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Specialty Revision > Renal and Acid-Base > Flashcards

Renal and Acid-Base Flashcards

1
Q
  • None ofWhat disturbances in NaCL are expected with administration of the following hypertonic solutions?
    a) Mannitol
    b) hypertonic saline
A

a - Na/Cl decreases transiently
b - NaCl has a more sustained increase

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2
Q

What is the relationship between AKI and biochemical markers of pancreatitis in dogs?

A

Not much relationship:
- 12% samples have increased cPLI but not many diagnostic for pancreatitis
- 4% samples increased lipase
- 34% increased TLI

No correlation to serum creatinine concentration

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3
Q

Is urinary neutrophil gelatinase-associate lipocalin or its index to creatinine (UNCR) a useful early marker of AKI?

A
  • UNCR was elevated at 8 days compared to 16 days for creatinine >50% increase
  • Recovery of renal function was documented earlier with UNCR (median 2 days earlier) than on reduction in creatinine
  • NGAR generally parralleled UNCR but had a triphasic response (earlier peak than UNCR) so maybe less useful

n.nb. NGAL is an induced neutrophil protein which is present in neutrophil granules, it has previously been identified to be induced early in the course of animal models of AKI

https://paperpile.com/app/p/b3cb83ba-bea0-02ce-8975-9dfef31bdbe6

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4
Q

Which biomarker(s) in canine proteinuric CKD correlates best with the following:
1. Glomerular damage
2. Tubulointerstitial damage
3. Immune complex glomerulonephritis
4. Survival

A
  1. FE IgM or IgG
  2. Serum creatinine
  3. Urinary IgM:creatinine and urinary NAG:creatinine
  4. Serum creatinine, FE IgM, TEM noted glomerular damage

https://paperpile.com/app/p/e17e736c-fe6e-027b-8abf-b721e021b083

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5
Q

What are the known risk factors for development of CKD in cats?

A

Annual or frequent vaccination
Moderate or severe dental disease

https://paperpile.com/app/p/c77aded0-671f-0901-82b4-ae45014af23c

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6
Q

How much earlier has SDMA been able to detect CKD in cats compared to using serum creatinine above the reference interval?

A

17 months

https://paperpile.com/app/p/ec84b5f5-ca20-0682-809e-845a92162b16

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7
Q

How much earlier has SDMA been able to detect CKD in dogs compared to using serum creatinine above the reference interval?

A

9 months

https://paperpile.com/app/p/ec84b5f5-ca20-0682-809e-845a92162b16

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8
Q

Is cystatin C a useful marker of CKD in cats (either urine or plasma?)

A

No, it was also not useful in indicating renal function in hyperthyroid cats

https://paperpile.com/app/p/ddafa747-f308-003f-9e5c-9cade2acaeed

https://paperpile.com/app/p/2f22b696-f403-0498-9c2b-7da119905ab0

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9
Q

What is cystatin C?

A

Cystatin C is a low molecular weight protein which is synthesized at a stable rate by most nucleated cells and is freely filtered by the glomeruli,4
therefore, serum cys- tatin C concentrations (sCysC) are inversely propor- tional to GFR.

Cystatin C is actively reabsorbed by the proximal renal tubules so appearance in the urine could be considered as a marker of renal tubular injury

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10
Q

What is a more important predictor of body temperature in uraemia dogs?

A

Bodyweight, uraemia seems to affect body temperature more in cats. Hypothermia can be corrected with correction of uraemia in animals >5kg.

https://paperpile.com/app/p/13dd7890-c8c0-02c1-9259-3be76013e44b

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11
Q

What is fenoldopam? What are its effects on urine output and electrolyte excretion in healthy animals?

A

A dopamin agonist that has been shown to increase urine output in healthy dogs and cats and also increased FE of Na in healthy dogs compared to infusion of D5W.

https://paperpile.com/app/p/9b6e901b-3af2-0db7-bba8-d32345cec528

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12
Q

What BWT cut-off at the time of diagnosis of CKD predicts survival in cats?

