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ECVIM Certifier > Renal > Flashcards

Renal Flashcards

1
Q

Function of the proximal tubule?

A

Isosmotic reabsorption of 70 % filtered water and NaCl, 90 % bicarb, NH3 production, reabsorption of almost all glucose and amino acids, reabsorption of potassium, phosphate, calcium, magnesium, urea and urate, secretion of organic anions and cations

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2
Q

Function of loop of henle?

A

Countercurrent multiplier, reabsorption 15-25 % filtered NaCl, active regulation of magnesium excretion

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3
Q

Function of distal tubule?

A

Small amount of NaCl absorption, active regulation of calcium excretion

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4
Q

Function of connecting segment/cortical collecting duct?

A

Aldosterone-mediated potassium secretion by principal cells, H+ secretion and potassium reabsorption by alpha intercalated cells, ADH mediated water reabsorption

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5
Q

Function of medullary collecting duct?

A

Potassium reabsorption or secretion, final NaCl reabsorption, ADH mediated water and urea reabsorption, H+ and NH3 secretion

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6
Q

Why is there more filtration in the glomerular capillaries than systemic?

A

More surface area, but not constant and can change eg with mesangial cell contraction under ATII influence

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7
Q

What substances constrict/relax the glomerular vessels?

A

Constrict afferent and efferent - norepinephrine, ATII, endothelin, thromboxane
Constrict just efferent - vasopressin
Relax both - acetylcholine, NO, dopamine, bradykinin, prostacyclin, PGI2
Relax afferent - PGE2

NE, ATII and ADH promote production of prostaglandins

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8
Q

What is tubuloglomerular feedback?

A

Local intrarenal negative feedback mechanism for individual nephrons:
Increased NaCl in the distal tubule sensed by extraglomerular mesangial cells of the juxtaglomerular apparatus, sensed by tubular cells of macular densa (transport of NaCl across them - requires Na K 2Cl transporter and ROMK potassium channel luminal, and NaKATPase basolateral)
Transcellular NaCl transport + ATII causes afferent constriction and decrease GFR to minimise NaCl loss

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9
Q

What transporter does furosemide inhibit?

A

NaK2Cl in loop of Henle, compete with Cl

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10
Q

What transporter do thiazides inhibit?

A

NaCl in distal convoluted tubule

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11
Q

What is sodium absorbed with in the PCT?

A

Glucose, amino acids, phosphate, bicarbonate

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12
Q

What is sodium absorbed with in the DCT/LoH?

A

Chloride

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13
Q

What transporters mediate luminal uptake of glucose in the PCT?

A

SGLT2 - high capacity low affinity, first and second portion
SGLT1 - low capacity high affinity, third portion

Saturatable

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14
Q

What mediates PCT phosphate absorption?

A

NaPi-IIa and IIc transporters

Low Tmax so ready excretion of phosphate at high conc cf glucose
PTH decreases Tmax and causes excretion

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15
Q

How is urea reabsorbed?

A

Passive (decreased with high tubular flow rates)
Facilitated transporters - UTA1/A3 in inner medulla collecting duct, ADH dependent, urea concentrates in interstitium

Can reenter thin descending LoH via UTA2, and reabsorbed to enter vasa recta (venous) and then arterial (have UTB) - countercurrent exchange

Impermeable to urea - DCT, cortical collecting duct, outer medullary collecting duct

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16
Q

What are the urinary concentrating mechanisms?

A

NaCl transport without water in ascending LoH causes hyper osmotic medullary interstitium
ADH increases water permeability of the collecting duct, tubular fluid equilibrates with hyper osmotic interstitium

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17
Q

What controls inner medullary collecting duct urea absorption?

A

ADH

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18
Q

What effect does aldosterone have in cortical collecting duct?

A

Sodium and chloride absorption and therefore water absorption

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19
Q

How is urine concentrated without ADH?

A

GFR decreased by dehydration, PCT reabsorbs more sodium and water

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20
Q

What is the vasa recta for?

A

Gains solute as moves distally, gains water as moves proximally. Interstitial osmolality increases as move distally (ascending LoH solute absorption) and decreases as move proximally

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21
Q

Where is renin from and what stimulates its release?

A

Juxtaglomerular apparatus, vascular endothelium, adrenal gland, brain.

Decreased renal perfusion sensed by afferent arterioles of granular cells of JGA, hypotension stimulation cardiac/arterial baroreceptors with SNS activity and catecholamines (beta 1 adrenergic receptors), decreased distal tubular flow or NaCl depletion (macula densa)

Inhibited by ATII

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22
Q

What are the effects of ATII?

A

Arteriolar vasoconstriction (most sensitive renal splanchnic cutaneous)
Facilitates NE release from adrenal medulla and sympathetic nerves
Increases PCT sodium absorption d/t NaH antiporter luminal membrane
Increases aldosterone secretion
TXA2 mediated glomerular vasoconstriction (efferent > afferent)
Increased sodium and water reabsorption
Mesangial contraction, decrease surface area
Release of vasodilatory PGE2 and I2

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23
Q

What inhibits 1alphahydroxylase?

A

Calcium, vitamin D, decreased PTH, increased phosphate

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24
Q

Definition of CKD?

A

> 2-3 m permanent irreversible loss of functioning nephrons

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25
Q

What does carbamylated haemoglobin measure?

A

Chronic measure of increases in circulating urea

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26
Q

Ideal GFR marker

A

Sole renal filtration, no metabolism, no protein binding, no tubular secretion, non toxic, don’t affect GFR

NB male dog active creatinine tubular secretion

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27
Q

Urinary clearance?

A

Urine flow rate x conc solute in urine

conc solute in plasma

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28
Q

What cats have increased creatinine?

A

Birman

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29
Q

What is SDMA?

A

Dimethylated derivative of arginine, produced from intranuclear L-arginine residues by protein arginine methyltransferase

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30
Q

What is cystitin C?

A

LMW protein, proteinase inhibitor, intracellular housekeeping gene production

Not protein bound and freely filtered, resorbed by megalin endocytosis in proximal tubules and catabolised

No secretion

Might be increased in tubular dysfunction?

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31
Q

What does the sulfosalicylic acid test check for?

A

Globulin/bence jones protein

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32
Q

Why would you measure microalbuminuria?

A

If suspect hereditary glomerular disease - more sensitive cf UPCR or dipstick

Needs to be persistent > 2 w to be of value

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33
Q

What impacts UPCR?

A

Active sediment, marked haematuria, hospitalisation, daily variability

Cysto does not change

If > 4 pool samples

Has to change 35 % if > 12 or 80 % if < 0.5 to be clin relevant change

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34
Q

When should a renal biopsy be pursued?

