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RUSVM Small Animal Medicine 2- A > Renal and Urinary Disease > Flashcards

Renal and Urinary Disease Flashcards

1
Q

Which is the least helpful indirect measure of GFR ?

Creatinine 
Cystatin C
Urea
Urine output
SDMA
A

Urea

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2
Q

A dog with kidney disease has isosthenuric urine (USG 1.008-1.012) without azotemia. What percentage of the kidney is damaged?/

A

66%

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3
Q

A dog has azotemia and inadequately concentrated urine (USG

A

Renal Failure
Hyperadrenocorticsm
Furosemide Treatment
Phenobarbitone

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4
Q

What statement is incorrect?

Normal water intake is 60-80 ml/kg/d
Normal urine production is 1-2 ml/kg/hr
Oliguria is urine production

A

Normal urine SG is 1.007-1.015

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5
Q

An owner brings in a free catch urine sample from a dog with a history of polyuria. The USG is 1.026, with no glucosuria. Name the most likely etiology

A

Lower UTI

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6
Q

A 10 year old Maltipoo has PU/PD, with a USG=1.007. What is the most likely diagnosis?

A

Cushings

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7
Q

A 6 year old Persian, FeLV positive, presents with PU/PD, bilateral renommegaly, irregular, painful kidney’s on palpation. What is the most likely DX?

A

PKD

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8
Q

A 4 year old male Corgi presents with pigmenturia that occurs at the end of urination. Urinalysis confirms both Hguria and ghost RBC. The dog is proteinuric and azotemic. What is the most likely diagnosis?

A

Renal Pelvis

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9
Q

Potential causes of hospital acquired AKI include all of the following except?

Radiocontrast agent
NSAID
Gentamycin
Leptospirosis
Septic Shock
A

Leptospirosis

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10
Q

A 4 YO beagle presents to you clinic with anorexia. Biochemistry detects a mild azotemia and a BG of 7.5mmol/L (RI 3.3-5.5mmol/L) and blood gas detected a metabolic acidosis. Urinalysis has the following abnormalities, USG: 1.022, glucose 1+, protein 1+, sediment: RTE cells. What is the most likely problem?

A

Renal tubular acidosis

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11
Q

What is not a feature of acute renal tubular injury?

renal tubular epithelial cells on sediment
Glucosuria 
Proteinuria
High fractional excretion of sodium 
Alkalosis
A

Alkalosis

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12
Q

Humpty, a Tonkinese, 2 YO, MN, visits your clinic as the owner has read on the internet that tiger lilies are toxic and she saw Humpty chewing some leaves this morning. You run some biochemistry and UA screening tests but all the results are WNL. What is going on?

A

He is in the initiation phase of AKI

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13
Q

Hansel, a 6 YO MN Bernese Mt dog, (50kg) arrives at you clinic. He is 10% dehydrated and azotemic. How much do you administer in the first 6 hours (dehydration & maintenance)

A 
Replacement (dehydration) -10%= 5000mL
Maintenance: 44-66 ml/kg/d
Giant breed therefore choose 44ml/kg/d (1.8ml/kg/hr)
Therefore for 6 hours: 540mL 
5540mL
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14
Q

You find out from the history that Hansel (50kg) drank ethylene glycol yesterday. You suspect AKD based on azotemia. Hansel is fully hydrated after 6 hours. you place an indwelling urinary catheter and he produces on average 20ml/hr. Hansel has?

A

Oliguria

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15
Q

Hansel has oliguric renal failure. As
part of his fluid calculation plan, the
total insensible loss is:

A

22 ml/kg/d

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16
Q

Hansel has been on 2 x maintenance for the last 12 hours but
gaining weight and no change in urine output (20 ml/hr). You
now decide to come up with a new fluid plan to prevent fluid
overload. The total IVF (crystalloids) that you administer is at the
rate of?

A

66 ml/hr

Insensible loss: 22 ml/kg/d (22x50/24hr =
45.83 ml/hr)
• Sensible loss: urine output: 20 ml/hr
• Ongoing loss: no V+/D+
• Total fluids/hr: 46 ml + 20 ml = 66 ml/hr

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17
Q

You read on Gretel’s ICU sheet (BW:10 kg) that she is
producing 7 ml/hr of urine (closed collection bag).
Considering her ‘ins’ and ‘outs’ per hour i.e. what do
we set her drip rate at?

A

16 ml/hr

  • Insensible loss: 22 ml/kg/d
  • Gretel: 10 x 22 / 24 hr = 9.1 ml/hr
  • Urine output: 7 ml/hr
  • Ongoing loss: none recorded
  • Total fluid rate: ‘ins’: 9.1 + 7 = 16 ml/hr
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18
Q

A dog with CKD, IRIS stage III and UPCR of 0.4, did
not have blood pressure measured. Which is the correct
classification?

A. IRIS III, NP, RND
B. IRIS III, BP, RND
C. IRIS III, BP, AP0
D. IRIS III, P, AP0

A

B. IRIS III, BP, RND

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19
Q

What are prognosticators (independent or
dependent risk factors) for outcome in a cat or
dog diagnosed with CKD?