A

4.2kg with cats having a BWT >4.2kg at the time of diagnosis having a better survival time.

Other points of interest are that often WL is present for several years prior to diagnosis and accelerates following diagnosis.

https://paperpile.com/app/p/aad6cd4e-8566-0b1b-9a1c-2c1121ffa729

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13
Q

What is the relationship between coccidiomycosis, azotaemia, proteinuria and ICGN in dogs? (5 points)

A
  • 13% dogs azotaemic
  • 63% proteinuric
  • 25% had clinically relevant proteinuria
  • 54% dogs had renal histopathology consistent iwth ICGN
  • 33% had granulomatous nephritis

https://paperpile.com/app/p/8c339848-2dc9-0f40-96a0-35cd9dc546ec

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14
Q

What is the effect on Ca-P homeostasis of feeding a moderately protein and phosphate restricted diet to healthy older cats?

A
  • Moderate protein and phosphate restricted diet resulted in changes in urinary FE phosphate, plasma PTH and iCa but id not hae an effect on the development of azotaemic CKD

https://paperpile.com/app/p/c31d9187-735a-0a1e-a87d-b0d4b03b48c8

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15
Q

What physical exam and haematological/biochemical changes trend higher/lower in dogs with age?

A
  • Several things re. disease and BP prevalence but I think the take homes are:
  • Platelet counts higher in older dogs
  • Body temperature, HCT, albumin and TT4 lower in older group

https://paperpile.com/app/p/6ac1adff-c733-0d80-b220-2e75bb67338a

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16
Q

Percentage of elderly dogs that are proterinuric

A
  • 11% dogs had overt proteinruia (persistent in 8%)
  • 14% were borderline proteinuric
  • Strong correlation (0.88) between free catch and cystocentesis
  • Overall 19% dogs had persistent proteinuria

https://paperpile.com/app/p/6fd9faf3-5e82-0f47-be4c-8e359877f985

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17
Q

NGAL and CKD in cats

A
  • NGAL and NG:Cr was significantly higher in CKD compared to healthy cats and was correlated with serum creatinine
  • Higher values predicted progression of CKD within 19 days

https://paperpile.com/app/p/324d6f76-bdd6-0a7c-a007-2635af40b1bb

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18
Q

What is the relationshiop between homocysteine, being a greyhound, folate and albumin levels?

A
  • Hyperhomocysteinaemia in 68% greyhounds, more common in hypofolataemic dogs and inversely corelated to folate but positively correlated with albumin
  • All healthy greyhounds had hyperhomocysteniaemia
  • No correlation between hyperhomocysteinaemia and hypocobalaminaemia
  • 41% greyhounds were hypofolataemic, this was more common in hypocobalaminaemic dogs
  • 70% greyhounds with chronic diarrhoea were hyperhomocysteinaemic
  • 75% (n.b. only 6/8 cases) with thrombosis were hyperhomocysteinaemic

https://paperpile.com/app/p/ce3078b0-f0b6-034c-8742-4e06d832d9ac

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19
Q

Relationship between hydroxyethly starch administration and AKI in dogs vs cats?

A
  • 6% HES exposure, ml/kg/d and AKI grade were not associated
  • Number of days of HES administration was associated with an increase in AKI grade within 10 days of HES administration

Note that a study in cats showed no risk of AKI in cats that had HES administered and did not find the number of days over which this was administered as a risk for AKI either.

https://paperpile.com/app/p/1a19c069-5ae0-0221-a5b5-395817d63fff

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20
Q

Relationship of urinay isoprostane F2 in cats with CKD and stages?

