Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Veterinary Medicine > Renal > Flashcards

Renal Flashcards

1
Q

Urinary tract infections

A

E.coli (Staph) usually from faeces

Urine culture and sensitivity

Antibiotics:

  • Based on culture and sensitivity
  • Bacteriocidal
  • Excreted in urine
  • No/low toxicity
  • Easy and cheap

Most likely: ampicillin, potentiated amoxicillin, cefalexin, top end of dose range

Therapeutic culture if signs not improved after 3-5d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

UTI

Protective factors

A
  • Urethral high pressure zone
  • Surface charcateristics of urethral urothelium
  • Urethral peristalsis
  • Prosthetic antibacterial fraction
  • Longer urethtral length
  • Ureterovesical valves
  • Antibody production
  • Surface GAG layer
  • Intrinsic mucosal antimicrobial properties
  • Bacterial interference
  • Exfoliation of cells
  • Extreme pH
  • Hyperosmolarity
  • HIgh urea
  • Organic acids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

UTI

Increased risk

A
  • Urethral obstructions
  • Spinal disease
  • Bladder atony
  • Poor husbandry
  • Ectopic ureters
  • Urethral sphincter mechanism incompetence
  • Anatomical abnormalities following surgery e.g perineal urethrostomy
  • Direct trauma e.g. urethral catheterisation
  • Disease processes e.g. neoplasia
  • Chemical irritants e.g. cyclophosphamide
  • Older cats
  • Bitches
  • Diabetes mellitus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

IRIS staging system

A

Stage 1:

  • Non- azotaemic
  • Normal-ish GFR
  • Some other renal abnormality

Stage 2:

  • Non-mildly azotaemic
  • Clinical signs absent or PU/PD

Stage 3:

  • Mild - moderate azotaemia
  • PU/PD
  • Extrarenal signs: vomiting, dehydration, weight loss may be present

Stage 4:

  • > 440
  • PU/PD
  • Extra renal signs are likely
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of intrinsic renal disease in dogs and cats

A

Infectious:

  • Dogs: pyelonephritis, leptospirosis
  • Cats: pyelonephritis, FIP

Metabolic: hypercalcaemia nephropathy

Neoplastic: Primary renal tumour, lymphoma, metastatic

Congenital/familial:

  • Dogs: numerous breed associated syndromes, amyloidosis
  • Cats: polycystic kidney disease, amyloidosis

Other: obstructive disease, glomerulonepritis, recovery from ARF, toxins

Unidentified: tubulointerstitial nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Renal secondary hyperparathyroidism

CKD

A
  1. Dietary phosphate restriction - renal diets

2. Intestinal phosphate binding drugs - mixed in food, aluminum hydroxide preparations (or lanthanum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Glomerular hypertension and hyperfiltration

CKD

A

ACE inhibitors:

  • Cause preferential dilation of efferent arterioles
  • Reduction of glomerular capillary pressure and reduce glomerular capillary permeability to protein
  • Thus reduces proteinuria prevents glomerulosclerosis development and ongoing renal injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hypokalaemia

CKD

A

20-30% cats with CKD
Treatment can lead to clinical improvement in the cats appetite and level of muscle strength and activity
Renal diets often potassium supplemented

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Acidosis

CKD

A

Metabolic acidosis

Do not administer bicarbonate unless imbalance is well documented

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Anaemia

CKD

A 
Erythropoetin deficiency 
Blood loss, GI ucers, frequent blood samples, surgery
Decreased RVC lifespan
Uraemic inhibitors of erythropoesis
Iron deficiency

Can give erythropoetin but risky!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hypertension

CKD

A

Can cause acute blindness in cats
- Retinal detachment, retinal haemorrhage, hyphema

Can also cause neuron signs and cardiac changes

Oscillometric and Doppler techniques (preferred in awake patients)

Treat when >170-180mmHg and consistent ocular lesions are present
Diagnosis confirmed when two clinic trips have been made

Amlodipine in cats 0.625mg/cat/day - double if does not improve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Proximal convoluted tubule

A

Returns 70% of filtrate to plasma

Sodium co-transport occurs linked to:

  • Glucose, amino acids
  • Hydrogen ions (bicarbonate resorption)
  • Phosphate
  • Chloride flux (between cells)
  • Water follows passively
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Loop of Henle

A

Thick ascending limb actively transports Na, K, Cl out of tubule
Impermeable to water
Vasa recta are important in maintain concentration gradient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Distal tubule - Macula densa

