Renal Diseases Flashcards
Describe the progression of lesions associated with ulcerative posthitis and associated clinical signs?
-begins as a small ulcer near mucocutaneous junction of prepuce as a loss red scab cover that is painful to palpation
–>spreads to internal mucosal prepucial surface– dysuria, vocalization while urinating
–>fibrous adhesions within the prepuce– stricture, impaired breeding soundness, weight loss in chronic cases
What are differentials for ulcerative posthitis and describe differentiating features
–ulcerative dermatosis– lip & leg ulcer of sheep, lesions bleed readily (ulcerative posthitis lesions usually do not)
–contagious ecthyma (ORF)– raised proliferative scab that is thick and durable on face, lip, udder
–Urolithiasis– ddx for any dysuric male sm rum
–preputial trauma
–Caprine herpesvirus-1 (CHV-1)– penile, vulva & vaginal lesions
–Ovine herpesvirus-2 (OHV-2)– ulcers tset pos for herpesvirus
What bacteria is most commonly implicated in ulcerative posthitis/vulvitis?
Corynebacterium renale
What are the virulence factors that allow C. renale to cause disease?
Contain enzyme urease
–>high protein diet–> INC ammonia production in Rumen–> converted urea in liver
–>proliferation of C. renale–> urease hydrolyzes urea back to ammonia– causes chemical irritation & ulceration to the prepuce
What are risk factors for the development of ulcerative posthitis?
-excessive protein diet ( usu. >16%)– alfalfa, lush legume, etc.
-Rams, pet weathers, club/show lambs
–wool & fiber production animals
- INC plane of nutrition in males prior to breeding
–breeds w/ dense wool/hair (merino sheep, angora goats)
Why are production losses seenw ith ulcerative posthitis?
pain
incapacitation of breeding
loss of breeding soundness
deformation of external genitalia
What antibiotics is C. renale sensitive to?
penicillin
amplicillin
cephalosporins
oxytetracycline
With antibiotic treatment of C. renale ulcerative posthitis/vulvitis,what other treatments/management changes need to be made
-dec protein& NPN intake (incorporate grass hay into feeding)
isolation of infected animals
fl y control
wool & hair removal from prepuce
topical antibiotic treatment (mastitis treatment tubes)
Describe the pathogenesis of Acute renal failure in horses caused by aminoglycosides:
-accumulate in proximal tubular epithelial cells (via urine–glomerulus)
–reaches toxic levels
—disrupts normal cell function
—-cell swelling & cell death
—– sloughing into tubular lumen, releasing lysosomal enzymes, intracellular Ca accumulation
Pigment nephropathy can occur with what diseases?
Rhabdomyolysis– myoglobin pigment
DIC/severe hemolysis/toxins (red maple leaf toxicosis)
Which form of vitamin K can cause renal damage
menadion sodium bisulfit– K3
How does vitamin K3 cause renal disease?
direct tubular damage d/t oxidative stress
and
pigment nephropathy d/t hemoglobinuria
NSAIDS cause kidney injury at what location?
medullary crest necorisis
Supplementation of what vitamin, or plants containing this vitamin can cause renal disease?
Vitamin D
List heavy metals that can cause renal disease:
mercury (also causes GI irritation)
cadmium
Zinc
Arsenic
Lead
What is the toxic principle of acorn toxicity?
tannin
Acorn toxicity manifests as what C/S/disease?
–erosive GI disease–> diarrhea, edema
–INC vascular permeability–> body cavity effusion
–uremia
SHOCK
List drugs (besides NSAIDs, aminoglycosides) that can cause renal disease
oxytetracycline
polymixin B
amphtericin B
imidocarb diproprionate (babesia equi tx)
ochratoxins
PA poisoning
Blister beetle/cantharidin toxicosis
What are risk factors for the development of vasomotor nephropathy?
hemorrhagic shock
severe IV volume deficit
septic shock
coagulopathy
adverse drug rxns
***Lesion is ATN
what is the pathogenesis of acute glomerulopathy (which is rare)?
arteriolar microgangiopathy– distends glomerular capillaries–> fibrin thrombi & proteinacious debris (BOwmans Capsule)
Which species/serovar of leptospira have been a cause of interstitial nephritis in horses?