A
  • F2 isoprostanes were not significantly increased in cats with stage 1 CKD compared to controls
  • They decreased through advancing CKD stages and were inversely correlated with creatinine

https://paperpile.com/app/p/60e9be9b-b205-0edc-b465-a61b8b2a1ff2

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21
Q

Association between SAA, hepcidin, TIBC, mean iron, creatinine and survival in cats with CKD

A
  • Hepcidin and SAA were higher in CKD cats
  • TIBC and mean total iron lower in the CKD group
  • Positive correlation between serum creatine SAA and hepcidin
  • Increased SAA and hepcidin associated with decreased TIBC and HCT in the CKD group
  • Anaemic CKD cats had lower TIBC
  • No association in survival with all of these parameters

https://paperpile.com/app/p/a950287e-b866-0385-8568-a512330947ef

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22
Q

Relationship between tCa and iCa (sensitivity and specificity) in cats with CKD?

A
  • tCa has a high specificity for prediction of iCa but poor sensitivity
  • Underestimation of iCa was associated with lower venous HCO3 levels
  • Cats with CKD had incrased risk for tCa increase

https://paperpile.com/app/p/74c1bfe0-5f5b-054a-96fb-fab07e627c62

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23
Q

Use of darbepoeitin in dogs with CKD, dosing intervals, side efects and number of responders.

A
  • Dosing interval >21d did not sustain a response in any dogs
  • 85% dogs achieved a PCV >30% and 67% dogs achieved PCV >10% increase
  • Median time to achieve PCV >30% was 29 days
  • adverse effects included hypertension 36%, seizures 15%, vomiting, diarrhoea and PRCA 6%.
  • Higher doses were better

https://paperpile.com/app/p/d7a0003a-2b5e-0a13-8f27-85934f1d133e

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24
Q

Mean number of urinations in cats recorded with VRS compared to cargiver observations

A

2.5 compared to 0.6

https://paperpile.com/app/p/ac9d6644-01fa-0029-a138-7967f7f9b5c9

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25
Q

What biomarkers are known ot be independent predictors of hypertension in cats?

A

CTnI and VEGF

https://paperpile.com/app/p/0e02251c-af97-04ff-bf38-fd457d556d71

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26
Q

What is the relationship between CKD stages in dogs and vitamin D metabolites, along with markers of calcium homeostasis?

A
  • All vitamin D metabolite concentrations were lower in IRIS stage 3 and 4 dogs but not different in stage 1 & 2 compared to normal dogs
  • Vitamin D metabolites were negatively correlated with PTH, FGF-23 and phosphorus concentrations

https://paperpile.com/app/p/3ede9cb0-59f9-0e82-93a4-19c17f213836

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27
Q

Is SDMA higher in dogs with CKD or AKI?

A

CKD - although it is not a useful parameter for distinguishing between them due to overlap

https://paperpile.com/app/p/3c83cecb-d549-07dd-a365-0b0552424e83

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28
Q

Which RAAS parameter is lower in greyhounds compared to non-greyhounds?

A

Aldosterone concentration, note that greyhound have higher creatinine and sodium than other dogs so actually this is an appropriate physiologic response.

https://paperpile.com/app/p/5dcda06e-de85-08de-a54d-fd6e97c0d049

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29
Q

What is the potential usefullness of giving gastric acid suppression in cats with CKD?

A

Cats with CKD have been shown not to have any changes in their gastric pH or gastrin concentrations suggesting that gastric acid suppression will not be beneficial in these animals.

https://paperpile.com/app/p/126c6805-fcd3-0808-abd4-0e511ebe221f

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30
Q

Which species has beraprost sodium demonstrated efficacy in the treatment of CKD?

A

Cats

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31
Q

What percentage of dogs with pyelonephritis have a concurrent disease?

A

75%

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32
Q

What percentage of dogs with UTI are successfully treated with infusion of E. coli 2-12 intothe bladder?

A

44%

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33
Q

What cytokines have been showwn to be elevated in cats with FIC?

A

IL-12, CXCL12, IL-18, Flt3L

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34
Q

What bone changes can be seen in the cortices of dogs with CKD on histology?