A

Passes right next to afferent arteriole
Senses amount of chloride passing per unit time
Signals to the glomerulus - controls GFR
Functions:
- Fine regulation of urine composition
- Site of action of aldosterone - salt retaining hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Connecting tubule, collecting tubule and collecting duct

A

Sensitive to ADH:

- Increases number of water channels present in epithelium - Enhances permeability to urea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Upper urinary tract signs

A 
PU/PD
Abnormal renal palpation
Oliguria/anuria
Depression, lethargy
Halitosis
Oral ulcerations
Haematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lower urinary tract signs

A 
Dysuria, polkauria
Oliguria, anuria
Urinary incontinence
Haematuria
Abnormal palpation of urethra/bladder
Abnormalities of external genitalia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Catheterisation

A

Males:

  • Extrude penis (make sure it’s straight in cat)
  • Pass catheter gently via external urethral orifice - stop if resistance
  • Stop once urine encountered

Females:

  • Visualise using speculum
  • Pass catheter into urethral orifice gently
  • Can do blind
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Urea and creatinine

A

Indicators of GFR
Urea produced in liver via urea cycle:
- Can be influenced by high protein meal, GI bleeding
- Not excreted in faeces
- Increases with dehydration
- Not a good indicator of renal function in cows - excreted in rumen and converted into ammonia - amino acids - protein production

Creatinine derived from creatine in muscle:

  • More sensitive in cows and horses
  • Useless in birds
  • Poor in dogs and cats
  • Ruptured bladder: abdominal fluid concentrations higher than serum - last longer than urea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Pre-renal azotaemia

A

Increased protein catabolism secondary to gastric/small bowel haemorrhage, necrosis, starvation, corticosteroid
High protein diets
Reduced renal perfusion

USG is high because ADH responds and kidney concentrate urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Renal azotaemia

A

3/4 nephrons non-function (dogs)

Insufficient excretion of urea and creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Post-renal azotaemia

A

Secondary to obstruction or post renal leakage
Oliguria, anuria
USG may vary
Urea and creatinine should return to normal once obstruction/leakage resolved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Isosthenuria

A

1.008-1.012

Kidney not diluting or concentrating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hyposthenuria

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Sodium

A

Main ion in ECF - regulated by kidney

Increased: increased intake, increased water loss or decreased water loss

Decreased: increased loss, increased water intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Chloride

A

Usually coincide with changes in acid/base

Interference from bromide and iodine salts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Potassium

A

Main ion in ICF

Increase: renal failure especially if anuria/oliguria present (dogs and cats)

Decrease: loss (vomiting, diarrhoea, renal) and decreased intake

28
Q

Calcium

A

In renal failure, increased amount is bound to anions
Levels regulated by PTH, vitamin D and calcitonin
Renal failure: hypo or normocalcaemic - cats, dogs and cattle
Horses: will become hypercalcaemia is major excretory route for calcium

29
Q

Urine sediment

A

Ammonium biurate crystals

PSS

30
Q

Bilirubin crystal

A

Most common in dog urine
No clinical importance in low numbers

Often significant in cats and horses

31
Q

Calcium oxalate

A

(Monohydrate: ethylene glycol toxicity)

Increased incidence especially in cats - prevent struvite, promote oxalate
Breed predispositioin, males more than females, older animals, upper urinary tract

(Dihydrate: normal urine)

Surgery, urohydropropulsion, medical dissolution not possible, ignore?
Increase water

32
Q

Struvite crystals

A

Most common type of crystals in cats and dogs
Alkaline urine pH
Often have concurrent UTI (dogs), sterile in cats
Most female, urease producing bacteria (Staph, Proteus)

Treat UTI for 3-4w
Reduce urinary magnesium, ammonium, phosphate
Can prevent with diet but is over-prescribed and can result in calcium oxalate

33
Q

Calcium carbonate

A

Normal horse urine

Horses can also have calcium oxalate crystals in low numbers

34
Q

Acute renal failure

A

> 75% of kidney is abruptly impaired
Abrupt increase in urea and creatinine
Retention of potassium - cardiac arrhythmias
Retention of phosphates - binds ionised calcium, muscle tremors, coma
Disturbance of electrolytes and decreased pH - metabolic acidosis
Hypertension
Oliguria/anuria
Often reversible

35
Q

Non-renal lesions of uraemia

A

Endothelial degeneration and necrosis - vasculitis with secondary thrombosis and infarction in a variety of tissues i.e. intestinal tract