A

UPCR persistently > 3.5, no response anti proteinurics, progressive proteinuria or azotaemia despite adequate management, if considering immunosuppressive management

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35
Q

Important things to do before renal biopsy?

A

Control BP, discontinue anticoagulants, check haemostasis

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36
Q

Contraindications for renal biopsy?

A

Stage 4 renal disease, tubulointerstitial rather than glomerular, hydronephrosis, pyelonephritis, haemostic disorder, suspect amyloidosis, suspect hereditary, renal abscess

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37
Q

What media do renal biopsies go into?

A

Formalin (standard)
Michel’s medium (IF)
Glutaraldehyde (TEM)

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38
Q

How to calculate fractional excretion of electrolytes?

A

urine conc x (plasma/urine creat) x plasma conc
x 100

Increases as GFR decreases - electrolytes used as hypertrophy/compensatory

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39
Q

What casts are not necessarily abnormal?

A

Rare hyaline/granular

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40
Q

What are hyaline casts?

A

Mucoprotein, TammHorsfall protein, uromodulin, albumin

Colourless/cylindrical

Increase with marked proteinuria and dissolve in urine

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41
Q

Epithelial casts?

A

Direct tubular damage eg gentamicin

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42
Q

Granular casts?

A

Ischaemic/nephrotoxic insult - partially degraded cellular casts

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43
Q

Waxy casts?

A

Due to tubular stasis

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44
Q

What causes renal hyperechogenicity?

A

Non specific - glomerulonephritis, acute tubular necrosis, lepto, FIP end stage CKD

Dramatic in ethylene glycol tox

Renal dysplasia - corr with histopath

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45
Q

Hypoechoic subcapsular thickening?

A

Lymphoma

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46
Q

Medullary rim sign?

A

Ethylene glycol

NB outer medulla may be hyper normally

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47
Q

Medullary band sign?

A

Inner medulla hyper echoic - lepto

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48
Q

AKI classification?

A

1: Non azotaemic AKI - increase creatinine by 27 over 48h, clinical findings eg documented history or volume response, oliguria < 1
2: Mild, 150 - 221
3: Moderate/severe 230 - 442
4: 451 - 884
5: > 884

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49
Q

Mortality association with azotaemia?

A

Increased mortality in ICU even if increased creatinine without azotaemia

Hypothermia px indicator

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50
Q

Causes of AKI?

A

Hypoperfusion (haemodynamic), intrinsic, post

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51
Q

What factors make the kidney susceptible to injury?

A

High cardiac output, high metabolic demand, toxicity potential

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52
Q

What determines renal blood flow?

A

Perfusion pressure, cardiac output, intravascular volume

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53
Q

What defines volume response in AKI?

A

If increase UOP to > 1ml/kg/hr with fluid challenge or decrease creatinine to baseline over 48h

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54
Q

What happens if you don’t address haemodynamic/volume responsive AKI?

A

Progresss to intrinsic

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55
Q

What is required to progress from haemodynamic to intrinsic AKI?

A

Other factors eg local or systemic inflamm, infrarenal blood flow distribution change, microcirculatory dysfunction/glomerular haemodynamics

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56
Q

Phases of AKI?

A

Initiation - injury
Extension - cellular damage - hypoxia/inflamm
Maintenance - static 1-3 w
Recovery - increased UOP increased Na in urine due to decreased sodium transporters, Na loss can cause vol depletion

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57
Q

What is fenoldopam?

A

Dopamine 1 receptor agonist - causes renal vasodilation, inhibits ADH AT II and NaKATPase

Increases UOP

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58
Q

What are the cellular mechanisms underlying AKI?

A

Hypoperfusion, tubular dysfunction, ischaemic injury

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59
Q

Explain intrarenal vasoconstriction AKI

A

Vasoconstriction (decrease NO injured cells increased ET) - decrease GFR, cause ischaemic damage to cells

Decreased O2
Decreased cell energy metab
Mitochondrial dysfunction (calcium)

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60
Q

Explain ischaemic damage AKI

A

Reperfusion/oxidant injury, intracellular acidosis, phospholipase/protease activation

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61
Q

Explain tubule dysfunction AKI

A

Cell swelling
Loss of fence, transporters on wrong side
Tubular obstruction detached cells
Leaking junctions back leak fluid
Energy depletion disrupts cell cytoskeleton

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62
Q

What potentiates contrast mediated injury?

A

Hyponatraemia
Ionic contrast
Decreased BP and vasoconstriction renal circulation

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63
Q

What part of the glomerulus does vasopressin constrict most?

A

Efferent - maintains GFR

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64
Q

Why are aminoglycosides nephrotoxic?

A

Not metabolised, low molecular weight and water soluble. Ionised to cationic complexes and bind anionic sites on PCT cells, internalised and concentrate there.

Potentiation/risk factors = multiple daily dosing, increased concentration, electrolytes low, acidosis, furosemide,antiprostaglandin, dehydration

30S ribosomal binding

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65
Q

Why are tetracyclines nephrotoxic?

A

If expired - metabolites in mitochondria, interfere with PCT oxidative enzymes

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66
Q

Penicillin and sulphonamide nephrotox?

A

Hapten/hypersensitivity/crystallisation

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67
Q

Role of prostaglandins in the glomerulus?

A

Prostaglandin maintains afferent arteriole dilation to maintain GFR when systemic vasoconstriction is present

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68
Q

Neutrophil gelatinase associated lipocalin?

A

Same things found cats & dogs

NGAL - increased before creatinine in AKI and CKD

Corr with AKI grade

Poss higher in intrinsic vs volume AKI and inflammatory AKI

No diff outcome AKI

Predict progression CKD

Made in neuts, increased production, decreased absorption and increased secretion during tubular injury

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69
Q

What is insensible loss?

A

22 ml/kg/day

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70
Q

What to give to an anuric patient fluid-wise?

A

Only insensible loss (may need to not give this if over hydrated)

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71
Q

What effect would increased chloride in the DCT have?

A

Afferent glomerular vasoconstriction (higher chloride increase incidence AKI?)

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72
Q

What factors to check to ascertain whether an animal is oligoanuric?

A

Optimise renal perfusion, BP MAP > 60, systolic > 80 and check cath

NB relative versus absolute oliguria

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73
Q

Mannitol mechanism of action?

A

Osmotic diuretic, extracellular volume expansion

Inhibits renin and renal sodium reabsorption

Increases tubular flow, decreases vascular resistance, decreases cell swelling, protects cf vascular congestion/RBC aggregation, scavenges free radicals, increases intrarenal prostaglandin and vasodilation

Increases renal blow flow and GFR - increases solute excretion, ANP, decreases the mitochondrial response to the calcium influx and therefore decreases progression from sublethal to lethal cell injury

BUT no evidence that it improves AKI

Can’t use if dehydrated or over hydrated

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74
Q

Furosemide mechanism of action?

