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Ettinger Old > Renal disease > Flashcards

Renal disease Flashcards

1
Q

What is considered the gold standard for assessment of GFR?

A

Urine inulin clearance

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2
Q

Why is plasma inulin clearance nor recommended in dogs?

A

40% inulin is cleared from the plasma by non-renal routes

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3
Q

Which breed of cat is associated with elevated sCr?

A

Birman

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4
Q

What is cystatin C?

A

Protease inhibitor

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5
Q

How is cystatin C handled in the kidneys?

A

Freely filtered
Reabsorbed by megalin-mediated endocytosis

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6
Q

What does increased urinary cystatin C indicate?

A

Tubular dysfunction

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7
Q

How and where are filtered proteins reabsorbed in the kidney?

A

Megalin- and cubulin- mediated endocytosis in proximal tubular cells

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8
Q

What can cause false positive/negative results on a urine protein dipstick?

A

Positive - cats, alkaline/concentrated urine, pyuria/haematuria
Negative - acidic/dilute urine, BJ proteinuria

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9
Q

What stain is used to highlight the basement membrane in renal biopsies?

A

Jones methenamine silver

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10
Q

Can serum albumin / AT III be used to guide thromboprophylaxis in dogs with PLN?

A

No - magnitude of hypoalbuminaemia, AT concentration or UPCR are predictive of thromboembolic complications

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11
Q

What is USG?

A

The weight of a volume of fluid compared to the weight of an equal volume of distilled water

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12
Q

Where is filtered glucose reabsorbed?

A

Mostly SGLT 2 (SGLT 1 to lesser extent) in proximal tubule

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13
Q

What is the function of different regions of the renal tubule with regards to pH regulation?

A

PT - main site of H+ and HCO3- reabsorption
DT - regulation of H+ secretion

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14
Q

What are hyaline casts composed of? What is their significance?

A

Proteinaceous material
Marked proteinuria

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15
Q

What are epithelial casts composed of? What is their significance?

A

Proteinaceous material and epithelial cells
Direct tubular cellular damage

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16
Q

What are granular casts composed of? What is their significance?

A

Partial degradation of a cast
Renal tubular insult

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17
Q

What are waxy casts composed of? What is their significance?

A

Complete cellular degradation
Protracted tubular stasis

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18
Q

What condition should be considered in a cat with a marked increase in renal cortical echogenicity?

A

EG toxicity

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19
Q

Ddx AKI

A

Haemodynamic (pre-renal)
Intrinsic renal - vascular
- acute glomerulonephritis
- acute interstitial nephritis
- acute tubular necrosis
Post renal

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20
Q

What GI complication has been reported in dogs with AKI?

A

Intussusception

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21
Q

What are the 4 stages of AKI?

A

Initiation
Extension
Maintenance
Polyuric

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22
Q

What test can be used to distinguish haemodynamic from intrinsic renal azotaemia?

A

FE-Na
<1% expected if haemodynamic

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23
Q

Do a) norepinephrine and b) vasopressin preferentially constrict the afferent or efferent arteriole?

A

a) Afferent
b) Efferent

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24
Q

What features of aminoglycosides make them associated with AKI?

A

Not metabolised
LMW
Water soluble
Ionise to cationic complexes which bind to anionic sited on PT epithelium - internalised and concentrate