A

Smaller lacuna and higher resorption cavity density and 2.3x higher porosity

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35
Q

What is the sensitivity and specificity of SDMA in detecting masked CKD in cats wht hyperthyroidism?

A

33% and 97.7%

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36
Q

What is the effect of tetrastarc administration on lung water and oxygenation?

A

Decreased EVLW in tetrastarch treated dogs but oxygenation status did not change in this group compared to dogs given LRS

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37
Q

What is the accuracy of in-=house microscopy for the diagnosis of UTI in dogs?

A

64.5%

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38
Q

What urine characteristics may reduce bacterial growth?

A

Concentrated and alkaline urine

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39
Q

Which viruses have not been shown to have increased prevalence in the urine of CKD cats?

A

Morbillivruis and paramyxovirus

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40
Q

What is the relationship between Mg and survival in cats wiht CKD?

A

Lower Mg is associated with poorer survival and is also inversely correlated with FGF23

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41
Q

What type of AKI is FE electrolytes expected to be increased in?

A

Intrinsic AKI, n.b. FE is also associated with survival

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42
Q

What is the relationship between E./ coli biofilm formation and MDR status?

A

Biofilm forming E. coli (around 50% form biofilms) is associated with decreased risk of MDR

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43
Q

Which markers may be most useful in developing eGFR models in cats?

A

Pelvic circumference and reciprocal of serum creatinine

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44
Q

What factors have recently been identified as prognostic indicators in dogs with CKD?

A

Low BCS
Muscle atrophy
Creatinine
increased phosphorus
Increased UPC
Increased CaxP
Increased FGF23
IRIS staging

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45
Q

What urine microspy finding is SediVue unlikely to be good at telling you about?

A

Epithelial cells and urine casts

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46
Q

What percentage of cats undergoing SUB placement have positive urine cultures? Which bacteria is most common?

A

25%
Enterococcus most common

47
Q

What type of uretheritis is most common in cases of proliferative urethritis?

A

Lymphocytic-plasmacytic

48
Q

What is the relationship between UPC and USG?

A

Negativly correlated

49
Q

What are the risk fators for candida UTI in dogs and cats?

A

Dogs: administration of ABx within 30d, previous history of Malasezia dermatitis, immunosupression, bacterial cystitis
Cats: LUT disease or other infections
n.b. DM was not associated

50
Q

What percentage of ureterocoeles appear to be ectopic?

A

71%

51
Q

What is the relationship between indocyl sulfate, FGF23, phosphate and CKD in cats?

A

Indocyl sulfate is corelated to FGF23 and phosphorus

52
Q

What increase in urinary electrolyte is expected following mannitol administration

A

Sodium

53
Q

What percentage of uroliths are expected to be CaOx in dogs?

A

50%

54
Q

What is the difference in prevalence between seronegative and seropositive for Borrelia dogs and polyarthritis?

A

NSD

55
Q

Does addition of meloxicam to treatment with phenoxybenxamine and alprazolam in cats with FIC make any difference to the risk of recurrent UTO?

A

No

56
Q

What is the CV of morning USG results in dogs?

A

155

57
Q

What variables may be used in modelling to predict CKD in cats?

A

creatinine, BUN, USG and age - note the model has poor sensitivity but high specificity

58
Q

Relationship of SDMA to FGF23

A

Weak positive

59
Q

Which miRNA may be increased in cats with pyelonephritis?

A

16

60
Q

What NGAL marker seems to perform best in studies of AKI?

A

NGAL:Creatinine, has been noted to be higher in:
- Dogs with intrinsic vs. volume responsive AKI
- Higher in dogs with progressive CKD
-

61
Q

What cut-off of SDMA may be most appropriate for detecting a ≥40% decrease in GFR in dogs?

A

18ug/dL

62
Q

What are the most common causes of urinary incontinance in cats?

