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Clin Path Test Three > Renal Chemistry > Flashcards

Renal Chemistry Flashcards

1
Q

What is the most early and significant indicator of urinary tract disease

A

Disturbances in water intake/ output - PU/PD

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2
Q

What is oliguria

A

Decreased urine output

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3
Q

What is pollakiuria

A

Increased frequency of urination

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4
Q

What part of the kidney is responsible for concentrating urine

A

Renal tubules

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5
Q

What phases of chronic renal failure does PU/PD occur

A

Acute and progressive

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6
Q

What phase of acute renal failure does PU/PD occur

A

Recovery phase

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7
Q

5 causes of PU/PD

A

Loss of medullary gradient, decreased ADH, ADH resistance, Iatrogenic, psychogenic

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8
Q

4 causes of loss of medullary gradient

A

CRD, diabetes, fanconi syndrome, post-obstructive diuresis

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9
Q

Other than PU/PD, what conditions accompany diabetes mellitus

A

hyperglycemia and glucosuria

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10
Q

Three symptoms of fanconi syndrome

A

Normoglycemia, glucosuria, PU/PD

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11
Q

What can cause medullary washout

A

any chronic PU/PD and liver failure due to decreased urea *****5

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12
Q

Hormonal effect of central diabetes insipidus

A

Decreased ADH, usually from hypothalamus or pituitary damage

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13
Q

USG in central diabetes insipidus

A

Typically hyposthenuric (

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14
Q

pu-pd causes - more common, more rare

A

common- ADH resistance; rare- decreased ADH secretion

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15
Q

Causes of ADH resistance (2)

A

Primary nephrogenic d. insip. (rare); secondary nephrogenic d. insip (common)

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16
Q

USG- Primary nephrogenic d. insip.

A

isosthenuric (1008-1012)

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17
Q

USG- secondary nephrogenic d. insip

A

Hyposthenuric (

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18
Q

Causes of secondary nephrogenic d. insip

A

pyometra, pyelonephritis, cystitis from endotoxin, cushings, addisons, hyperthyroidism

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19
Q

Electrolyte abnormalities and their effects- secondary nephrogenic d. insip

A

Hypercalcemia (interferes with ADH at distal) and hypokalemia (decreased medullary gradient)

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20
Q

Causes of Iatrogenic PUPD (2)

A

Drugs (diuretics, corticosteroids, anticonvulsants), fluid therapy

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21
Q

Psychogenic PUPD

A

Animal just drinks too much

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22
Q

Anuria/oliguria- causes (3)

A

Pre-renal (dehydration), renal (acute/chronic), post-renal (obstruction)

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23
Q

Anuria/oliguria- phases of renal disease

A

Unresolved ARF or end stage CRF

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24
Q

Lab diagnostics- uroabdomen

A

High BUN/Creat, low sodium, high postassium

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25
Q

Lab dx- ethylene glycol toxicity

A

Low Ca, high anion gap, seizures, oliguria 1-4 days post

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26
Q

What is the cause of anemia in chronic renal failure

A

Decreased EPO production *****10

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27
Q

What is dysuria an indicator of

A

Lower urinary tract disease (bladder and/or urethra)

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28
Q

Neuro causes of dysuria

A

UMN- tight, distended bladder, difficult to express; LMN- flaccid bladder, easy to express

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29
Q

Which dogs are prone to incontinence

A

Older, spayed female

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30
Q

What electrolytes may be abnromal in urinary disease

A

Ca, Cl, K, Na, CO2, Phos

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31
Q

BUN/Creat are markers for

A

GFR,

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32
Q

Decrease in GFR can cause (2)

A

azotemia or uremia

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33
Q

Azotemia- define

A

Increased BUN and/or creat due to decreased GFR

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34
Q

Uremia- define

A

Clinical condition of azotemia + clinical signs

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35
Q

BUN- increases due to (3)

A

decreased kidney flow leading to increased reabsorption; increased protein catabolism (eating many rawhides); hemorrhage in GI tract

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36
Q

Renal disease and BUN in ruminants- diagnostics

A

unreliable bc cows excrete urea elsewhere

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37
Q

BUN source

A

Urea formed in liver from N waster like NH3 from gut protein breakdown

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38
Q

BUN reabsorption

A

Inversely proportional to flow rate

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39
Q

Fate of ammonia in body

A

Ammonia dangerous to pH so convert to urea despite energy cost

40
Q

Pre-renal azotemia (2)

A

increased BUN- decreased filtration rate due to dehydration or shock= decreased blood flow; high protein diet, GI hemorrhage

41
Q

What chem results would indicate GI hemorrhage

A

Increased BUN, normal creat

42
Q

Renal azotemia

A

Increased BUN due to decreased filtration rate

43
Q

Post-renal azotemia

A

Obstruction or rupture leading to decreased filtration

44
Q

USG- pre-renal azotemia

A

elevated

45
Q

Pre-renal azotemia elevations

A

USG, RBC, PCV, Na, Cl, plasma protein/albumin

46
Q

Renal azotemia- when?