A. Creatinine
concentration
B. Phosphorous
C. Renal proteinuria
D. Blood pressure
E. Elevated BUN
F. Decreased Hg or PCV
G. Hypokalemia
H. Hypocalcemia
I. Vomiting
A 
A. Creatinine
concentration
B. Phosphorous
C. Renal proteinuria
D. Blood pressure
E. Elevated BUN
F. Decreased Hg or PCV
20
Q

Renal diets have strong evidence to support their use
due to the benefits of prolonged survival.
When should you recommend starting a renal diet in a
cat with CKD?

A. In hospital
B. Stage I
C. Stage II
D. Stage III
E. Stage IV
A

C. Stage II

21
Q

A 12 yr, M(N) British shorthair, “Churchill”, is currently being
IRIS staged in your clinic. You submitted urine 48 hr prior to
IDEXX and the result returns as follows:, sediment: negative,
C&S: nil, UPCR is 0.5. What do you recommend?

A. This is proteinuria. Start ACEi
and ARI
B. Repeat the sample in 2 weeks
time to demonstrate persistent
proteinuria
C. Recommend an investigation
including an abdominal US
D. Ignore this proteinuria, it is
tubular and expected in a cat
with CKD
A 
B. Repeat the sample in 2 weeks
time to demonstrate persistent
proteinuria
C. Recommend an investigation
including an abdominal US
22
Q

A WHWT diagnosed with CKD and BP. Blood pressure
(Systolic, Doppler, non-invasive) is 168 mmHg measured on 3
different occasions 30 min apart. There are no clinical signs
related to hypertension (TOD). What do you recommend

A. “Watch and wait”
B. Start ACEi
C. Start amlodipine
D. Hospitalize, restrict fluids,
induce with amlodipine
and then beta blockers if
necessary
“
A

A. “Watch and wait”

23
Q

A 5 year old male neutered Scottish terrier with IRIS III, BP, AP3
has persistent severe hypertension (190 mmHg) for 2 weeks with
no TOD. What is your first choice of antihypertensive agent?

A. Amlodipine
B. Benazepril
C. Propanolol
D. Hydralazine

A

B. Benazepril

24
Q

A 11 year old female Abyssinian with IRIS stage II, NP,
AP3 (persistent severe hypertension for 2 weeks). What
is your first choice of treatment?

A. Amlodipine
B. Benazepril
C. Propanolol
D. Furosemide

A

A. Amlodipine

25
Q

When ACEi Rx is started we repeat blood tests 3
days later to monitor for which laboratory
change?

A. Rise in sodium
concentration
B. Rise in packed cell
volume
C. Rise in creatinine
D. Rise in calcium
A

C. Rise in creatinine

26
Q

Multiple myeloma and Bence-Jones
proteinuria is an example of which
category of proteinuria?

A. Pre-renal
B. Renal
C. Post-renal
D. Physiologic

A

A. Pre-renal

27
Q

What would be a contra-indication for
renal biopsy in the investigation of
renal proteinuria?

A. Hypoalbuminemia
B. A breed with
familial history
C. IRIS stage IV
azotemia
D. Hypertension
A

C. IRIS stage IV

azotemia

28
Q

What is an example of immunecomplex
glomerulonephritis

A. Shar pei amyloidosis
B. X linked hereditary
proteinuria in
Samoyed
C. Ehrlichiosis
D. Alport syndrome in
Cocker spaniels
A

C. Ehrlichiosis

29
Q

The complications of a
glomerulonephritis syndrome include
all of the following except?

A. Hypertension
B. Azotemia
C. Hypoalbuminemia
D. Hypocoagulable
state
A

D. Hypocoagulable

state

30
Q

You have diagnosed ICGN in a 5 year
old dog with diabetes. What is the
most appropriate therapy?

A. Prednisolone
B. Mycophenolate
mofetil
C. Azathioprine
D. Cyclosporin
A

B. Mycophenolate

mofetil

31
Q

What immunosuppressive protocol is
least desirable for ICGN

A. Prednisilone
B. Mycophenolate
mofetil
C. Mycophenolate +
Prednisilone
D. Mycophenolate +
azathioprine
E. Mycophenolate +
chlorambucil
A

A. Prednisilone

32
Q

When is immunosuppressive therapy
contraindicated

A. When the cause of
proteinuria is not known
B. If there is no kidney
biopsy to support ICGN
diagnosis
C. If the patient is
azotemic
D. If the patient is
hypoalbuminemic
E. If the patient is
hypertensive
A

A. When the cause of

proteinuria is not known

33
Q

‘Peanut butter’, 7 year old MN DSH. Complaint: PuPd.
On clinical examination you palpate one large kidney.
The most likely differential is?

A. Lymphoma
B. Carcinoma
C. Ureteral obstruction
D. PKD

A

C. Ureteral obstruction

34
Q

‘PB’ has an abdominal ultrasound. The LK has
hydronephrosis and the RK is small and shrunken. PB is
azotemic. You cant find a ureterolith.
What is the best diagnostic test?