A

Loop diuretic - inhibits NaK2Cl pump in LoH - increases tubular flow with no increase in GFR

Makes basal NaK pump unnecessary

Decreases medullary O2 consumption

Renal vasodilatory effects

Use for over hydration/hyperkalaemia?

CRI gives more sustained diuresis with lower dose

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75
Q

Calcium channel antagonists?

A

Eg diltiazam, which might help with more complete resolution in dogs with lepto

Reverse vasoconstriction, dilate mostly afferent, inhibit glomerular feedback-mediated vasoconstriction

GFR independent natriuresis

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76
Q

Peritoneal dialysis?

A

Probably more helpful in cats

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77
Q

Mechanisms of calcium, magnesium and phosphate changes in AKI?

A

Increased calcium - usually inc total with N ionised but can be increased if decreased GFR and no excretion

Decreased calcium - complex with phosphate

Phosphate - decreased excretion

Magnesium - decreased excretion/increased loss if PU

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78
Q

Problem with ACEi in AKI?

A

Afferent arteriole vasoconstriction

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79
Q

What AKI cause has best outcome?

A

Obstructive in cats, toxic and other = worst

Ischaemia = better px

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80
Q

How often does azotaemia persist after AKI?

A

Around half

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81
Q

Distribution of types of CKD dogs and cats?

A

Dog - 60 % tubuloint, quarter glomerular, rest amyloidosis/other
Cat - three quarters tubuloint, 15 % glomerular, rest lymphoma/amyloidosis

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82
Q

How does the failing kidney adapt?

A

Increased load per nephron, increased tubular secretion to maintain electrolyte and water excretion.

Maintained better for Na/K/water than phosphate

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83
Q

Organic solutes

A

Mediators of uraemia - accumulate as can’t be secreted when GFR starts to fall.

Inhibit NaKATPase, alter platelet, red cell and white cell function

NB as kidney fails can’t catabolise compounds like PTH and cytokines. PTH is a uraemic toxin

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84
Q

Uraemic gastric changes in dogs and cats?

A

Dogs - can get uraemic gastropathy with ulceration

Cats - fibrosis, gland atrophy, mineralisation in stage III/IV, no evidence ulceration,

Gastric hyperacidity not documented

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85
Q

Halliitosis in renal dz?

A

Bacterial urease converts urea to ammonia

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86
Q

Enterocolitis in renal dz?

A

Ammonia produced in colon is irritant

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87
Q

What mediates impaired urine concentrating ability in CKD

A

Impaired genesis of concentrating gradient due to medullary architecture disruption/countercurrent multiple disruption

Impaired response to ADH (uraemia), increased distal tubular flow rate

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88
Q

What is the most common cause of secondary hypertension?

A

CKD

Renin, sodium/water retention

Aldosterone and SNS imp

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89
Q

Factors causing anaemia in renal disease?

A

EPO - decreased production and decreased efficacy d/t nutrient deficiency and uraemic factors
Blood loss (GI, thrombocytopathy)
Inflammation
Decreased RBC lifespan

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90
Q

What does hypoxia inducible factor do?

A

Increases EPO production and intestinal iron uptake

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91
Q

What does FGF23 do?

A

Causes phosphate excretion

Inhibits 1alpha hydroxylase

FGF/klotho system

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92
Q

Renal secondary hyperparathyroidism?

A

Phosphate retention, PTH, FGF23, 1alphahydroxylase inhibition

Decreased calcitriol, decreased neg feedback, increase PTH. Initially calcitriol production is increased to normal at the expense of persistent increases in PTH

CKD progression decreases amount of viable renal cells and more calcitriol deficiency

Calcitriol deficiency impairs bone response to PTH and elevates the set point for PTH so continues to be secreted despite normal or increased calcium.

Uraemic toxins impact PTH response to calcitriol

50 % cats advanced CKD hypocalcaemic.

May get inc PTH prior to azotaemia

RSHP majority cats with CKD and corr with creatinine

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93
Q

Metabolic acidosis in CKD?

A

Decreased GFR, can’t get rid of daily acid load, no filtration phosphate/sulphate products, impaired tubular proton excretion

Nephrons compensate by increasing ammonium secretion. Structural damage impairs renal ammonium production.,

Retention of organic acids increases the anion gap

Stimulates branched AA degradation - catabolism of muscle

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94
Q

What does urea correlate with?

A

Uraemic toxins

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95
Q

When does SDMA increase?

A

Decreased GFR by 25 - 40 %

17/10m earlier than creatinine on cat/dog

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96
Q

IRIS staging categories

A

I - dog < 125 cat < 140 SDMA < 18 both
II - dog < 250 cat < 250 SDMA dog < 35 cat < 25
III - dog and cat < 440 SDMA dog < 54 cat < 38
IV > 440 > 54 > 38

Proteinuria - dog 0.2 - 0.5/>0.5, cat 0.2 - 0.4/>0.4

BP: <140. 140 - 159, 160 - 179, > 180

Breed spec - 10/10-20/20-40/>40 inc from RI

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97
Q

Sighthound blood pressure?

A

40 mmHg higher

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98
Q

Phosphate restriction CKD?

A

Stage II onwards dog and cat - slow progression, decrease RSHP, decrease mortality

I < 1.45
II < 1.45
III < 1.61
IV < 1.94

Diet 4-6 w then add binder
Diet can be effective alone in II and III

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99
Q

Diet in CKD?

A

Renal diets evidence stage III onwards (maybe II cats?) - increase survival time decrease risk renal death decrease risk uraemic complications. Maintain QoL and decrease clin signs. Decrease phosphate decrease PTH decrease FGF23 in stage II - IV cats. Rec all proteinuric dogs.

Protein restriction - decreases glomerular protein loss which is detrimental to tubules
Controversial otherwise.
Restrict in stage III/IV, decrease urea and uraemia.
But renal diets not restricted enough to cause protein malnutrition if consumption adequate.

Omega 3 - decrease mortality, improve renal function, decrease renal lesions/proteinuria/cholesterol, favourable lipid metab, suppress inflammation and coagulation, decrease BP, antiox, may be synergistic with antioxidants to reduce the decrease in GFR

Phosphate restriction - dog and cat stage II onwards, slow progression decrease mortality

Also: B vitamins neutral acid base soluble fibre increased caloric density and potassium supp feline.

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100
Q

Benefit of subq fluids CKD?

A

Decrease dehydration which can cause AKI, imp appetite/activity/decrease constipation

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101
Q

Hypokalaemia in CKD?