L. interrogens serovar pomona
How to diagnose leptospira interrogens serovar pomona as a cuase of interstitial nephritis in horses?
urine PCR
–> furosemide and getting 2nd voided sample will increase sensitivity
OR
rising serum titer or baseline >1:6400
What is the risk of performing a renal biopsy?
life threatening hemorrhage
- INC complication risk– L Kidney bx (go through spleen), neoplasia, low USG
Why are newborn foals often proteinuric the first couple of days of life?
proteinuria (1-2 d) d/t absorption of small molecular weight proteins in colostrum
Spurious hypercreatinemia in foals should decrease within what time period?
within 12 to 24 hours after birth
What form of acute renal failure is seen in foals? and through what pathologic mechanism?
Acute tubular necrosis
– post diarrhea
— d/t dehydration= poor perfusion (vasomotor nephropathy)
Why do foals have a greater dose of aminoglycosides than adults?
because of greater volume of distribution
Multifocal renal abscesses/infarcts are seen in foals, with what bacteria isolated most commonly?
Actinobacillus equilli
**usu die/euthanize before see ARF
**2-4 d old foals @ highest risk
What is the most common glomerular disease in horses?
proliferative glomerulonephritis
Describe the pathogenesis of proliferative glomerulonephritis.
circulating immune complexes along glomerular capillaries or in situ along basement membrane
Which immune complex is most commonly seen with proliferative glomerulonephritis?
IgG
What are common antigens seen to cause proliferative glomerulonephritis in horses?
–streptococcal antigen
–Equine infectious anemia virus
What is the most common cause of chronic renal failure in horses?
Chronic interstitial nephritis & fibrosis
Causes of chronic interstitial nephritis
ATN
nephrotoxins or vasomotor nephropathy
other etx: drug induced, urinary obstruction, pyelonpehritis, renal hypoplasia/dysplasia/papillary necrosis
What horses are at risk for the development of pyelonephritis (rare)?
-multiparous mares
-horses with bladder paralysis (d/t vesiculoureteral reflux)
What bacteria are commonly isolated in pyelonephritis (horses)?
staph
strep
corynbacterium
What are clinical signs of uremic encephalopathy?
obtundation
anxiety
head pressing
seizure
What are electrolyte abnormalities seen with CRF?
INC K
DEC Na
DEC Cl
+/- INC Ca
Dec PHOS (w/ inc Ca)
What is normal urine protein concentration?
100 mg/dL
What is normal urine protein to urine creatinine ratio?
1:1 (normal)
What is considered an abnormal urine protein to urine creatinine ratio?
> 2:1
What is the calculation for GFR?
{(Crea urine)/ (Crea serum)} X urine flow/ body weight (kgs)
What is considered a normal gfr and decreased GFR?
Normal: 1.5 to 3.0 ml/kg/min
Dec GFR: <1.0 ml/kg/min
What is the cause of enzootic hematuria?
Chronic bracken fern ingestion
others: peteris spp,, chelarithes sieberi, onchyium contigium
Acute ingestion of bracken fern causes:
acute coaguloapthy or fulminant septicemic crisis (assoc with severe bone marrow suppression)
What are clinical signs of enzootic hematuria?
hematuria
chornic blood loss– tachycardia, pale mm, tachypnea, exercise interolance, pale mm
dysuria
pollakuria
what does the bladder palpate like with enzootic hematuria?
thickened bladder wall
bladder tumours
– rare we see obstruction of bladder trigone
What are potential ddx for enzootic hematuria
UTI
Malignant catarrhal fever
urolithaisis
What are the pathophysiologic consequences of bracken fern ingestion?
irritant
mutagenic
carcinogenic
immunosuppressive
What is the toxic principle of bracken fern?
ptaguiolside
What is thought to have synergism with bovine pappilloma virus 2 responsible for bladder tumors?
ptaquiloside carcinogenic in bracken fern
How to stop the hematuria seen with bracken fern ingestion?
will d/c with brakcen feeding
**before onset of tumour formation
What are the most common bacteria that cause ascending UTI in ruminants?
C. renale
E coli
Others: Salmonella spp., T pyogenes, P aeruginosa, Strep spp, Staph spp, corynbacterium pseudotuberculosis
Cystitis associated with UTI can lead to showing of what C/S?
dysuria
pollakuria
driblle urine
retained arched stance after voiding
What are the most common presenting C/S in ruminants with UTIs?