Caustic injury to epithelium of the oral cavity and stomach (ulceration) consequent to production of large concentrations of ammonia after splitting of salivary or gastric urea by bacteria

Ulcerative glossitis and stomatitis:

  • Brown foul mucoid material stuck to oral mucosa
  • Often bilaterally symmetrical on underside of the tongue

Ulcerative and haemorrhagic colitis - horses and cattle

Ulcerative and haemorrhagic gastritis - dogs and cats, can also occur secondary to mineralisation of the gastric mucosa and submucosal arterioles, vomiting (black tarry stomach contents)

Uraemic encephalopathy - white matter spongiform degeneration

Uraemic pneumonitis:

  • Vasculitis affecting alveolar capillaries - increased vascular permeability
  • Pulmonary oedema, fibrin exudation and a mild infiltrative of macrophages and neutrophils
  • With uraemic pneumonitis, patchy or diffuse pulmonary calcification - failure to collapse, pale and gritty areas

Intercostal mineralisation: calcification of the subpleural connective tissue of the intercostal space

Fibrinous pericarditis

Arteritis: finely granular plaques within the left atrial endocardium and proximal aorta and pulmonary trunk

36
Q

Portal of entry

A

Haematogenous
Glomerular infiltrate e.g. oxulate crystals, toxins
Ascending from the ureter
Direct penetration

37
Q

Causes of glomerular damage

A

Damage to the filtration barrier by deposition of immune complexes
Entrapment of thromboemboli and bacterial emboli
Direct viral or bacterial infection of glomerular components
Damage to other parts of the nephron
Reduced blood flow
Chronic loss of tubular function
Amyloid deposition

38
Q

Protein losing nephropathy

A

Leakage of albumin into the glomerular filtrate
Protein-rich glomerular filtrate accumulates in dilated tubular lumina - proteinuria and hypoproteinaemia
Prolonged severe renal protein loss - reduced plasma colloid osmotic pressure and loss of angiotensin III - nephrotic syndrome
- Generalised oedema
- Ascites
- Pleural effusion
- Hypercoagulability
- Hypercholesterolaemia

39
Q

Immune-mediated glomerulonephritis

A

Immune complexes deposited in subepithelial, subendothelial or mesangial locations
Stimulates complement fixation - chemotactic for neutrophils and macrophages - release of proteineases and oxygen derived free radicals - damage the basement membrane
Persistent infections etc.

Associated with:

  • Specific viral infection - FeLV and FIP
  • Chronic bacterial infection
  • Chronic parasitism
  • Autoimmune disease such as SLE
  • Neoplasia
40
Q

Glomerular amyloidosis

A

Reactive amyloidosis - amyloid deposits are composed of fragments of a serum acute phase reactant
Idiopathic
Hereditary predisposition: Abyssinian cats and Shar Pei

PLN and the nephrotic syndrome

41
Q

Acute suppurative glomerulitis

A

Bacterial or embolic nephritis
Bacteria lodge in glomerular and interstitial capillaries

Actinobacillus equuii (foals)
Erysipelothrix rhusiopathiae (pigs)
Corynebacterium pseudotuberculosis (sheep and goats)
Arcanobacterium pyogenes (cattle)

Toxic by-products

42
Q

Glomerulosclerosis

A

Decrease in number of functional glomeruli
Loss of glomerular capillaries and replacement of mesangial and Bowman’s space by FCT
Hypoxia -> tubular epithelial degeneration and loss
Chronic proteinuria

43
Q

Inherited abnormalities in renal tubular function

A

Primary renal glucosuria:

  • Norweigan Elkhounds
  • Decreased ability of tubular epithelial cells

Fanconi syndrome:

  • Basenji dogs - heriditory defect in tubular re-absorption of protein, glucose, phosphate, amino acids
  • Can develop progressive renal insufficiency and associated renal fibrosis

Cystinuria: sex-linked inherited tubular defect in male dogs

44
Q

Acute tubular necrosis

A

Most important cause of acute renal failure

Oliguria/anuria: leakage of filtrate across disrupted basal membrane, intratubular obstruction

Nephrotoxic pigments:

  • Haemoglobinuric nephrosis: chronic copper toxicity in sheep, babesiosis in cattle, red maple toxicity in horses and AIHA in dog
  • Myoglobinuria nephrosis: extensive muscle necrosis- azoturia of horses, capture myopathy of exotic/wild animals and severe trauma
  • Renal threshold for re-absorption of Hg and Mg is exceeded
  • Increased intraluminal concentration: increased tubular necrosis from renal ischaemia