A

Around 1/3 of stage II and III cats

Might get hyperkalaemic in stage IV

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102
Q

Hypertension and renal mortality?

A

Risk factor in canine CKD

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103
Q

What factors should be taken into consideration when using amlodipine in CKD?

A

Make sure BP not < 120, no signs hypotension, creatine doesn’t increase > 45 or SDMA >2

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104
Q

Development of EPO ABs?

A

30 % cats 50 % dogs (not all anaemic) when tx epoietin

less darbo

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105
Q

When to use rhEPO?

A

Stage III onwards, PCV < 22 % with clin signs anaemia

Half to all cats reach target (bottom end RI), responders live longer

Aim 1 - 3 % increase per week

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106
Q

Calcitriol use in CKD?

A

Decreases PTH

Decreases mortality in canine stage III and IV by slowing progression - cats maybe not so much (?improve podocyte viability and decrease RAAS?)

Use in canine III onward (? II?) with normal phosphate. and iCa

Give fasted to minimise. increase in Ca and phosphate

Make sure calcium phosphorous product <52

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107
Q

Proteinuria and CKD?

A

Every 1 increase UPCR increases risk of death/uraemic crisis 1.5 x in dogs

Benazepril assoc with survival benefit in cats if UPCR > 1

Intervene if stage I > 2 or stage II onwards > 0.4/0.5

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108
Q

ACE escape?

A

Chymase enzymes

Bradykinin also degraded by ACE - vasodilation and renoprotection via NO stim

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109
Q

ARB mech?

A

Block type 1 not 2 - latter imp for vasodilation

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110
Q

Aldosterone blockers?

A

Attenuates renal damage independent. of BP

Aldosterone might be fibrogenic in kidney (TGFbeta)

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111
Q

Prognostic factors feline CKD?

A

Stage (1000, 700 and 30d for II - IV)
Phosphorous, proteinuria, anaemia (?), weight loss

NOT nephrolithiasis NOT BP

112
Q

Prognostic factors canine CKD?

A 
Stage (2.6/4.7 X risk death stage III and IV)
BUN
Creatinine if no renal diet fed
Diet (stage III 250 d vs 600 d)
Proteinuria - clin signs, uraemia, death, every 1 UPCR increases death risk 60 %
Increased BCS longer survival
BP
Cause - hereditary slower
113
Q

HMWP in AKI?

A

Higher ratio of HMWP to albumin could indicate more severe glomerular injury

114
Q

Urinary retinol binding protein?

A

Marker of tubular damage

115
Q

Why are urinary enzymes more sensitive than protein?

A

Increased before overt dysfunction

Also, easier to measure and amount of leaked enzymes might be predictive of degree of ongoing damage

116
Q

Overhydration and AKI?

A

Might be prognostic (worse disease) or may worsen outcome

117
Q

Most common glomerular diseases in dogs?

A

Immune complex glomerulonephritis, glomerulosclerosis, amyloidosis

118
Q

Signalment of dogs with nephrotic syndrome?

A

Younger

119
Q

What glomerular diseases have what USG?

A

Normal common in general, amyloidosis more frequent isosthenuria

120
Q

Most common cast in glomerular disease?

A

Hyaline - Tamm Horsfall mucoprotein secreted due to proteinuria

121
Q

Membranoproliferative glomerulonephritis?

A

Immune complex glomerulonephritis

Most severe clin signs and clin path changes

BMD - mesnagiocapillary, familial, auto recessive - asco with lyme dz

Immune complex deposition subendothrlial GBM, cytokine complement activation (NB congenital C3 deficiency in Brittany sp)

C3 IgG/M/A deposition

If can’t fix with address underlying dz consider immunosupp

122
Q

Membranous nephropathy?

A

Most common feline, NB young dobermann

Immune complex glomerulonephritis

AB deposition sub epithelial GBM, less complement/cytokine activation

Primary - immune mediated, ABs interact with podocyte antigens

Also secondary - circulating immune complex

Progresses through stages - spikes, GBM thickening and projections surround the immune complexes, bearded appearance due to immune complex deposition
May not have GBM thickening in later stages

Px - later stages poor, C3/IgG better than IgM/A, may be slowly progressive

Immune supp if progressive and no dz to manage

123
Q

Proliferative glomerulonephritis?

A

ICGM

Milder

Less likely to be caused by infectious. dz

Mesangial hyperplasia with mononuclear infiltrate
IgG/M GBM or mesangium or cap walls
Immunesupp if no dz and prog

124
Q

Immunoglobulin A nephropathy?

A

Enteric/hepatic dz

IgA - polymeric, nonspecific trapping in mesangium

increased formation/decreased clearance

Can also have less intense IgG/M/C3

125
Q

Amyloidosis?

A

Familial breeds?

Sharpei, beagle, foxhound, Abyssinian, siamese

More medulla in cats and shar pei, otherwise glomerular dep

Other dogs chronic inflamm - collie, female, walker hounds

Beta pleated amyloid

Don’t need TEM

Colchicine may be helpful in deposition face (decreased SAA release from hepatocytes?)
DMSO maybe in deposition phase? Decrease SAA conc? Anti-inflamm/decrease interstitial fibrosis?

126
Q

Hereditary nephritis?

A

ECS/ESS auto rec
Bull terrier/Dalm auto dom
Samoyed one fam X link dom

Type 4 collagen defect causes GBM deterioration (5. in samoyed)

Samoyed males v severely affected
ECS proteinuria from a few months.
Both terminal CKD < 2y
BT/Dal more variable

Need TEM to dx - splitting and fragmentation of GBM

127
Q

Minimal change glomerular disease?

A

Masitinib

Rare in dog and cat

Human - lymphokine dysfunctional T cell increase GBM, perm, dx TEM, response steroid

128
Q

Glomerulosclerosis?

A

20 % dogs end stage lesion

DM? Hypertensive damage?

Non spec Ig/C3 trapping

Focal segmental glomerulosclerosis = primary dz

129
Q

How many dogs with glomerular disease have a secondary cause?

A

Just over half

130
Q

Target protein in glomerular dz?

A

< 0.5 or 50 % decrease

Decrease dose or stop if creat increases > 30 % or to stage 4, K > 6.5 or BP < 120

131
Q

Other tx?

A

Thromboxane synthase inhibitor may decrease proteinuria, decrease glomerular inflammation

Omega 3 - renoprotective, decrease BP, decrease trig/chol

132
Q

How many immune mediated glomerular disease in dogs?

A

Half

133
Q

When to use immunosuppression in glomerular disease?

A

Biopsy evidence immune mediated - subepi/endothelial, intramembranous or mesangial electron dense deposits, immunofluorescent staining for immunoglobulin or complement with anti-GBM pattern

No response standard tx

134
Q

Steroids and glomerular disease?