Dec feed intake and dec milk production
other C/S: fever, inc RR, dec skin trugor, renal enlargement, ruminal stasis, etc.
What are ddx for C/S of dysuria seen with urinary tract infections?
vaginitis
perivaginal abscess
pelvic entrapement of bladder
vulvar trauma
postparturient swelling vagina and vulva
What are ddx for C/S of hematuria seen with UTIs?
parturition
papillomas in UT
postparturient hemoglobinuria
enzootic hematuria (many animals affected)
Describe the pathogenesis of diarrhea seen with pyelonephritis:
D/t proteinuria
–> dec albumin
–> dec oncotic pressure
Describe the pathogenesis of anemia seen with pyelonephritis
d/t dec EPO production
blood loss in urine
**chronic disease
How is uti definitively daignoses?
-midstream/end stream– most accurate urien sample
other sources of contam: mertirit, vaginitis, prostatitis
UTI urine abnormalities
hematuria
proteinuria
bacteria
USG: 1005 to 1020
gram stain urine– prelim dx
Describe routes that lead to the itnro of pathoens that lead to development of UTI:
-urogenital trauma– calving
-obstetric manipulation
-abnormal vulvar confirmation
-urine retention conditions: baldder adhesions, uracha reminan infection, spinal cord dzes
-bladder catheterization
-urolithiasis
-urogenital pappilloma
-dec bladder function or ectopic ureters
Describe the pathogenesis behind the development of pyelonephritis after bacteria establish in urinary tract
- Dec bladder function or ectopic ureters
- vesiculourteral reflux– aid infection/development of infection
3 papillary & tubular epithelium necrosis, accumulation of necrotic debri in renal pelvis
(loss of nephron function, abscessation, necrosis & loss of kidney shape) - struvit uroliths or other calculi form around debri
What is the most common cause of pyelonephritis in bovine spp?
C renale
What is the most virulent bacterial spp to cause pyelonephritis in cattle?
C. cystidis
C. pilosum
How does C. renale cause UTI/pyelonephritis?
- adheres to UT epithelium via pili (pH mediated)
- enhanced in alkaline conditions, Dec acidic (feed urine acidifying diet– improvement)
–ureolysis and ammonium– maintain alkaline environment and INC colonization
UTI are seen more commonly in which gender & why?
Females more commonly d/t shorter urethra
– breeding/parturition trauma
Most pyelonpehritis cases are seen when in ruminants?
IN cattle– 90 d post-vacliving
In 7 out of 15 cows diagnoses with pyelonephritis, have what repro trat abnormalities?
pneumovagina
metritis
poor perineal conformation
Long term antibiotic treatment is recommended with what antibiotic for treatment of C. renale?
Penicillin
Which antibiotics in the treatment of C. renale reach higher serum and urinary concentrations, compared to PPG?
Na or K Penn: 22,000-44,000 IU/kg q6h
Na ampicillin: 10-50 mg/kg q8h
What can be used as a prognostic indicator for cull rate d/t pyelonephritis in cattle?
marked azotemia & pylonephritis: BUN >100 mg/dL, CREA > 1.5 mg/dL are more likely to be culled than nonazotemic w/ pyelonephritis
What are preventative measures that can be taken to prevent pyelonephritis?
isolation, esp with C. renale
clean & disinfect contam. reas
aseptic technica to prevent iatrogenic spread
-venereal transmission– prevent with AI
Define pyuria
> 5-10 WBC/HPF of urine
bacteria >20 per HPF
List antibiotics that get good concentrations in the lower urinary tract?
penicillin
ampicillin
cefiotiofur
fluoncazole
gentamicin
amikacin
**Tx 7 to 14 days
What is the drug of choice for treatment of candida spp involves in lower UTI?
fluconazole
What antibiotics of choice in UPper UTI ?
TMS
ceftiofur
penicillin
ampicillin
**2 to 3 weeks of treatment
What are the most common organs of amyloid deposition in horses?
kidney
liver
spleen
Describe the pathogenesis of amyloidosis in cattle
-long standing inflammatories dzes (TRP, metritis)
– lead tos ecdonary renal amyloidosis – sustained heavy proteinuria
**signs of chronic wasting disease, chronic diarrhea
On rectal palpation of the kidneys in cattle, what is felt with amyloidosis?
enlarged kidney, that is not painful and has normal architecture
Amyloid is what ind of protein?