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25
How do NSAIDs cause AKI?
Renal function more dependent on prostaglandin synthesis in situations of low blood flow Predominant renal prostaglandin causes afferent arteriolar dilation - maintains RBF during systemic vasoconstriction
26
MOA fenoldopam
Selective DA-1 agonist
27
What are the hypothetical benefits of mannitol in AKI?
Inhibits renin => inhibits NA reabsorption Increases tubular flow Decreases vascular resistance and cellular swelling Increases RBF, GFR and solute excretion Induces intrarenal prostaglandin production and vasodilation Induces ANP release May blunt Ca influx into mitochondria
28
What is the evidence for mannitol in AKI?
No evidence of benefit in people or healthy cats
29
When is mannitol contraindicated in AKI?
Dehydration Overhydration May worsen pulmonary oedema
30
What are the theoretical benefits of frusemide in AKI?
By inhibiting Na/Cl/K pump, NaK pump becomes unnecessary - medullary oxygen consumption reduces Renal vasodilatory effects
31
What is a proven benefit of frusemide in AKI?
Reduced structural damage in thick ascending LOH
32
What are established indications for frusemide in AKI?
Hyperkalaemia Overhydration
33
When is frusemide contraindicated in AKI?
Aminoglycoside-induced AKI
34
What are potential complications with dialysis?
Dialysis disequilibrium syndrome - rapid decline in osmolality - CNS signs Hypotension Haemorrhage Hypocalcaemia Catheter thrombosis
35
What treatment is recommended for Aminoglycoside toxicity?
Ticarcillin and carbenicillin - complex aminoglycosides and prevent uptake
36
What treatment is recommended for sulphonamide toxicosis?
Urinary alkalisation +/- high-volume fluid therapy/mannitol
37
What treatment is recommended for pigment nephropathy?
Urinary alkalisation +/- high-volume fluid therapy/mannitol
38
What ECG findings are reported with hyperkalaemia?
Bradycardia, tall spiked T waves, shortened QT interval, wide QRS complex with small/absent P wave
39
What ECG findings are associated with SEVERE hyperkalaemia?
Sinoventricular rhythm, VF, ventricular standstill
40
What effect does metabolic acidosis have on calcium?
Increases ionised fraction
41
What is the mechanism of hypercalcaemia in AKI?
v GFR = ^P Ca decreases by law of mass action
42
When should hypomagnasaemia be suspected in AKI?
Refractory hypokalaemia, normally in PU phase
43
What are the most common histopathological findings in dogs with CKD?
58% tubulointerstitial nephritis 28% glomerulonephropathy 6% amyloidosis
44
What are the most common histopathological findings in cats with CKD?
70% tubulointerstitial nephritis 15% glomerulonephropathy 11% lymphoma 2% amyloidosis
45
In cats with CKD, what 2 baseline parameters are associated with survival?
Creatinine and phosphorus
46
What are the mechanisms of PUPD in CKD?
Increased solute load per nephron Impaired renal responsiveness to ADH Impaired genesis of hypertonic gradient of medulla
47
What RBC morphological abnormalities are recognised inCKD?
Burr cells or echinocytes
48
Do CKD patients have relative or absolute EPO deficiency?
Relative (higher than normal but nor proportional for degree of anaemia)
49
What changes in plasma aldosterone and PRA are seen in azotaemic hypertensive cats?
Elevated aldosterone with reduced renin
50
What are the 3 layers of the filtration barrier?
Fenestrated endothelium Glomerular basement membrane Visceral epithelial cells (podocytes)
51
What CBC finding is common in dogs with glomerular disease?
Thrombocytosis
52
What are the hallmarks of nephrotic syndrome?
Hypoalbuminaemia, proteinuria, hypercholesterolaemia, oedema
53
What stains are used for evaluating renal biopsies and what do the stain?
PAS - glycoprotein, interstitial and glomerular scarring and assessment of GBM Methenamine silver - GBM Trichrome - mesangium and immunoglobulin Congo red - amyloid
54
What breed is associated with a familial membranoproliferazive glomerulonephritis?
Bernes Mountain dogs
55
What infectious disease is associated with a rapidly progressive form of membranoproliferazive glomerulonephritis?
Borrelia
56
What is the pathogenesis of membranoproliferazive glomerulonephritis?
Immune complex deposition - cytokine-mediated complement activation, expansion of the mesangium and inflow of leukocytes
57
What are the histo findings of membranoproliferazive glomerulonephritis?
Thickened capillary loops and mesangial hypercellularity
58
What is the recommended treatment of membranoproliferazive glomerulonephritis?
Identification and treatment of underlying disease Immunosuppression if severe/progressive Anti-platelet medication
59
What is the most common glomerular disease in cats?
Membranous nephropathy
60
What is the pathogenesis of membranous nephropathy?