A

Use short term, as steroid excess induces glomerular lesions

Myco/ciclosporin considered

Ciclosporin only one prospective (wasn’t found to be of benefit…)

Use immune supp 8-12w before change
If response, use 3-4 m then taper

135
Q

When to recheck glomerular disease dogs?

A

Stable stage I/II 3 - 14 d
Unstable or III 3-5d

No need to rebx, changes don’t necessarily resolve

136
Q

Albumin and hypercoag?

A

Albumin binds arachidonic acid - if free may get increased platelet aggregation

137
Q

Hypercoagulability in glomerular dz?

A

Less alb and AT

More fibrinogen, cholesterol, procoag cytokines, alpha2macroglobulins, alpha 2 antiplasmin

138
Q

Hyperlipidaemia and glomerular dz?

A

LDL/oxLDL alter mesangial cell function, increase matrix synthesis and cause glomerulosclerosiss
Lipoprotein deposition is cytotoxic

139
Q

Prognostic factors glomerular disease?

A

Azotaemia
Type - GN and amyloidosis worst
Nephrotic syndrome

140
Q

Cystinuria breeds and causes?

A

Newfie and lab type 1 - SLc3a1 (rBAT protein) autosomal recessive

Aussie cattle dog - SLc3a1 auto dom incomplete pen (non-type 1)

Min Pin - SLc7a9 - bo+ AT protein

Eng bulldog, rottie, SBT, JRT, welsh corgi, chih, dachs

Form calculus 5 y, newfie/lab younger

Type III = androgen dependent

Cats described

Cysteine, carnitine fail to resorb NB cardiac

141
Q

Management cysteineuria?

A

Alkalinising diet
Low protein
Diuresis
2 - mercaptopropionylglycine

142
Q

Breeds and cause hyperuricosuria?

A

Dalmatian - can’t move uric acid into hepatic cells, impaired PCT uric acid absorption, active urate excretion DCT. Slc2a9 - auto recessive, all dals have mutation

English bulldog, Black Russian terrier Slc2a9, auto rec

Primary hepatic dz
Cats PSS and idiopathic

NB neoplasia HAC CKD

143
Q

Management of hyperuricosuria?

A

Allopurinol, xanthine oxidase inhibitor
Purine restricted diet, alkalinising to decrease tubular ammonia

Medical dissolution in PSS if fix

144
Q

Breeds and cause of hyperxanthinuria?

A

Allopurinol tx
CCKS wire-haired dachs
Cats

Decreased xanthine oxidase activity

145
Q

Breeds for primary renal glucosuria?

A

Basenji, scottie, Norwegian elkhound

146
Q

How many Basenjis get Fanconi?

A

10 - 30 %

147
Q

Causes of acquired Fanconi?

A

Gentamicin, hypoparathyroidism, tubular necrosis

Chlorambucil cats

Jerky treats

148
Q

Common amino acid in urine of Fanconi?

A

Cysteine

149
Q

What is lost from tubules in Fanconi?

A

AAs glucose bicarb sodium potassium urate uric acid phosphate

150
Q

What acid base disturbance do Fanconi dogs get?

A

Hyperchloraemic (nonAG) metabolic acidosis (bicarb loss)

151
Q

How to manage Fanconi?

A

Potassium citrate, aim bicarb 18 - 24 K 4 - 6

152
Q

Prognosis Fanconi?

A

Good - MST 5 y (and some don’t present until 4-8y). most good/excellent qol. 50 % die reasons unrelated

153
Q

Type I renal tubular acidosis?

A

Distal tubular acidosis
Failure excrete H+
Hyperchloraemic metabolic acidosis, severe acidosis, urine pH > 6
Hypercalciuria, hyperphosphaturia
More severe bone dz and nephrocalcinosis poss, urolithiasis poss
Can have severe hypoK
No PCT defects
Good response to alkali tx and don’t need as much
Low bicarb excretion
Urine pH > 6 in acidaemia and if give ammonium chloride
Citrate in urine decreased

NB: pyelonephritis cats and lepto dogs

154
Q

Type II renal tubular acidosis?

A

Proximal tubular acidosis
Failure to prevent bicarb loss (DCT compensates)
Basolateral Na-bicarb cotransporter defect, bicarb leaks to tubular lumen
Hyperchloraemic MA (less severe)
Other tubular defects poss
Need large amount of alkali tx and less good response - marked bicarbonaturia with increased pH and increased fractional excretion of bicarb
Urine pH acidic and decreased with ammonium chloride challenge
Less clin consequences eg bone, no nephrocalcinosis and urolithiasis unusual
Still have calcium and phosphate in urine

155
Q

Type IV renal tubular acidosis?

A

Hypoaldosteronism/aldosterone antagonism

Loss HATPase stim, decreased distal sodium absorb
Hyperchlor MA and increased K

156
Q

High and intermediate molecular weight protein used for acute tubular injury?

A

Systemic circulation
Albumin - glomerular/prox tubule - non specific
Immunoglobulin IgA/G - glomerular, no advantage over UPCR

157
Q

Low molecular weight protein used for acute tubular injury?

A

From PCT or systemic circ and decreased resorption

Retinol binding protein - from prox tubule, stable in acidic urine and frozen, increases progressively in CKD, wide interindividual variation

Alpha 1 microglobulin - stable in acidic urine, decreased in hepatic disease

Beta 2 microglobulin - UNSTABLE acidic urine - predictor GFR in dogs but not sensitive enough to monitor progression

158
Q

Tubular enzymes used in acute tubular injury dx?

A

Large molecules expressed in urine from damaged tubular cells and increased before overt dysfunction. May predict degree/severity of injury?

Neutrophil gelatinise associated lipocalin - PROX tubule only, haematuria/pyuria interfere and infection or inflammation decreases specificity. Is freeze/thaw stable.

Lactate dehydrogenase - PROX tubule

Gamma glutamyl transferase - PROX tubule, UNSTABLE in acidic urine. Haemorrhage and pyuria interfere

N acetyl D glucosaminidase - prox and distal affected by HT4/DM, pyuria and storage

Intestinal ALP - prox and distal

159
Q

Breeds predisposed to renal agenesis?

A

Beagle, doberman, sheltie

160
Q

Breeds for renal dysplasia?

A

Lhasa/shih tzu, SCWT, Gret, Boxer

161
Q

AUS renal dysplasia?

A

Loss corticomedullary definition, hyper echoic speckles

162
Q

Histopath renal dysplasia?

A

Inappropriate differentiation of nephron components - immature alongside mature
Functional nephrons hypertrophied

163
Q

Podocytopathy?

A

SCWT NPH1/KIRREL2 genes (split diaphragm proteins nephrin neph5 filtrin)

164
Q

Polycystic kidney dz breeds and cause?