A

Spinal cord disorders (40%) and urethral disorders (37%)

63
Q

SI there a benefit to measuring UCa:Cr in dogs for prediction of CaOx urolithiasis?

A

Has a poor sensitivity (50%) but good specificity

64
Q

What percentage of asymptomatic, inactive sediment proteinuric dogs will have a positive urine culture?

A

1.8%

65
Q

What is the most common findings on cystoscopy of dogs with recurrent UTI?

A

Blader mucosal oedema

66
Q

What AUS marker is negatively correlated with disease severity in cats with CKD?

A

Cortical thickness

67
Q

What size of dogs might 3D ultrasound for estimation of bladder volume be ok for?

A

> 5.5kg

68
Q

What factor is associated with short and long term outcomes in acute on chronic kideny disease in cats?

A

Phosphorus for short term and creatinine at presentation and discharge for long term

69
Q

how long after VetFoam agent for treatment of USMI would clinical signs be expected to recur?

A

11.1 months on average

70
Q

What medullary change is thought to be more frequent in cats with CKD?

A

Medullary band

71
Q

Prevalence of hypertension in dogs with AKI and prevalence of hypertensive retinopathy

A

75%, 16%

72
Q

What risk factors are there for hypertension in dogs with AKI?

A

Fluid overload, hypertension itself not associated with survival

73
Q

What sex seems predisposed to FSGS?

A

Female

74
Q

Other than azotaemia, what is the other common clinical manifestation of grape/rasin toxicity?

A

Neurological signs

75
Q

Which bacterial species is more commonly associated with recurrent UTI in dogs?

A

Enterococcus

76
Q

Which ultrasound techniques over or underestimate bladder volumes?

A

3D underestimates, 2D overestimates

77
Q

What clinical parameters are correlated to vitamin D metabolites in dogs with PLN?

A
  • Lower Vitamin D overall
  • Serum 24,25 and 25 OHD are both negatively correlated with albumin and UPC
  • Urinary 25D:Cr is negatively correlated with serum albumin and positively correlated with UPC
78
Q

What percentage reduction in UPC is expected with telmisartan vs. enalapril?

A

65% telmisartan vs. 35% enalapril

79
Q

What is the effect of cacifediol supplementaiton on CKD markers in dogs

A

Doesnt affect many things other than increasing FGF23

80
Q

What predictors of outcome have been found for dogs with acute on chronic CKD?

A

Hospitalisation time (longer in surviros)
Respiratory rate, CK and creatinine predict short term outcome
Long term factors could not be identified

81
Q

What intervenional treatment option results in longer duration of urethral patency in dogs with proliferative urethritis?

A

Stents (vs. balloons)

82
Q

What are the risk factors for development of hypercalcaemia in cats on a restricted phosphorus diet with CKD? What is the potential worry with this?

A

Lower plasma potassium and phosphorus
Cats with increasing tCa also had trends of increase in creatinine, phosphorus and FGF23 over time

83
Q

What is the effect of azotaemia on ampicillin pharmakokinetics?

A

Higher peak ampicillin, longer T 1/2 and reduced clearance compared to healthy dogs

84
Q

What leght of time after starting a cat that has become hypercalcaemic on a renal diet would it be expected to take for iCa to reduce?

A

2.2 months

85
Q

What is the third most common feline urolith?

A

Urate

86
Q

Which stone type has increased in dogs in recent years?

A

Cystine

87
Q

What biochemical change is most associatd with GI bleeding in dogs?

A

Increased urea:creatinine ratio

88
Q

What pelvic and ureteral size are seen in cats with ureteral obstruction?

A

Pelvic size 5mm and ureteric size 3mm on CT

89
Q

Which of the following is associated with urine volume produced during hospitalisation in dogs?
a) BWT >10kg
b) BWT <10kg
c) Anaesthesia
d) administration of IVFT

A

a

90
Q

Which vitamin D receptor SNPS have been associated with increased risk of CaOcx urolithiasis in dogs?