Beta pleated sheets of amyloid proteins that are highly resistant to proteasomes or macrophages
What are consistent signs of amyloidosis?
proteinuria
hypoalbuminemia
What test can confirm protein levels in urine, for diagnosis of amyloidosis?
sulfasalicyclic acid precipitation test
What are DDx for renal amyloidosis?
Other causes of chornic diarrhea/hypoproteinemia/wt loss/poor productivity: GI parsitism, BLV, Glomerular nephritis
-johnes dz
-cu deficiency
-salmonellosis
-BVD
Describe the findings of amyloidosis of the kidneys and how to confirm that diagnosis
INC kidney size
yelllow-tan-white discoloration
waxy renal parenchyma on cut surface
generalized edema
***amyloid deposits stained with congo red– bright green birefringence with polarized light
Glomerulonephritis is an example of what time of hypersensitivty reaction?
type III hypersensitivity
**vasculitis reaction
There are many causes of tubular necrosis, ultimately the main cause in the development of TN is:
impaired renal perfusion
— infarction of renal cortex (endotoxemia)
— renal vein thrombosis ( lambs w/ heat stress injury)
– mechanical obstruction of renal vasculature (severe rumen distention, rumen acidosis, etc)
LIst nephrotoxic plants
Amaranthus retroflexus (pig weed)
Lilium spp (easter lily)
Wuercus spp (oaks)
Philodendron spp (philodendron)
Pinus ponderosa (nephrosis occurs win ocnjunction iwth hepatocellular damage & abortion)
Xanthium spp (cocklebur)
Cestrum diurnum (day-blooming jasmine)
Oxalate containing plants
How does dehydration lead to tubular injury?
Blood flow to kidneys
– renal tubular epithelial cells have high metabolic demands– toxins disrupt cellular enzymes
— dehydration
– concentrates toxins in tubular filtrate
–slows toxin clearance
–dec renal perfusion
Describe how sulfonamides can cause renal tubular injury?
deposition of insoluble precipitates in renal tubules & block excretion of creatinine
Describe how NSAIDS cause renal tubular injury
block effect of prostaglandins– which maintain renal blood work
prolonged administration & dehydration
medullary crest necrosis
What are treatments that can restore urine production in TN?
furosemide: work at the LOH, 1 mg/kg IV or IM, repeat q1-2 h until urien produced, monitor serum NA & K concen b/c K wasting
Mannitol: 0.25 to 1 g/kg IV bolus, osmotic diuresis
List DDx for neurologic diseases that cause urinary incontinence (equine)
EHV-1
cauda eqiuina neuritis
polyneuritis equi
sorghum tox
aberrant larval migrans (haliceophalobus ginigvalis)
EPM
Bethanechol in the treatmetn or urinary incontinence
0.03 to 0.04 mg/kg Sc or IV q6-8h
improves detrusor tone and strength of contraction
The use of phenoxybenazmine with bethanechol is used for the treatment of urinary incontinence for:
is an alpha adrenerigc block to decrease urethral sphincter tone
4 mg/kg PO q6h
Cattle is the primary maintenance horse of what lepto sppecies
L. interrogens serovar hardjo type hardjo (UK)
L. borgpetersenii serovar ahrdjo type hardjobovis (worldwide)
Cattle are the incidental host for what lepto species?
L interrogens serovar pomona
L interrogens serovar grippotyphosa
What serovars of lepto cause renal infection in cattle?
L interrogens serovars jardjo and pomona rippotyhposa
Which serovar is host adapted in cattle causing persistent latent urogenital infection?
serovar hardjo
L interrogens serovards hardjo cause what reproductive abnormalities in cows?
infertillity
stillbirth
abortion
birth of weak calves (PI)
milk drop syndrome or flabby udder (fever, agalactia, mastitis, soft udder, milk yellow to red tinged)
in non host adapted lepto serovars cause what C?S
severe systemic dz
hemolytic anemia
hepatitis
interstital nephrtis
tubular nephrosis (calves > adults)
menintis (rare)
agalactia, mastitis– lactating cows
abortion– pregnant cows
Leptospira pomona causes produces what that causes acute IV hemolysis and anemia?
hemolysins
IN the non-symptomatic, convalescent phase of Leptospirosis in cattle, lepto localizes to what organs?
mammary gland
kidney
genital tract
**chronic renal infection
Once lepto organisms localize to specific organs, it is shed and transmitted via what routes?
urine
uterine & vaginal secretions
placenta
fetal tissues
semen
Where is leptospira protected from macrophages and humoral antibodies?
within the lumen of renal proximal convoluted tubule
What are virulence factors of leptospira?
- LPS toxin & outer membrane proteins– interstitial nephritis
- adhesion to cells & extracellular matrix (fibrinectin binding proteins, lig A, B & C)
- bact motility
- hemolysis: sphingomyelinase C & H, hemolysis assoc protein 1 (HAP-1)
- Iron sequestration
What diagnostic tests are commonly used to diagnose lepto?
Floursecent ab test
PCR
immunoblot
***inc sensitivity in testing by doing 2 tests on one sample
What is the best urine sample for diagnosis of lepto?
2nd voiding urine samples after furosemid administration
How is lepto diagnosed on histology
Wartharin starry silver stains
immunoperioxidase stain– more sensitive
Serum titer of what value, is indicative of leptospira infection as a cause of acutre renal failure in horses?
> 1: 6400
Proteinuria indicative of glomerular injury at what diagnostic value?
urine protein: creatinine ratio >2:1
What it the most accurate assessment of renal function?
glomerular filtration rate
**inulin or radiolabelled substances
define oliguria
fail to produce urine w/in 12 to 24 hours of IV fluid therapy
In oliguric renal failure of >12 to 24 hours, what treatment can be pursued:
-furosemide (max of 4 doses)
-dopamine
-dobutamine (do not use with furosemide)
-mannitol
**no improvement in 72 hours, then hemodialysis or continuous flow peritoneal dialysis
Which ruminants are at highest risk in developing urolithiasis?
castrated small ruminants
dietary and environmental factors inc risk
What are common disorders results from urolithiasis?
- urethral obstruction
- chronic urethral obstruction
- urethra rupture
- urinary bladder rupture
What differentials come to mind with proteinuria and hematuria on dipstick?
Glomerulonephritis & ruminant urolithiasis
On rectal what is appreciated in small ruminants with urolithiasis?
pulsation of urethra
What are the most common sites of obstruction of urolithiasis in cattle, sheep & goats?
cattle: distal aspect of sigmoid flexure
sheep & goats-urethral process
What are DDx for congenital abnormalities for urolithiasis?
ectopic ureter
pelvic displacement of urinary bladder
urethral duplication
List differentials for urine dribbling seen in chronic urethral obstruction:
neuro dz
previous urethral trauma (Stricture)
congenital anomalies
infection
neoplasia (rare, slow progression)
ulcerative posthitis
What is a diagnostic that can be performed to diagnose strictures in the urethra?
contrast urethrography
Urethral rupture is most commonly seen in what species with what C/S
feed lot steers
**water belly
Pressure necrosis leading ot urethral rupture manifests as what C/S
cellulitis
penile adhesions
urethral fistula formation
urethral stircture
eretion fialiure
depression
inappetance
bilateral symm pitting edema
Bladder rupture most commonly occurs in what spp?
bulls– testosterone b/c high mm pressure
What electrolyte abnormalities are seen on peripheral bloodwork with urine in the abdomen?
LOW Na, CL, PHos
uremia & hemoconcentration
With a bladder rupture, the creatinine in abdominal fluid compared to serum is:
abdom fluid 2: 1 serum
indicative of uroperitoneum
Which stones form in alkaline urine?
struvite (magenesium ammonium phosphate)
Calcium phosphate
Ca carbonate
What stones are not affected by urine pH
Calcium oxalate
How is vitamin A deficiency implicated in urolithiasis?
Metaplasia of UT epithelium
–> nidus
–> desquamation of cells/altered cells surface
What diet predisposes to the deveopment of phosphate calculi?
High phosphate rations– grain based
What diets prevent phosphate calculi?
High Ca: phosphate ratio will help prevent
In what location of US are ruminants predisposed to development of silica calculi?
native rangeland grasses of western N america
**silica fraction in these grasses inc with maturity
What diet predisposes ruminants to the development of calcium based stones?
alfalfa hay: INC Ca, low Phosph, Low Mg, INC oxalate
**common in ruminants on lush clover pastures
What is the risk of passing a catheter & retrograde flushing utheral stones?
can rupture urethera & rarely successful clearance of obstruction acheived
What are surgical options for treatment of urolithiasis and obstruction?
urethral process amputation
penectomy
perineal urthrostomy
prepubic urethrostomy
urethrotomy
cystotomy
tub cystotomy
bladder marsupilization
What are the most common form of ureteral calculi that form in horses?
calcium carbonate
Is hematuria typically seen with cystic calculi in horses?
No– hematuria is typically seen after exercise, with bleeding visualized at the beginni go fstream
Cystic calculi should be differentiated from:
soft tissue masses (neoplasia)
sabulous urolithiasis
What is sabulous urolithiasis?
accumulation of urine sediment in ventral aspect of the bladder
What are options for treatment options for cystic calculi?
perineal urthretomy
laparocystotomy
Gokel cystotomy
laxer or shockwave lithotripsy
What can be administered to acidify urine in horses?
ammonium chloride
ammonium sulfate
change legum to grass hay diet
sodium chloride (25-50 g) to promote diuresis
Urethral obstruction in horses most commonly occurs where?
males– located at ischial arch where urethra is its narrowest
Idiopathic renal hematuria C/S
sudden onset gross, life threatening hematuria of one or both kidneys
What is seen on endoscopy of bladder with idiopathic renal hematuria?
no abnormalities in urethra or bladder
**+/- blood clots exiting ureters
What breeds have been seen with idiopathic renal hematuria?
several breeds (donkeys & mules)
–Arabians overrepresented >50%
With urethral hemorrhage when is hematuria seen?
AT the end of urination (with urethral contraction)
What is seen on endoscopy with urethral hemorrhage/ at what most common location?
dorsocaudal aspect of urethra at the level of ischial arch
** can find location with external digital palpation
What ist he pathology of urethral hemorrhage?
suspect d/t “blow out” corpus spongiosum” of penis
– inc ejaculation pressure
**urination = contraction at end of urination to empty urethra
What are common and uncommon causes of pu/pd in horses?
Common: CRF, PPID, primary/ psychogenic polydipsia
Less common: excessive salt consumption, central & nephrogenic diabetes insipidus, diabetes mellitus, sepsis/SIRS, iatrogenic (corticosteroids, diuretics, alpha 2s)
What is the mechanism of PU/PD with PPID?
- osmotic diuresis
– renal threshold of glucose ~170 to 175 mg/dl
+/- concurrent EMS - Antagonism of antidiuretic hormone (ADH) on collecting ducts via cortisol
- Central DI
–growth of pituitary adenoma leading to impingement oon other areas of brain (posterior pitutiary & hypothalamus– storage and production of adh) - excessive sweating & hirsuitism
How is the diagnosis of primary psychogenic polydipsia made?
Dx of exclusion:
-renal failure
-PPID
-Diabetes insipidus
-chornic, persisten hyperglycemia
other factors: med administration, salt
What is a diagnostic that can be performed to diagnosis primary psychogenic polydipsia?
water deprivation test: fail to concentrate urine (USG 1020)
What are the types of diabetes insipidus?
- inadquate secretion ADH (neurogenic/central DI)
- Dec sensitivity of renal epithelial cells of collecting ducts to circulatingAD or loss of ADH receptors on these cells
How do animals with diabetes insipidus respond to a water deprivation test?
animals fail to concentrate urine
What is sued to treat nephrogenic diabetes insipidus?
thiazide diuretics (unknown mech)
NSAIDS/prostglandin inhibitors
Amiloride (Na ch. blocker)
What it the mechanism that Diabetes mellitus causes PU/PD?
chronic hyperglycemia & glucosuria
–> PPID- INC ACTH & cortisol–> INC glucose levels
–> EMS– peripheral insulin resistance
–islet cell exhaustion (B cell)- inadequate insulin production with persistent hyperglycemia
Renal tubular acidosis is characterized by:
improper functioning of renal tubules: characterized by: hyperchloremia, metabolic acidosis and normal anion gap
Causes of renal tubular acidosis:
Primary dz
genetic
idiopathic
secondary to underlying dz
drug induces (suggest mechanism)
others: pyelonephritis, hyperparathryoidism, hypervitaminosis D
What is type 1 renal tubular acidosis?
distal tubular excretion of H ions is compromised
**patients unable to produce acidic urine, so patients develop severe acidosis and patients develop hypokalemia (K ions excreted in exchange)
What is type 2 renal tubular acidosis?
decreased proximal tubular bicarb resorption and subsequent urinary loss of bicarb
**normal excreted when bicarb reabsorbed in PCT
–hyperchloremia d/t inc renal absorption of CL in subseq bicarb loss
Differentiation between T 1 and T2 renal tubular acidosis
T1: hypokalemia
T2: hyperchloremia
What is fanconi syndrome?
defective resorption: glucose, aa, phosph, K, Na, Ca, Mg, Uric acid & other orhganic acids
-inherited/primary
-secondary renal me ror autoimmune
ON chemistry what is seen with renal tubular acidosis?
metabolic acidosis ,low bicarb, high chloride
**compensatory: low PCO2, +/- Low K
What is urine pH with renal tubular acidosis?
neural/alkaline
What is the primary treatment in renal tubular acidosis?
IV/oral Na bicarbonate: replace 1/2 or 6 to 12 hours
– initial tx promotes kaliuresis (exacerbating low K)
–IV/oral KCL may be necessary
What is the prognosis for treatment of renal tubular acidosis?
short term: good
– may require month long bicarb supplementation
Bladder rupture is uncommon in adult horses, however what are the most common causes for bladder rupture males vs females?
Males: urolithiasis
females: foaling
What are common primary kidney neoplasms?
renal cell carcinoma
adenoma (most common in older horses)
nephroblastoma- young horses
**Squamous cell carcinoma– most common bladder tumor in horses
Bladder neoplasias are rare in ruminants, except for
Those caused by bracken fern
Pelvic entrapment of the bladder is seen in ruminants, associated with:
postpartum straining
perineal hernia
vaginal prolapse
vaginal irritation
secondary displacement from trauma
Urinary bladder eversion and prolapse is rarely seen, however is most common aseen with
dystocia d/t forceful straining that moves the bladder fundus caduall, +/- then forced out urthral orifice (bladder rolapse)
What is the most common bacteria isolated, with septic foals leading to bladder necrosis
E coli is the most common isolate
Uroperitoneum in foals is commonly mininterpreted as:
tenesmus in meconium impaction
What is administered pre-operatively to correct hyperkalemia in uroperitoneumi n foals?
1-3 L of 0.9% NaCL with 5% glucose solution
**drain urine from abdomen
How are ureteral defects diagnosed in foals?
US: retroperitoneal fluid around kidney on affected side
CT: find where abnormality is
What is the most common cause of cystitis in down, recumbent foals?
candida spp common
what is the treatment of candida cystitis?
fluconazole
What is the most frequently reported developmental anomaly of the urinary tract in horses?
ectopic ureter
what spp are predisposed to developing a patent urachus?
cloned calves
What are pseudocysts?
outpocketings of renal capsule
Why do pseudocysts develop?
d/t renal trauma, urinary tract obstruction or vascular or lymphatic anomalies
What is renal oxalosis
metabolic dz, suspected to be inherited abnormality of glycine or glycoxalate metabolism (high levels of endogenous oxolate)
–> calcium oxalate cyrstals accumulate in renal tubules
–> obstruction of tubular outflow
What disease should be ruled out with calclium oxalate crystals seen in urine?
exposure to xolate contianing plants or ehtylene glycol
What are common sites of terminating ectopic ureters: Males
urethra
vas deferens
seminal vesicles
What are common sites of terminating ectopic ureters: Females
urethra
vagina
cervix
ca bladder trigone
What is the most common C/S of ectopic ureter?
urinary incontinence
What is the triad of C/S/ consequences of EHEC that are characteristic of hemolytic uremic syndrome?
mciroangiopathic hemolytic anemia
thrombocytopenia
renal fialure
What red cell abnormality is seen with hemolytic uremic syndrome?
shistocytes
What is the difference between the typical and atypical form of hemolytic uremic syndrome in humans?
typical form: major cause of ARF yong children assoc with food/water consumption contam with shiga toxin–producing bact **enterohemorrhagic E. Coli (EHEC)
Atypical form: inheritated mutations of complement regulatory proteins & diverse acuases of enodthelial injry, including antiphospholipid abs, pregnancy, etc.
What are the major pathogenesis hallmarks of hemolytic uremic syndrome?
- endothelial injury & activation leading to IV thrombosis
- plt aggregation
What are sources of EHEC?
cattle are major source
** also isolated from humans
