Renal Flashcards
1
Q
Pre-renal azotemia
A
dehydration
hypotension
shock
blood loss
2
Q
Most common cause of renal azotemia in horse?
A
tubular azotemia
3
Q
Most common cause of post-renal azotemia in foals
A
ruptured bladder
4
Q
Most common causes of post renal azotemia in adult horses
A
calculi
bladder atony
5
Q
Clinical signs associated with lower urinary tract problems
A
- alterations in micturition
- not many systemic signs
6
Q
Clnical signs associated with upper urinary tract problems
A
- alterations in urine volume
- azotemia
- systemic signs
- increased urine protein, glucose
7
Q
renal glucose threshold in horses
A
180 g/dl
8
Q
Horse urine is normally high in what?
A
Calcium carbonate and mucous; also triple phosphate and CaOx crystals can be seen
9
Q
Acidic urine in horses may indicate?
A
infection
10
Q
USG-adult horses vs. foals
A
adults: 1.020-1.050
foals: normally dilute (<1.008)
11
Q
Most commonly diagnosed urinary system problems in horses
A
- acute renal failure
- usually tubular
- usually due to dehydration, hypovolemia and/or nephrotoxic drugs
- urolithiasis
- bladder problems in addition to urolithiasis
- bladder atony
- sabulous bladder
12
Q
Causes of acute tubular necrosis
A
- renal ischemia most often
- toxins
13
Q
What are the most common agents associated with acute glomerulonephritis?
A
- EIA
- S. equi var equi
- Lepto
- EHV
14
Q
Two pretty uncommon causes of ARF
A
- abnormalities of hemostasis
- acute interstitial nephritis
15
Q
Most common nephrotoxic drugs in horse
A
NSAIDs, aminoglycoside abx
16
Q
ARF clnical signs
A
- depression
- anorexia
- changes in urine output
- fluid retention->edema
- “colic” pain
17
Q
Acute renal failure-chemistry changes
A
- Increased BUN/Creatinine
- hyponatremia, hypochloremia
- variable potassium (probably depleted if not eating)
- metabolic acidosis
- hyperphosphatemia
18
Q
urine to serum creatinine of <37 indicates what?
A
renal injury
19
Q
Factors that improve the prognosis of AFR
A
- tubular basement membrane not disturbed
- no oliguria
20
Q
Treatment of ARF
A
- treat underlying cause
- discontinue (minimize) nephrotoxic drugs
- fluid therapy-IV preferable; field situation may necessitate oral
- diuretics, vasodilators (dopamine)
- hemodialysis and peritoneal dialysis are described
21
Q
CRF-causes
A
- chronic tubular necrosis
- urinary tract obstruction
- chronic glomerulonephritis
- pyelonephritis
22
Q
CRF-clnical signs
A
- weight loss
- lethargy, exercise intolerance
- rough hair coat
- PU/PD
- mild ventral edema
- signs of uremia
23
Q
signs of uremia in the horse
A
- poor appetite
- dark MM
- oral erosions
- vasculitis
- soft feces
- GI ulceration/bleeding/PLE, melena
- dental tartar
24
Q
What should you follow up on if you see dental tartar in a horse?
A
check creatinine, look for kidney dz
25
Chronic interstitial nephritis is usually secondary to:
* ARF (tubular necrosis) that was undiagnosed/untreated
* ascending UTI (pyelonephritis, pyelonephritis in association with urolithiasis)
26
Rationale for feeding grass hays to horses with CRF
lower in calcium
27
CRF prognosis
fairly poor
28
Cystic calculi-clinical signs
* dysuria
* hematuria
* pyuria
* complaint of bloody urine after exercise or urinating frequently while being ridden
29
Nephroliths-clinical signs
* dysuria
* hematuria
* colic, abdominal pain
* poor performance, lethargy
* inappetance, weight loss
30
Causes of urinary incontinence
* cystitis
* ectopic ureter
* urolithiasis "sabulous bladder"
* neurologic disease
* vaginal injuries, polyps
31
Make sure to perform _________ as diagnostics in cases of urinary incontinence
urinalysis & urine culture
32
Causes of hematuria
* UTI
* urolithiasis
* phenylbutazone
* urinary tract neoplasia
* nephrotoxicity
* urethral defects/tears
* idiopathic
33
difficult or painful urination
dysuria
34
slow and painful urination
stranguria
35
unduly frequent passage of small amounts of urine
pollakiuria
36
anuria
lack of urine production
37
decreased urine production
oliguria
38
Total protein and albumin may be decreased if \_\_\_\_\_\_\_
glomerular disease
39
What causes false positives for protein when using dipstick? What are better tests?
alkaline urine; use SSA test or colorimetric assay instead
40
Fractional excretion of electrolytes
* clinically useful indicator of renal function in large animals
* does not require collection of urine over time
* blood and urine samples obtained at same time, before horse started on any fluid therapy
* fractional excretion of sodium is indicative of renal tubular fxn; \>1% indicates renal tubular dysfunction
41
Increased [GGT] in the urine indicates \_\_\_\_\_\_?
renal tubular necrosis
42
BUN/Creatinine ratio \<10:1
prerenal or acute renal disease
43
BUN/Creatinine ratio \>15:1
chronic renal failure
44
What are some things you may be able to detect by rectal palpation?
* bladder stones, sludge
* thickened bladder wall
* dilated ureters
* enlargement or atrophy of left kidney
* irregularity of left kidney surface
45
How do aminoglycosides cause renal toxicity?
damage cellular organelles of proximal renal tubular cells
46
kidneys receive \_\_\_\_% of total cardiac output
20%
47
What part of kidney is most susceptible to injury from toxins?
renal cortices
48
The renal medulla is susceptible to what type of injury?
ischemic
49
Three stages of ARF
* induction: onset of injury to development of decreased GFR and azotemia
* maintenance: period of azotemia
* recovery: repair of damaged nephrons and hypertrophy of remaining functional nephrons to compensate
50
Treatment of hyperkalemia
* potassium free fluids (0.9% NaCl)-may be enough
* NaHCO3 or calcium gluconate if K very high
51
When might furosemide be ineffective?
if horse has marked decrease in GFR; must be filtered through glomeruli in order to reach site of action
52
Renal neoplasia
* rare
* usually carcinoma
* only affects one kidney; does not cause azotemia
53
Mechanism of anemia seen with CRF
decreased erythropoietin, decreased RBC life span
54
most common site of uroliths in horse
bladder
55
Contributing factors to urolithiasis
* concentrated urine
* prolonged urine transit time
* reduced inhibition of crystal growth
* areas of tissue damage
56
What are some neurologic causes of urinary incontinence?
* spinal cord injuries
* EPM
* herpes myelitis
* rabies
* cauda equina syndrome
* sorghum or sudan grass toxicity