A

Persian and crosses, auto dominant PKD1 (polycystin) gene mutation - also Himalayan and British blue. Probably other mutations too as described in absence of this mutation.

Bull terrier - auto dominant PKD1 gene mutation

Cairn/WHWT auto recessive PKD1- get liver cysts too

165
Q

Cystadenocarcinoma?

A

GSD, auto dom mutation, BHD gene

166
Q

False neg protein dipstick?

A

Bence Jones acid dilute, quite sensitive overall though for albumin

Also poor specificity

167
Q

What does the sulfosalicylic acid test check for?

A

Bence jones proteins and globulins

Poor sens and spec for albumin

168
Q

Physiological proteinuria?

A

Stress, exercise, seizures, hyperthermia

169
Q

Pre-renal proteinuria?

A

Bence jones

170
Q

Postrenal?

A

Cysto help but prostatic secretion can reflux

171
Q

How is persistent proteinuria defined?

A

Three or more tests more than 2w apart.

NB proteinuria may decrease as renal dz progresses (less nephrons)

172
Q

When is protein change significant?

A

35 % at UPCR 12, 80 % at 0.5

Need to pool 3 if > 4

173
Q

When should proteinuria be treated?

A

No renal dz - > 1

Renal dz stage 1 onwards - > 0.4/0.5

174
Q

What effect does enalapril have on glomerular disease?

A

Sig decrease proteinuria, delay onset and progression of azotaemia

175
Q

Why might potassium be high in glomerular disease?

A

ACEi/ARB

Pseudohyperkalaemia d/t thrombocytosis

176
Q

Why less cell response in membranous glomerulonephropathy?

A

immune complex dep not endothelial, is sub epithelial GBM

177
Q

Difference between familial and reactive amyloidosis?

A

Familial Abyssinian shar pei medullary mostly some glomerular, reactive all glomerular

178
Q

What colloid to use in nephrotic syndrome?

A

Not colloids - HMW molecules lost quickly and leave high sodium fluid behind, increasing hydrostatic pressure

Use plasma or human albumin

179
Q

When to give aspirin in glomerular disease?

A

< 20 g/l albumin

180
Q

When to use bicarb/citrate in CKD?

A

Cat bicarb < 16 dog < 18

181
Q

Most common NSAID nephrotoxicity?

A

Acute cortical nephrotoxicity, chronic medullary cytotoxicity less common

Doesn’t differ selective/non-selective

182
Q

General risk factors for renal NSAID tox?

A 
Dehydration
Hypotension
Admin of anti-hypertensives which are not renal vasodilators
Higher NSAID dose
Hypoalbuminaemia
Genetic? GSD?
183
Q

Only risk factor for acute cortical NSAID nephrotox?

A

Dietary salt restriction, diuretic, GA

184
Q

Pathophys of the NSAID nephrotox’s?

A

Acute cortical nephrotox:
Loss renoprotective effects vasodilatory prostaglandins. Decreased renal blood flow/GFR Cox 1 > cox 2

Chronic medullary cytotoxic:
Loss cytoprotective prostanoids. Medullar interstitial/tubular cell papillary necrosis Cox 2 > Cox 1

185
Q

Clin findings NSAID nephrotox?

A

Acute cortical nephrotox:
Early: Renal cells/casts in urine, renal enzymuria, proteinuria, microalbuminuria
Intermediate - electrolytes abnormal, decreased conc
Late - creatinine

Chronic medullary cytotoxic:
No early
Intermediate - renal enzymuria, decreased conc ability
Late - electrolytes, acid base, creatinine

186
Q

What factors may be problematic when using NSAIDs in CKD?

A

Hypoalbuminaemia (protein bound)
Metabolites might be renally excreted
Low reserve so damage may be disastrous

NB cat CKD NSAID slowed progression… low dose 0.01-0.03

Use sub therapeutic dose at first, titrate up, and use in bursts rather than continuously

187
Q

When does risk of UTI increase with indwelling ucath?

A

3d onwards

188
Q

Furosemide and diuresis?

A

CRI more effective cf intermittent bolus

189
Q

Dopamine agonists for diuresis?

A

Dopamine itself not recommended

Fenaldopam D1 receptor antagonist, renoprotective in people - might be effective? Monitor for hypotension

190
Q

How to give amlodipine if you can’t give it orally?

A

Rectally

191
Q

Negative prognostic indicators AKI?

A

Ethylene glycol and azotaemia
Severe azotaemia
No imp/worsening despite tx
Concurrent dz eg pancreatitis, sepsis

192
Q

What marker of renal function has least within individual variability in azotaemic cats?

A

Creatinine, better than GFR

193
Q

What does high phosphate diet do to healthy cats?

A

Glucosuria and microalbuminuria and decreased creatinine clearance in the short term

194
Q

What happens to magnesium in CKD cats administered gastroprotectants?

A

Decrease over time with combined PPI H2 blocker

Also increased sodium PPI

No increase in CKD progression though

195
Q

What is subclinical bacteriuria associated with in cats?

A 
Uncommon - 6%
Most single organism (E coli)
More likely female
Assoc with bacteriuria and pyuria
Assoc with low USG and CKD
Hepatic disease
196
Q

NAG in feline idiopathic cystitis?

A

N-acetyl beta D glucosaminidase:
NAG/creatinine higher in FIC - > degrade GAG? Is in tubules (PCT) and can degrade glycoprotein and mucopolysaccharide
UPCR higher too
UPCR corr with NAG

197
Q

CKD risk factors cat?

A

Feeding commercial dry food PROTECTIVE

Periodontal dz increased risk

198
Q

Feline familial amyloidosis?

A

Oriental/siamese - mainly liver -
Abyssinian/somali - renal, die young

Difference between - ? different kind of amyloid?

199
Q

Glomerular proteinuria in cats?

A

Young male with higher proteinuria
Immune mediated dz common

ICGN: live longer if get immunosuppressive, effusion neg prog

75 % immune complex mediated

Membranous glomerulonephritis most common

Poor px overall

200
Q

FGF 23 in canine CKD?

A

Increased in stage 2-4 cf 1 and corr with stage

Corr with increased phosphate
More stage 2 have increased FGF23 cf PTH

PTH, creatinine and phosphate predict FGF23

Correlated with survival

201
Q

What is FGF23?

A

Phosphotonin. Released from osteocytes when phosphate and calcitriol increased, increases urinary phosphate excretion by decreasing sodium phosphate cotranssporter

Inhibits calcitriol

As CKD progresses, less alpha klotho (cofactor)

Binds to FGF receptor

202
Q

Cat CKD and FGF23?