Heavy metals: Lead - membrane or mitochondrial damage in the PCT cells

NSAIDs, fungal and plant toxins (Aspergillosis, lilies in cats, grapes and raisins, oak in cattle, oxalate containing plants), ethylene glycol (calcium oxalate crystals precipitate in renal tunular lumens), vitamin D, pet food contaminants, bacterial toxins (Clostridia in small ruminants - pulpy kidney)

45
Q

Diseases of the interstitium

A 
E.coli septicaemia - white spotted kidney
Equine arteritis virus or PRRS
Canine adenovirus
Leptospirosis
FIP
46
Q

Kidney neoplasia

A

Primary are highly malignant

Nephroblastoma: pigs and chickens

Mesenchymal tumours: primary renal sarcomas are rare, fibromas, fibrosarcomas and haemangiosarcoma

Epithelial tumours: adenomas, carcinomas (large, usually occupy and obliterate one pole of the kidney, paraneoplastic condition), transitional cell papillomas and carcinomas

Metastatic tumours: carcinomas and sarcomas, renal lymphoma (cats and cattle)

47
Q

Hydronephrosis

A

Dilation of the renal pelvis because of obstruction of urine outflow
If contaminated by blood borne bacteria lodging in the hydronephrosis - pus - pyonephrosis
- Corynebacterium spp., E.coli, Staphylococcus spp., Streptococcus spp., Pseudomonas aeruginosa and Arcanobacterium pyogenes
- Cow and sow - parturition, service and catheter use
- Ascending infection

Cause: congenital malformation, ureteral or urethral blockage due to urinary calculi, chronic inflammation, ureteral or urethral neoplasia, neurogenic functional disorders

48
Q

Papillary necrosis

A

Primary:

  • Prolonged/overdose NSAIDs
  • Decrease prostagladin synthesis

Secondary:

  • Decrease vasa recta blood flow - glomerular amyloidosis or glomerulosclerosis
  • Compression of the vasa recta within the medulla - interstitial oedema or fibrosis
  • Compression of the renal papilla
49
Q

Development anomalies of the lower urinary tract

A

Ureteral aplasia and hypoplasia - obstruction - hydronephrosis
Ectopic ureters - empty in urethra, vagina or bladder neck
Patent urachus - foals, foetal urachus fails to close - direct channel between bladder and umbilicus

50
Q

Lower urinary tract obstruction

A

Congenital: cysts, ureter aplasia or ectopic ureters

Acquired: calculi, neoplasia, trauma and inflammation, circumferential fibrosis, bladder paralysis, vaginal and uterine prolapse, Feline urologic syndrome (fine struvite crystals - sand, in a mucoid protein matrix fill the urethra)

51
Q

Urolithiasis

A 
Urinary obstruction (males) and larger calculi form (females)
Local pressure necrosis and mucosal ulceration and haemorrhage
Uric acid in Dalmation dogs, substances processed abnormally by the kidney (cystine or xanthine), magnesium in commercial food, vitamin A deficiency

Sites of obstruction:

  • Cattle - proximal end of the sigmoid flexure
  • Sheep - urethral process
  • Dogs - proximal to the base of the os penis
52
Q

Acute cystitis

A

Bacterial infection - most common cause
Uropathogenic E. coli in many spp. Corynebacterium renale in cattle and Eubacterium suis in pigs
Hydrolysis of urea by urease producing bacteria - C renale and E suis in pigs - release excessive ammonia - damage mucosa and increase urine pH

Predisposing factors:

  • Urinary stasis
  • Infrequent urination
  • Calculi
  • Catheterisation
  • Prolonged antibiotic use
53
Q

Neoplasia of the lower urinary tract

A

Epithelial tumours: transitional cell papillomas or carcinomas, SCC and adenocarcinomas

Mesenchymal tumours: leiomyomas, fibromas, lymphoma, rhabdomyosarcoma

54
Q

Developmental disorders of the kidney

A

Renal aplasia - one or both kidneys to develop
Hypoplasia - in complete development
Ectopic kidneys - leads to secondary hydronephrosis
Fused kidneys - fusion of cranial or caudal poles
Dysplasia
Progressive juvenile nephropathy - severe bilateral renal fibrosis
Renal cysts

55
Q

Ammonium urate

A

Dalmations: reduced conversion of uric acid to allantoin, defective transport uric acid into hepatocytes and out of the urine
Hepatic dysfunction: PSS, increased excretion of ammonia and urea
English bulldogs

