafiltration
• Diffusion
• Convection
• Adsorption

Question 23

What is ultrafiltration?

Answer 23

• Movement of fluid through a semi permeable membrane caused by a pressure gradient
• Leads to removal of “plasma water” from the blood and produces a fluid known as “ultrafiltrate”

Question 24

What is diffusion?

Answer 24

• The movement of solutes from an area of higher concentration to an area of low concentration
• Useful for smaller molecules

Question 25

What is convection?

Answer 25

• The movement of solutes with water flow

Question 26

What is adsorption?

Answer 26

• The adhesion of molecules from a liquid (blood) onto a solid surface (membrane)

Question 27

What are the four dialysis treatment modes?

Answer 27

• Continuous veno-venous hemofiltration
• Continuous veno-venous hemodialysis
• Continuous veno-venous hemodiafiltration
• Slow continuous ultrafiltration

Question 28

What is continuous veno-venous hemofiltration (CVVH)?

Answer 28

• Most similar to IHD
• Uses convection
• Used for solute and fluid removal
• Produces ultrafiltrate
• Dialysate NOT used - replacement fluid used to aid convection

Question 29

What is continuous veno-venous hemodialysis (CVVHD)?

Answer 29

• Similar to IHD
• Uses diffusion (D for hemoDialysis and Diffusion)
• Utilises dialysate - replacement fluids NOT used

Question 30

What is continuous veno-venous hemodiafiltration (CVVHDF)?

Answer 30

• Combines CVVH and CVVHD
• Solutes are removed by diffusion and convection
• Both replacement fluids and dialysate are used

Question 31

What is slow continuous ultrafiltration?

Answer 31

• Primarily used for fluid removal
• Not aimed at solute removal
• Resulting fluid is EFFLUENT

Question 32

What is dialysis disequilibrium syndrome?

Answer 32

• The development of cerebral edema induced by rapid changes in the osmolality of blood
• Directly related to rate
• Occurs in 1st few hours - 48 hours

Question 33

Which modes are safest for hypoalbuminemic patients

Answer 33

• CRRT & HD