A

Increased earlier than phosphorous or PTH, neg px indicator

Corr with low magnesium, magnesium corr with risk of death

Corr SDMA and creat, increased in non-azotaemic but SDMA inc cats

203
Q

Bacteria and disease progression feline CKD?

A

No effect positive urine culture if treat with ABs

PUC around 22 % CKD cat
Most no clin signs

204
Q

Telmisartan in proteinuria in dogs?

A

Probably more effective than enalapril

Combo might cause azotaemia

205
Q

Predictor of short term outcome in acute on chronic AKI?

A

AKI grade

206
Q

Vitamin D in PLN?

A

Decreased in non-azotaemic - corr with amount of protein loss and with decreased albumin

Decreased vitD binding protein as albumin decreased

207
Q

Risk factors for enterococcal bacteriuria in dogs?

A

Recurrent bacteriuria, anatomical abnormalities, urolithiasis, neoplasia

Is this bacteria a marker of concurrent dz?

208
Q

Glucosuria and USG?

A

Not actually that much change

209
Q

What confers fluoroquinolone resistance?

A

DNA gyrase/topoisomerase genetic mutations in bacteria

210
Q

Blood in urine and UPCR?

A

Microscopic might effect UPCR

211
Q

Platelet changes in CKD dogs?

A

Hypercoag.

Increased alpha IIb beta 3 and P-selectin

212
Q

Experimentally, what may accelerate renal regeneration after AKI?

A

Autologous bone marrow derived mesenchymal stem cells, GCSF (latter decrease fibrosis)

213
Q

Cranberry extract and canine UTI?

A

Prevented UTI
Prevent E coli kidney cell adherence in vitro

In another study not better than placebo

214
Q

Recurrence in feline urinary obstructions?

A

No difference any outcome measure for saline lavage

Less if indwelling

Meloxicam didn’t help

Intravesicular pentosan polysulfate didn’t help

215
Q

How many SUBS cats survive to discharge?

A

94 %

216
Q

Prevalence bacteriuria CKD dog?

A

Not assoc stage
Around 20 %
Sub clin then pyelonephritis then cystitis most common

217
Q

How to maximise renal bx yield?

A

16 g, US guided

218
Q

Stent vs SUBS cat?

A

Mortality more, survival less, hosp more, complication more in stent

Stent lower urinary signs and get infected more

219
Q

Calcium oxalate urolithiasis and weight?

A

More in fat dogs

220
Q

Amoxicillin and feline kidney disease?

A

Amoxicillin decreased in urine of azotaemic cats, may be inc in serum

? SEs?

221
Q

Mirtazapine in CKD

A

Transdermal works to increase appetite and weight

222
Q

Troponin I in renal disease?

A

Increased in serum same as cardiac

Increased in urine more than cardiac

Cats

223
Q

Categories for bacteriuria?

A

Sporadic cystitis (< 3 in a year)

Recurrent cystitis (3+ in a year or 2+ in 6m) - relapse/reinfection/persistence/superinfection

Pyelonephritis - acute uncomplicated/complication, chronic

Subclin bacteriuria - no clin signe

Bacteriuria with implant or ucath

224
Q

UTI in FLUTD?

A

Low prevalence (3 - 19 %) in young but. up to 45 % in > 10y

225
Q

Prevalence pos urine cultures cats diff dz?

A

CKD up to 30 %, DM/HT4 around 13 %

Clin signs more common latter two?

Pos in 30 % ureteral obstruction, also SUBS infections reach 30 %

226
Q

Where does KIM1 live?

A

Kidney injury molecule - prox tubule - increased in sepsis/urethral obstruction

227
Q

Cat breed with higher creatinine?

A

Birman

228
Q

Homocysteine/CKD?

A

Uraemic toxin

Dogs:
Increased if decreased renal excretion or impaired metabolism
Corr proteinuria

Cats:
Increased and corr with stage/UPCR, not hypertension

NB may not be assoc with cobalamin deficiency in cat

229
Q

Main difference bacterial cystitis in cats?

A

Often comorbidity present and far more common older cats

230
Q

How to treat sporadic UTI?

A

3-4d amoxicillin or TMPS

Always culture cats

NSAID alone might be enough

This also applies to males with no evidence prostatitis, and comorbidities not affecting utract

This does not apply to recurrent (additional UTI < 3m)

Check culture afterwards not recommended

231
Q

How to treat recurrent UTI?

A

Determine relapse/persistence/recurrence

Evaluate for cause

Check AB propriety and compliance

3-5 day for recurrent, longer (7-14) persistent/relapse

NB amoxicillin-clav ineffective against E. coli in tissue

Can reculture during if using longer course/after, but ? change tx if clin signs gone

232
Q

How to treat pyelonephritis?

A

Do blood culture if immune supp or fever

Interpret susceptibility with serum/tissue breakpoints not urine

Check lepto if culture neg

Quinolone (efficacious cf e coli)

10 - 14d, recheck culture 1-2w after stop AB but NB ? change tx if clin response

233
Q

AB for prostatitis?

A

Weakly alkaline, lipid soluble high pKa ABs

Quinolone or trimethoprim

Chloramphenicol, tetracycline don’t penetrate, and macrolide/clindamycin penetrate but no e coli efficacy so poor choice

234
Q

How to treat prostatitis?

A

Always check for in male dog with bacteria in urine

Breakpoints for serum

? aspirate prostate? 100000CFU bacteria might be normal in prostatic wash

Drain abscess

4-6w + castrate, longer chronic

Rpt wash if clin signs remain + consider other ddx

235
Q

How to manage subclinical bacteriuria?

A

Not assoc with survival or development of clin signs

Poss treat if high risk ascending inf or if think caused inf elsewhere

Poss treat if can’t show signs (paralysed) with fever or other clin signs - short course 3-5d

Poss treat if plaque/urease forming (Corynebacterium urealyticum or Staph), 3-5d

236
Q

Risk factors subclinical bacteriuria dog?

A

DM, obesity, parvo pup, acute disc, paralysed dogs, steroid/ciclosporin

237
Q

Enteroccous tx?

A

Need aminoglycoside with ampicillin

238
Q

Bacteria assoc with struvite?

A

Staph pseudintermedius, proteus mirabilis

239
Q

Urolithiasis and AB?

A

Always culture as could be struvite component

Cats almost all sterile

Culture urine, and urolith if urine neg

AB 7d if signs, if struvite with urease producing bacteria (duration? 7d ab seemed fine in one study)

240
Q

Urinary heat shock protein 72 in renal dz?

A

Stress induced cytoprotective protein

Predict survival time CKD cat

Increased in CKD and AKI cat

Sens > spec cat

Dog - same, sens and spec better than cat, sens still > spec. AKI only. Predict survival AKI.