A

CC or CT

91
Q

What drug may be administered to dogs with excessive PU/PD from prednisolone therapy although what adverse effect may be noted?

A

DDAVP, reductions in serum sodium are possible

92
Q

What is the rate of resolution and median time to resolution for medical management of struvite urolithiasis?

A

58% in a median of 35 days

93
Q

What factors are associated with increased likelihood of sucessful medical dissolution of struvte uroliths?

A
  • <10% non-struvite material in the stone
  • Administration of antimicrobials
  • Interestingly urine PH and size of uroliths was not associated with success
94
Q

What FGF23 cut-off seems to predict time to development of hyperphosphataemia and CKD progression in dogs?

A

> 528pg/mL

95
Q

& of cats with a SUB that:
- Develop UTI
- Develop SUB obstruction
- Number that kink

A

a) 26%
b) 17%
c) 10%

96
Q

What combination of clinical features predict survival in cats wiht big kidney little kidney syndrome?

A

BUN, phosphorus and body temperature predicts 30 day survival in these cases

97
Q

What is the difference in disease progression for cats fed a protein/phosphorus restricted diet compared to a moderately protein/phosphate restricted diet?

A

More severely restricted cats may normalsie their creatinine within 6 months but their tCa and FGF23 will increase. However, if feeding a moderate restriction then creatinine will not decrease ut FGF23 will

98
Q

What percentage of renal donor cats will develop urinary tract disease in the long term?

A

4%

99
Q

What is the relationship of BCS and CaOx urolithiasis in dogs?

A

Median BCS is higher in dogs with CaOx although the proportion of overweight animals is not different to controls

100
Q

What clinical consequence of ureteral stent placement in cats is associated with poor outcomes?

A

Peritoneal effusion

101
Q

What percentage of dogs having a PCCL require conversion to open surgery?

A

10%

102
Q

Prevalence of cystitis in dogs treated with metronomic cyclophosphamide and frusemide?

A

3.6%

103
Q

Asssociations between upper and lower urinary tract stones and CKD in cats?

A

CKD is more common in both groups combined although CKD has a negative correlation wiht the presence of lower urinary tract stones

104
Q

What risks of stent placement are their compared to SUBs in cats?

A

Stents have a longer duration of surgery, higher post-operative mortality, reduced MST, greater risk of LUT signs and device occlusion

105
Q

What is the clinical performance of a commercial point of care culture and sensitivity plate for UTI culture?

A

There is 39% discordance between the plate nad reference culture

106
Q

What are the most common sites of urinary tract rupture in dogs?

A

Bladder, urethra, kidenyand ureter

107
Q

What are the causes of uroabdomen in dogs?

A

Trama ? obstruction > iatrogenic

108
Q

Survival to discharge in dogs with uroabdomen

A

79%

109
Q

What needle gauge size seems to collect more glomeruli in renal biopsies?

A

16-guage

110
Q

What long term risk factors are their for cats developing CKD

A

Periodontal disease
GA within a year and cystitis at any time
DM and HL seem to have a reduced CKD risk in this study

111
Q

Success rate of endoscopic stent placement for dogs with ureteral obstruction, how does this compare to surgical placement?

A

81% (comapared to 100% for surgery)

112
Q

What statement is true of renal FNA?
a) For diagnosis of neoplasia sensitivity is hig and specificity low compared to non-neoplastic diseases where the opposite is true
b) Opposite of the above

A

a

113
Q

Should urinary catheters be in and out in cats with UO?

A

Probnably not as this is a risk factor for re-obstruction

114
Q

What clinicopathologic variables may predict occurance of postobstructive diuresis in cats wiht ureteric obstruction?

A
  • Creatinine and BUN
  • Potassium
  • Phosphorus
  • Anuria (anuric animals have a longer duration of POD)

Specialty Revision (13 decks)

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