A

75% loss of nephron function

47
Q

When is urine concentration ability lost

A

66% nephron loss

48
Q

First indicator of renal azotemia

A

Altered USG - because concentration lost before BUN/creat elevation

49
Q

Adequate concentration of urine USG

A

1008-1030 (1035 cats)

50
Q

Reduced concentration USG

A

1012-1030

51
Q

No concentration- USG

A

1008-1012

52
Q

Diagnose USG

A

NOT renal- likely ADH related (d. insip)

53
Q

Post renal azotemia- causes (2)

A

Obstruction, uroabdomen

54
Q

Chem findings- post renal disease

A

Azotemia with hyperkalemia, hyponatremia - USG not helpful

55
Q

Diagnose post renal azotemia

A

Abdominal fluid- low protein, BUN increase

56
Q

Without azotemia- diagnose renal disease

A

Urinalysis- proteinuria, glucosuria (without hyperglycemia), casts, reduced urine concentration in dehydrated animal

57
Q

What should be monitored in animals on aminoglycosides-

A

Can become azotemic- UA, BUN/creat

58
Q

BUN- helpful in cows/horses? Why/why not

A

No- gut bacteria

59
Q

Low BUN- causes

A

Liver failure, low protein diet, overhydration

60
Q

Creatinine- source

A

Skeletal muscle metabolism product

61
Q

Creatinie changes- sources

A

Muscle wasting or necrosis- not diet/GI

62
Q

Breed with greatest mean serum [Creat]

A

Greyhounds

63
Q

What does creat measure

A

GFR

64
Q

When will creat rise

A

After BUN rises, as GFR decreases.

65
Q

Increased creat- artifact

A

acetoacetate, glucose, vitamin C, uric acid, pyruvate, cephalosporins, amino acids

66
Q

Physio increased creat

A

Foals, muscular horses, greyhounds, after protein meal

67
Q

Decreased creat (3)

A

Artifact of increased bili, pregnancy (increaseD CO = increased GFR), significant muscle mass loss

68
Q

2x higher creat in abdomen than serum =

A

Uroabdomen

69
Q

Elevated potassium- conditions

A

Post-renal and renal azotemia

70
Q

Polyuric renal failure- consequence

A

Hypokalemia (mostly cats, cows, rare in dogs)

71
Q

Sodium elevation - conditions

A

pre-renal due to dehydration concurrent with increased Na, Cl, alb

72
Q

CRF effect on sodium

A

Hyponatremic due to loss of ability to retain

73
Q

Distinguish renal from pre-renal azotemia

A

Pre-renal- Na 1 ***22

74
Q

Diagnose- hyponatremic and hyperkalemic

A

Uroabdomen

75
Q

TCO2 =

A

HCO3-

76
Q

Why is HCO3 often reduced in renal patients

A

Become acidotic due to organic waste build up

77
Q

Two types of metabolic acidosis

A

Normal anion gap- Loss of bicarb/retention Cl; increased anion gap- bicarb not lost, no Cl retention *****24

78
Q

Phosphorus- how effected by renal failure

A

Hyper due to decreased excretion

79
Q

What species will not have hyperphosphatemia in renal disease

A

Cattle (not a route of excretion), horses- will be hypo

80
Q

Why must phos be controlled in renal disease

A

Can develop secondary hyperparathyroidism with bone resorption and renal mineralization ( because thyroid wants to raise calcium and dump extra phos )

81
Q

How can phos be controlled in renal disease

A

Oral phosphate binders to lower level

82
Q

Calcium in horses with renal disease

A

Hyper (bc kidney route of excretion), rare in other species

83
Q

What species see hypocalcemia with CRF, why?

A

Cats and cattle due to polyuria

84
Q

Acid-base effect of renal disease in dogs/cats

A

Metabolic acidosis due to decreased H and organic acid product excretion, loss of ability to conserve bicarb

85
Q

Acid base effect of renal disease in cattle

A

none to alkalosis (rumen stasis and HCl sequestering)

86
Q

Pre-renal azotemia albumin

A

Increased

87
Q

Renal azotemia albumin

A

Normal or decreased from protein losing nephropathy

88
Q

DIagnose protein losing nephropathy

A

Protein:creatinine ratio

89
Q

Cattle in renal failure- random findings

A

High fibrinogen

90
Q

Dogs in renal failure- random findings

A

Elevated amylase and lipase bc degraded/excreted by kidney

91
Q

ARF vs CRF- urine output initial/later, K, Na, acidosis, anion gap

A

ARF- oliguria initially, PU later; K high, high anion gap
CRF- PUPD initially, an/oliguric at end stage; Na/K low, normal anion gap, anemic (non-regen)
*** CRF usually anemic due to lack of EPO production

Phos high in both, metabolic acidosis in both

92
Q

When should a water deprivation test be used

A

PUPD, not azotemic, urine not concentrated (but not in hyposthenuria)

93
Q

What is urine creat used to measure

A

Fractional clearance; can distinguish renal/prerenal azo

94
Q

Renal vs pre-renal azotemia- distinguish via

A

Creatinine- >50:1 - pre-renal;

95
Q

What does UPC measure

A

Urine protein:creatinine - for magnitude of proteinuria to diagnose PLN; radio >0.5 indicates PL glomerular nephropathy

Clin Path Test Three (2 decks)

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