241
Q

Parvo and AKI?

A

Increased urinary IgG, CRP, retinol binding protein and neutrophil gelatinise associated lipocalin
Also increased UPCR

Urea/creatinine not increased

242
Q

Plasma indoxyl sulfate in CKD?

A

Protein bound uraemic toxin, metabolic breakdown of tryptophan in intestine > indole > hepatic metabolism. Renal tubule excretion. Accum in tubular cells cause progression?

Predicts stage progression in dogs and cats

Cats - assoc with FGF23 (assoc with phosphate metabolism?), strong corr with phosphate

243
Q

GGT/ALP in AKI?

A

Urinary - both prox tubule brush border

Poor sens/spec, ALP better than GGT

244
Q

Urinary IgM/IgG?

A

Increased in AKI and CKD

More increased in ICGN - also prognostic

245
Q

Urinary retinol binding protein?

A

Inefficient tubular absorption

Increased AKI

Increased CKD and prognostic

Higher in proteinuria animals

246
Q

Urinary NGAL?

A

Decreased tubular absorption and prox tubular cell damage releases

Gentamicin - early marker and corr with injury

Increased AKI/sepsis

Also increased CKD, glomerular dz, lower utract dz

Active sediment big problem

Increased neoplasia same as CKD

247
Q

Which urine markers glomerular which tubular?

A

Tubular - UPCR SDSPAGE albumin NAG clusterin cystatin C GGA KIM NGAL RBP THP

Glomerular - UPCR SDSPAGE albumin CRP Ig NAG NGAL

248
Q

Urinary N-acetyl beta d glucosaminidase?

A

Tubular cell lysosomal enzyme - released on damage.

Higher intact males.

AKI/CKD

Corr proteinuria

Sensitive

Glomerular dz (better glomerular?)

249
Q

Serum cystatin C?

A

Small protein cf SDMA (which is creatinine sized)
More sens GFR cf creatinine?

Inferior creatinine SDMA for GFR dogs

250
Q

Urinary active transforming growth factor beta?

A

Increased 6m pre azotaemia in cats

Predict fibrosis, renal inflamm and UPCR

Also assoc with fibrosis:

251
Q

Mini schnauz and proteinuria?

A

Corr trig and UPCR

UPC >0.5 60 % hypertrig cf none normal trig

No azotaemia/hypoalb/hypertension, no cardiac dz, AT3 normal

Lipid induced glomerular injury?

Decreased lipoprotein lipase?

Segmental glomerular sclerosis

252
Q

Immune supp and glomerular dz?

A

Mycophenolate +/- chlorambucil - all/6 alive at end of study vs one/7 with no immune supp

ICGN less common in UK? 27 % vs 50 %?

253
Q

Risk factors urinary incontinence dog?

A

Early onset (<8y)= neutering and neutering <6m, no impact age of spay in UI overall

Hazard increased with inc bodyweight, Irish setter most hazard breed

Decreased oestrogen, LH/FSH, COX2/gonadotropon receptors?

Increased GAG/collagen?

High risk breeds - Irish setter, doberman, bearded collie, dalmatian

254
Q

Type III cystinuria?

A

Androgen dependent - mastiff, staffie, Scottish deerhound, Irish terrier. Entire males.

255
Q

Grape/raisin tox?

A

Neuro signs 75 % in a group of AKI not assoc severity outcome etc

256
Q

Focal segmental glomerulosclerosis?

A

Non immune complex, podocyte injury, compression of capillary lumen

Females

26 % cases

Severe hypoalb/ascites/oedema and azotaemia uncommon, hypertension frequent

Creatinine and alb assoc with survival

NB SCWT, Airdale, mini schnauz

257
Q

USMI bulking outcomes?

A

70 - 100 % effective

258
Q

Acute on chronic kidney disease cats?

A

Phosphate assoc short term outcome creatinine long term

Short survival after discharge

Around 60 % discharged

259
Q

Most common infectious dz exposure proteinuric dogs?

A

Rickettsia, Ehrlichia, Borrelia

More if alb lower/creatinine higher

260
Q

Neuroendocrine alterations in FIC cats?

A

Increased systemic/localised sympathetic
Decreased HPA
increased muscarinic stim response

261
Q

Feline CKD microbiome?

A

Decreased diversity.

May increase SCFA

Dysbiosis exacerbates colonic derived uraemic toxins eg indoxyl sulfate and p cresol sulfate

262
Q

What is beraprost sodium?

A

Prostacyclin analogue, might help with renal hypoxia/fibrosis

263
Q

Name urease producing bacteria

A

Corynebacterium urealyticum, Staph, Klebsiella, Proteus, Mycoplasma

264
Q

What urinary tract infection bacteria are catalase negative?

A

Enterococcus/strep

265
Q

UTI bacteria in dogs/cats?

A

E coli most common in both
Mostly gram negative dogs, equal gram neg/pos cat

Enterococcus second most common cat

266
Q

What UTI bacteria express fimbriae?

A

E coli

Gram neg

Klebsiella pneumoniae

267
Q

Most common compound urolith?

A

CaOx inner struvite outer, then struvite inner calcium phosphate outer

268
Q

Urate stone former mutation?

A

SLC2A9
Failure reabsorption prox tubule
Secretion DCT

269
Q

Breeds for feline urate and cysteine stones?

A

Urate - Egyptian mau, Birman, siamese

Cystine - siamese

270
Q

Additional amino acids which are deficient with cysteine loss in urine?

A

Carnitine/taurine dogs

Cats - COLA

271
Q

What makes up the COLA transporter?

A

2 heterodimers, RBAT and bo+AT

SLC3A1 and SLC7A9 genes

272
Q

Deficiency in what vitamin can predispose to calcium oxalate deficiency?

A

B6 - decreased oxalate metabolism

273
Q

USMI response for various management options?

A

Oestrogen: 89 %
Phenylpropanolamine: 75 - 90 % female, 43 % male
Collagen: 60 %, more if add phenylpropanolamine
Artificial sphincter: 90 % medical refractory

274
Q

Risk factors for FIC?

A

Overweight, multicat household, fearful behaviour, less outdoor access, decreased water intake

275
Q

Ectopic ureter morphology?

A

Dog - male and female most intramural and bilateral

Cat - intramural, equal bilateral/unilateral

276
Q

Characteristics of bacteria causing UTI?

A

Fimbriae/pili adhesins
Toxins eg haemolysin
Host immune system evasion eg capsular antigen
Utilise host nutrients eg aerobactin

Uropathogenic E coli B2/D

277
Q

Risk factors UTI dog/cat?

A 
Dog:
Steroids/immunosuppressivess
DM
Parvo
Obesity
Chemo
Cat:
DM
CKD
Female
HT4?

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