Renal and Urinary Disease Flashcards
Which is the least helpful indirect measure of GFR ?
Creatinine Cystatin C Urea Urine output SDMA
Urea
A dog with kidney disease has isosthenuric urine (USG 1.008-1.012) without azotemia. What percentage of the kidney is damaged?/
66%
A dog has azotemia and inadequately concentrated urine (USG
Renal Failure
Hyperadrenocorticsm
Furosemide Treatment
Phenobarbitone
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
Normal urine SG is 1.007-1.015
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
Lower UTI
A 10 year old Maltipoo has PU/PD, with a USG=1.007. What is the most likely diagnosis?
Cushings
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?
PKD
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?
Renal Pelvis
Potential causes of hospital acquired AKI include all of the following except?
Radiocontrast agent NSAID Gentamycin Leptospirosis Septic Shock
Leptospirosis
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?
Renal tubular acidosis
What is not a feature of acute renal tubular injury?
renal tubular epithelial cells on sediment Glucosuria Proteinuria High fractional excretion of sodium Alkalosis
Alkalosis
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?
He is in the initiation phase of AKI
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)
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
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?
Oliguria
Hansel has oliguric renal failure. As
part of his fluid calculation plan, the
total insensible loss is:
22 ml/kg/d
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?
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
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?
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
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
B. IRIS III, BP, RND
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. Creatinine concentration B. Phosphorous C. Renal proteinuria D. Blood pressure E. Elevated BUN F. Decreased Hg or PCV
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
C. Stage II
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
B. Repeat the sample in 2 weeks time to demonstrate persistent proteinuria C. Recommend an investigation including an abdominal US
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. “Watch and wait”
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
B. Benazepril
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. Amlodipine
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
C. Rise in creatinine
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. Pre-renal
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
C. IRIS stage IV
azotemia
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
C. Ehrlichiosis
The complications of a
glomerulonephritis syndrome include
all of the following except?
A. Hypertension B. Azotemia C. Hypoalbuminemia D. Hypocoagulable state
D. Hypocoagulable
state
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
B. Mycophenolate
mofetil
What immunosuppressive protocol is
least desirable for ICGN
A. Prednisilone B. Mycophenolate mofetil C. Mycophenolate + Prednisilone D. Mycophenolate + azathioprine E. Mycophenolate + chlorambucil
A. Prednisilone
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. When the cause of
proteinuria is not known
‘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
C. Ureteral obstruction
‘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
C. US guided
pyelography
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
E. Subcutaneous ureteral
bypass (SUB)
implantation
‘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
B. Collect blood (Creat/BUN,
electrolytes, acid base)
measurement and start IVF
‘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. Start with cephalexin while
waiting for C&S
B. Radiograph and ultrasound of
the abdomen
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
B. Relapse
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
C. Recommend MDB,
radiographs and US of
bladder
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
C. Treat with 30-50% of
total dose daily in
evening for 6 months
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
B. Complicated UTI
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
B. CaOx
Recommend Rx
A. Dietary dissolution with Abx B. Surgery C. Basket retrieval D. Urohydropulsion E. Mini-laparotomy cystotomy
E. Mini-laparotomy
cystotomy
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
C. Acidifying diet
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
C. Magn Ammonium
Phosphate
Recommend Rx
A. Dietary dissolution with Abx B. Surgery C. Basket retrieval D. Urohydropulsion E. Mini-laparotomy cystotomy
A. Dietary dissolution
with Abx
‘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
E. Prostatic carcinoma