Antibodies bind to supepithelial (urinary) side of GBM Primary - ICGN Secondary - circulating immune complexes Complement and formation of MAC
61
What are the histo findings of membranous nephropathy?
Uniform thickening of GBM Irregular thickening of capillary walls Immune deposits +/- engulfment by GBM on TEM
62
What specific treatment is recommended for membranous nephropathy? What is the prognosis?
Identification and treatment of underlying disease Immunosuppression Can be slow to progress, spontaneous remission reported Worse if higher grade
63
What is the pathogenesis of proliferative glomerulonephritis
ICGN causing endocapillary or mesangial proliferation
64
What are the histo findings in proliferative glomerulonephritis?
Mesangial or endocapillary hyperplasia with deposits of IgG or IgM
65
What is the pathogenesis of IgA nephropathy? Why are dogs more prone than people?
IgA non-specifically trapped in GBM Dog IgA is polymeric, so more likely to be trapped n GBM than monomeric IgA
66
What are the light microscopy findings in IgA nephropathy?
Mesangial proliferative glomerulonephritis
67
What diseases are most associated with IgA nephropathy?
Hepatic/GI
68
What breeds are associated with amyloidosis? In which is there a pattern to amyloid deposition?
Chinese Shar-Pei - medulla Beagles/English Fox hounds - glomeruli Abysinninans - medulla Siamese
69
How is reactive amyloidosis confirmed on histo?
Stains red with Congo Red Discoloured by potassium permanganate oxidation
70
MOA colchicine?
Inhibits release of SAA from hepatocytes by binding microtubules
71
What breeds are affected by hereditary nephritis and what is the method of inheritance?
English cocker - autosomal recessive English springer - autosomal recessive Bull terrier - autosomal dominant Dalmatian - autosomal dominant
72
What is the pathogenesis of hereditary nephritis?
Mutation/deletion of type IV collagen - premature deterioration of the GBM
73
What are the histo findings of minimal change disease?
Light microscopy - minimal TEM - podocyte foot process effacement
74
What is the treatment for minimally change disease?
Steroids
75
Where do defects associated with cystinuria occur?
Proximal tubule
76
What is the mechanism of inheritance of cystinuria? Give examples of affected breeds
Type 1 - autosomal recessive. Labrador, Newfoundland, Australian Cattle dog Type 2 - autosomal dominant
77
What genes are abnormal in cystinuria?
Slc3a1 and Slc7a9
78
What treatment is recommended to avoid calculi in cystinuria?
Reduced protein Urine alkalisation Diuresis +/- 2-MPG and D-penicillamine
79
What is a consequence of carnitinuria?
DCM
80
What condition is carnitinuria commonly associated with?
Cystinuria
81
How is the purine portion of amino acids metabolised?
To hypoxanthine and xanthine, oxidised to uric acid by xanthine oxidase Uric acid metabolised to allantoin by hepatic uricase
82
What diseases increase excretion of xanthine?
HAC, neoplasia, CKD
83
What breeds are associated with hyperuricosuria?
Dalmatian, English Bulldog, Black Russian Terrier
84
What are the differences in purine metabolism in Dalmatians? What gene is involved?
Abnormal uric acid transport across hepatic membrane, unable to transport uric acid to uricase Less proximal reabsorption of uric acid Increased tubular secretion of uric acid Slc2a9
85
How is hyperuricosuria treated? What is the rationale for each treatment?
XO inhibitors - reduce uric acid production Purine restricted diet - to prevent xanthine calculi Urine alkalisation - reduced proximal tubular ammonia production - reduces ammonium ions that complex with urate to form calculi
86
What breed is Fanconi syndrome reported in? What is it's prevalence?
Basenji's 10-30%
87
What medication has been associated with acquired Fanconi syndrome in a) dogs and b) cats
a) Gentamicin b) Chlorambucil
88
What acid-base abnormality is associated with Fanconi syndrome?
Hyperchloraemic metabolic acidosis
89
Which breeds are overrepresented for renal a genesis?
Beagle, Doberman, Shetland Sheepdog
90
What breed is affected by podocytopathy? What is the typical age of presentation?
Soft coated Wheaten Terrier 6y
91
What gene is involved in PKD?
Polycystin-1 (PKD-1)
92
Which dog breeds are affected by PKD? What is the mechanism of inheritance?
Bull Terrier - autosomal dominant Cairn Terrier - autosomal recessive WHWT - autosomal recessive
93
What is the mechanism of inheritance of PKD in Persian cats?
Autosomal dominant
94
What is the proposed mechanism for hyperlipidaemina in glomerular disease?
Hypoalbumoinaemia stimulating hepatic protein synthesis leading to production of lipoproteins Glomerular loss of orosomucoid, leads to reduced hepatic production of heparin - cofactor for normal lipoprotein lipase function

Ettinger Old (13 decks)

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