Diet, allopurinol

56
Q

Cystine

A

Renal tubular defect resulting in excess urine cystine which is poorly soluble
Middle aged dogs
Radiolucent
Medical dissolution effective but very expensive

57
Q

FLUTD

A

FELINE LOWER URINARY TRACT DISEASE

Haematuria, stranguria, pollakiruria, dysuria
Licking of penis and prepuce
Inappropriate unrination
Vocalisation, hiding
Signs of urethral obstruction
58
Q

FLUTD

Older cats

A 
Over 10y
Can usually identify underlying cause: UTI
- CKD
- Hyperthyroidism
- Diabetes mellitus
- Urolithiasis
- Bladder tumours

If no UTI, identified - try imaging

59
Q

FLUTD

Younger cats

A

Typically episodic and resolve in 3-7d unless urethral obstruction occurs
Recurrence very common

Risk factors: Persians, obesity, young, neutered, sedentary life style, dry food, stress

  • Infectious agents - rarely isolated
  • Viral - herpesvirus, calicivirus etc.
  • Newer theories: neurogenic inflammation, deficient GAG layer, sympathetic overactivity

Treat:
Wet food, increase water intaker, reduce stress, (synthetic GAG, amitriptyline

FIRST EPISODE

  • PE and history (rule out obstuction, stress)
  • Urinalysis if possible - USG (high - idiopathic, stone)
  • Educate owner
  • Environmental changes, water fountain, wet food
  • Feliway

RECURRENT

  • All above
  • Imaging
  • If idiopathic, try GAG
  • Behaviourist, butorphanol, repeat imaging
60
Q

Renal diets

A

Reduced protein: does not protect kidneys but may reduce urea/creatinine in blood, can lead to muscle breakdown

Phosphate restriction: can have positive results but may difficult to administer

Sodium: unclear need

Acid-base status:

  • Metabolic acidosis: (cats) anorexia, nausea, vomting, lethargy, weakness, muscle wasting, weight loss
  • Oral bicarbonate may not work due to taste

Caloric intake:

  • Supportive measures: fluids, gastroprotectants
  • Slowly switch diets
  • Place feeding tube
  • Avoid force feeding (cats)

Omega-3 fatty acids:

  • Preserve renal morphology
  • Omega-6 fatty acids are detrimental
  • May improve appetite
61
Q

Urolithiasis

Farm

A

Urinary obstruction in small ruminants due to dietary imbalances:

  • Generally only males show signs
  • High concentrate/low roughage, high phosphate/low calcium, high magnesium, alkaline urine
  • Dehydration, UTI
  • Urethral processes (vermiform) in small ruminants
  • Distal sigmoid flexure in cattle
  • Compications: bladder rupture, urethtral ruptue, hydronephrosis
62
Q

Amyloidosis

Farm

A

Common in cattle, associated with chronic sepsis
Inflammation drives serum amyloid A (SAA) production: glomerularopathy
Loss of glomerular function results in protein losing nephropathy
Oedema, weight loss, chronic diarrhoea
Proteinuria, hypoalbuminaemia, azotaemia
Raised serum fibrinogen, SAA, globulins
No treatment

63
Q

Enzootic haematuria

Farm

A

Cattle and sheep grazing bracken - chronic (>12m exposure), multiple cases

Bladder wall neoplasia

Anaemia

Differentiate from haemoglobinuria

64
Q

Ulcerative posthitis/vulvitis

Farm

A

Pizzle rot in small ruminants
Ulcerative bacterial infection of prepuce and vulva mucous membranes - Corynebacterium renale, high protein diets appear to predispose

Pain, loss of condition, decreased fertility/libido

Penicillin, NSAIDs, reduce dietary protein

65
Q

Pyelonephritis

Farm and horses

A

Ascending infection of the urinary tract - common in renal disease

Acute: pyrexia, anorexia, depression, colic, decreased milk yield, stranguria, polyuria, haematuria, pyuria

Chronic: weight loss, colic, decreased milk yield, diarrhoea, PU, anaemia, less obvious signs of UTI

Gram negatives: coliforms, Proteus sp., Klebsiella sp., Enterobacter sp.
(Gram positive: A. pyogenes, rarely C. renale)

66
Q

Protein:creatinine ratio in urine

A

o.4, >0.5 (cats) Proteinuric

67
Q

Cause of proteinuria

A

Pre-glomerular
Glomerular: increased glomerular pressure
Tubular: only ever mild, can be seen in CKD
Post-glomerular: UTIs, urolithiasis

Veterinary Medicine (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions