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RUSVM Clinical Pathology > Renal Function > Flashcards

Renal Function Flashcards

1
Q

USG <1.007

A

Hyposthenuria

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2
Q

Markedly decreased urine production

A

Oliguria

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3
Q

No urine produced

A

Anuria

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4
Q

Straining to urinate

A

Stranguria

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5
Q

Increased frequency of urination

A

Pollakiuria

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6
Q

Increased urea nitrogen with/without increased creatinine

A

Azotemia

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7
Q

Excessive urea in blood with clinical signs of renal failure

A

Uremia

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8
Q

T/F: with the loss of nephrons, unaffected nephrons will compensate by hypertrophy of function

A

True

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9
Q

Where is BUN synthesized?

A

Liver

Proteins form the small intestine -> amino acids –> deaminated in the liver –> amine group is used to make urea -> blood -> filtered by the glomeruli and excreted

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10
Q

What can cause the BUN concentration to vary?

A

Production by the liver

Reabsorption

  • kidney
  • GI tract

Excretion

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11
Q

Is BUN a good marker of kidney function in ruminants ? Why or why not?

A

Nope

BUN excretes into saliva and rumen
Rumen microflora create amino acid
Urea is lost in creation of proteins

Results in a net protein gain and BUN loss

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12
Q

Increased BUN due to liver production is usually due to?

A

Upper GI bleed (stomach or proximal duodenum)

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13
Q

How is BUN increased by the kidney?

A

Decreased GFR

Renal resorption varies with rate of flow through tubules

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14
Q

If flow through the renal tubules is flow, what will occur to the serum BUN?

A

Increased

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15
Q

If there is a fast flow rate through the renal tubules, what will occur to the serum BUN”?

A

Decreased

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16
Q

What can caused decreased production of BUN by the liver?

A

Decreased aa delivery to liver

  • portosystemic shunt (PSS)
  • decreased protein in the diet

Hepatic insufficiency (80% loss)

Intestinal loss of proteins

  • monogastric species
  • cattle (lost through microbiota and loss in saliva)
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17
Q

What problems associated with the kidney cause a decreased BUN?

A

Decreased water resorption in proximal convoluted tubules

  • increased GFR
  • increased tubular flow
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18
Q

Where is creatinine produced?

A

Endogenous muscle catabolism
- creative phosphate
(Proportional to muscle mass)

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19
Q

T/F: creatinine is NOT reabsorbed by the kidney and is an excellent indicator of GFR

A

True

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20
Q

Will an old cat with muscle wasting have high OR low creatinine levels

A

Lower

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21
Q

If CREA is increased, what does it imply?

A

Decrease in GFR

Possibly altered nephron function

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22
Q

The concentration of BUN is dependent on ..

A. Dietary protein
B. Liver function
C. Glomerular filtration rate
D. Body condition

A

A
B
C

Not body condition because that is creatinine

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23
Q

What renal biomarker is released into circulation by all nucleated cells and is freely filtered by the glomerulus ?

A

Symmetric demethylarginine

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24
Q

You will see an increase in symmetric dimethylarginine with ___% loss of renal tubular function

A

40

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25
Q

What is indicated if SDMA is increased but CREA is normal?

A

You must rule out all other causes of decreased GFR

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26
Q

For the kidney to concentrate and dilute urine, it requires ____% functional neurons

A

33

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27
Q

The function of the kidney to concentrate/dilute urine is depended on production/responsiveness to _________ and maintaining ___________

A

ADH (vasopressin)

Medullary hypertonicity

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28
Q

How is urine specific gravity measured?

A

Refractometer

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29
Q

The higher the urine specific gravity, the more ________ the urine

A

Concentrated

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30
Q

Lower limit of USG in active concentration of urine in cat ?

A

1.035

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31
Q

Lower limit of USG with ability to concentrate urine in a dog?

A

1.030

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32
Q

Lower limit of USG where equine and ruminants are still concentrating urine?

A

1.025

33
Q

T/F: USG should always be interpreted with hydration status

A

True

34
Q

Polyuria occurs with loss of ______% of functional renal mass

A

66

35
Q

You get azotemia with ____% loss of nephrons

A

75

36
Q

What is azotemia?

A

Retention of nitrogenous waste products in blood

37
Q

Categorize the azotemia..

Increased BUN
Increased CREA
Increased USG

A

Pre-renal

38
Q

What are your two most common DDx for pre-renal azotemia?

A

Dehydration (decrease renal blood flow)

Upper GI bleed (increased urea production )

39
Q

What 3 renal analyses affected by decreased GFR

A

BUN
CREA
SDMA

40
Q

T/F: persistently decreased blood flow will cause renal damage

A

True

41
Q

An increased production of urea can be due to?

A

Upper GI bleed
Decreased rumen motility
Endogenous protein catabolism

Liver takes aa -> urea -> measured as BUN

42
Q

What are pre-renal causes of increased creatinine

A

Increased muscle mass

Neonatal foals -> dysfunctional prevent clearance of fetal CREA

43
Q

Define the azotemia…

Increased BUN
Increased CREA
Decreased USG

A

Renal azotemia

44
Q

In renal azotemia, what happens to the serum phosphorus levels

A

Increased

45
Q

What are the causes of renal azotemia?