A. IVP with CT
B. IVP with radiographs
C. US guided
pyelography
D. Retrograde cystogram
A

C. US guided

pyelography

35
Q

You confirm an obstruction midway down the ureter. ‘PB’ has
been on fluids for 3 days, he has normal urine output but remains
azotemic. The urinalysis from the pyelocentesis is normal. What
treatment do you recommend

A. Watch and wait, ‘first do
no harm’
B. Nephrectomy
C. Ureteral stent
D. Ureteral implantation
E. Subcutaneous ureteral
bypass (SUB)
implantation
A

E. Subcutaneous ureteral
bypass (SUB)
implantation

36
Q

‘Kintaro’ 4 year old M(N) DSH presented with a history of
unproductive straining in the litter tray overnight. You palpate a
large firm painful bladder. The owner wants to do everything she
can for her little ‘Japanese hero’.
What is the next most appropriate thing to do for Kintaro?

A. Sedate and attempt to ‘unblock’
the urethra
B. Collect blood (Creat/BUN,
electrolytes, acid base)
measurement and start IVF
C. Start with a Ca-gluconate infusion
while ECG monitoring, as it is
cardioprotective
D. Warm Kintaro as hypothermia is
associated with mortality
A

B. Collect blood (Creat/BUN,
electrolytes, acid base)
measurement and start IVF

37
Q

‘Jelly bean’ a F(S) 3 year old Miniature schnauzer.
Primary complaint: stranguria, pollakiuria.
Cystocentesis confirms a UTI (bacteria and leukocytes
with RBC)
What do you recommend to the owner?

A. Start with cephalexin while
waiting for C&S
B. Radiograph and ultrasound of
the abdomen
C. Potassium citrate since she is a
Min Schnauzer
D. A prescription diet to prevent
supersaturation and increase
thirst due to high sodium
content
A

A. Start with cephalexin while
waiting for C&S
B. Radiograph and ultrasound of
the abdomen

38
Q

A female (S) crossbreed, “Sunshine”, has a urine C&S, 7
days post 6 weeks course of Abx for a complicated UTI.
The bacteria is E. coli with the same spectrum of sens.
What is the diagnosis?

A. Superinfection
B. Relapse
C. Reinfection
D. Uncomplicated

A

B. Relapse

39
Q

What do you recommend to
“Sunshine’s” owner.

A. Repeat a 6 week
course of Abx
B. Rx for 6 months with
urinary disinfectants
C. Recommend MDB,
radiographs and US of
bladder
D. Cranberry juice
extract
A

C. Recommend MDB,
radiographs and US of
bladder

40
Q

You investigate Sunshine and find she has a lower
motor neuron disease causing urinary retention. What
protocol do you recommend to control the relapse UTI?

A. Treat with full course
Abx for 1 year
B. Treat with 30-50%
daily in morning for 6
months
C. Treat with 30-50% of
total dose daily in
evening for 6 months
D. Treat at 60% of dose
daily for 3 months
A

C. Treat with 30-50% of
total dose daily in
evening for 6 months

41
Q

A 12 month old, F(S) Shih tsu presents with stranguria, incontinence and
hematuria. You treat with TMS for 14 days. 7 days later the clinical signs recur.
What is the diagnosis?

A. Uroliths
B. Complicated UTI
C. Superinfection
D. Cushing’s
E. Ectopic ureters
A

B. Complicated UTI

42
Q

An 8 year old M(N) Min Schnauzer presents with
stranguria. Examine the radiograph and make
the most likely diagnosis.

A. Cysteine
B. CaOx
C. Magn Ammonium
Phosphate
D. Urate
A

B. CaOx

43
Q

Recommend Rx

A. Dietary dissolution
with Abx
B. Surgery
C. Basket retrieval
D. Urohydropulsion
E. Mini-laparotomy
cystotomy
A

E. Mini-laparotomy

cystotomy

44
Q

Which is not a potential Rx option
after surgery, considering there is a
high recurrence rate?

A. Thiazide diuretics
B. Potassium citrate
C. Acidifying diet

A

C. Acidifying diet

45
Q

An 8 year old F(S) Shih tsu presents with stranguria
and hematuria. Examine the radiograph and make the
most likely diagnosis

A. Cysteine
B. CaOx
C. Magn Ammonium
Phosphate
D. Urate
A

C. Magn Ammonium

Phosphate

46
Q

Recommend Rx

A. Dietary dissolution
with Abx
B. Surgery
C. Basket retrieval
D. Urohydropulsion
E. Mini-laparotomy
cystotomy
A

A. Dietary dissolution

with Abx

47
Q

‘Benji’ 8 y.o. M(N) Golden retriever presents with a Hx of
hematuria. Rectal examination detects a large, irregular, painless,
asymmetrical prostate
The most likely etiology is?

A. BPH
B. Acute prostatitis
C. Chronic prostatitis
D. Prostatic abscesses
E. Prostatic carcinoma
A

E. Prostatic carcinoma

RUSVM Small Animal Medicine 2- A (8 decks)

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