A 
Infectious 
Toxin 
Hypoxia 
Neoplasia 
Congenital 
Hydronephrosis
46
Q

What infectious agents can cause renal damage

A

Pyelonephritits

Leptospirosis

47
Q

What toxins can cause renal damage

A 
Ethylene glycol 
Drugs
Grape 
Asiatic lilies 
Melamine
48
Q

T/F: an animal with azotemia and polyuria is NOT always in renal failure

A

True

49
Q

What other conditions can appear like renal failure?

A

Hypercalcium
Diabetes insipidus
Endocrine: cortisol or glucose
Franconi syndrome

50
Q

A post renal azotemia can be caused by?

A

Urolithiasis (castrated males)
Trauma
Feline lower urinary tract disease

Uroabdomen (urine leaks into peritoneal cavity

51
Q

What is the most likely cause of this azotemia..

Patient has tacky mucus membranes

Increased BUN
Increased CREA
Increased USG

Increased PCV
Increased TP
Increased Alb

A

Pre-renal azotemia

-> dehydration

52
Q

Define the azotemia

Increased BUN
Increased CREA
Low USG

Straining to urinate
Large turgid bladder

A

Post renal azotemia

USG is variable in these cases-> looks to signalment and PE findings

53
Q

Will phosphorous be increased or decreased in renal azotemia

A

Hyperphosphatemia

-> when GFR drops below 25% of normal phosphorus excretion is impaired

54
Q

Most animals with renal failure are _____calcemic

A

Normo

Early/mid stages of renal failure

55
Q

What are the mechanisms by which hypocalcemia develops in renal azotemia

A

Decreased renal tubular Ca resorption
Decreased renal tubular production of vit D
Hyperphosphatemia -> mineral depot

56
Q

What occurs to PTH in renal azotemia?

A

Hyperparathyroidism

-> hypocalcemia stimulates PTH production (mobilize Ca from bone)

57
Q

In what species can you see hypercalcemia in renal azotemia?

A

Horse and cat

Usually chronic renal failure

58
Q

What is the expected USG of a patient with hypercalcemia due to renal azotemia?

A

Hyposthenuric

Calcium interferes with ADH receptors

59
Q

In cats and cattle, what will occur to the levels of potassium in renal azotemia?

A

Hypokalemia

Cats-> hypokalemic nephropathy

60
Q

Hyperkalemia due to renal azotemia is caused by what mechanisms?

A

Oliguria/anuria (decreased excretion) -> end stage chronic renal failure or acute renal failure

Metabolic acidosis -> hydrogen ions move intracellularly and potassium moves extracellularly

61
Q

In most cases of renal failure, what are the levels of sodium and chloride?

A

Normal

Chronic renal failure can sometimes cause hyponatremia and hypochloremia

62
Q

Hyponatremia and hypochoremia are always a finding in _________

A

Uroabdomen

63
Q

What is the mechanism by which you get metabolic acidosis in renal disese?

A

Increased urinary loss of bicarbonate

Decreased tubular secretion of H+

Production of sulfate and phosphates

  • unmeasured anions
  • increased anion gap
64
Q

The UA dipstick is best at detecting what protein?

A

Albumin

65
Q

What are causes of physiological pre-renal proteinuria?

A

Hypertension
Fever
Seizure
Strenuous exercise

66
Q

What proteins can be increased in pre-renal proteinuria?

A

Hemoglobin
Myoglobin
Para-proteins (bence-jones)

67
Q

Renal proteinuria can be due to what causes ?

A

Glomerulonephritis (damaged barrier)

  • Ag-Ab
  • amyloid

Tubular proteinuria

  • acute renal disease
  • fanconi’s syndrome
68
Q

What would the urine protein : creatinine ratio be in a glomerulonephritis ?

A

UPCR > 1.0

69
Q

If the UPCR is greater than 0.5 what is the cause of the proteinuria?

A

Tubular proteinuria

Acute renal disease
Fanconi’s syndrome

70
Q

What is the only time you will see hypoalbuminemia?

A

Glomerular proteinuria

71
Q

A secondary globmerulonephropathy can be due to???

A

Chronic infectious disease
Non-infectious inflammatory disease
Neoplasm

72
Q

What is the pathogenesis of glomerulonephropathy?

A

Renal glomerular damage
-damage to podocytes (AgAb complex or amyloid deposits)

Podocyte retraction

Filtration of larger proteins
Albumin -> hypoalbuminemia
Antithrombin -> hypercoagulability

73
Q

What is nephrotic syndrome?

A

Protein losing enteropathy that leads to abdominal effusion

  • proteinuria
  • hypoalbuminemia
  • abdominal effusion
  • hypercholesterolemia
  • hypercoaguable state
74
Q

Acute renal failure can have what etiologies?

A

Toxicant (eg lilies or ethylene glycol)

Renal ischemia

Infection (lepto)

75
Q

What is this ?

Azotemia
Hyperkalemia
Acidemia

Oliguria/anuria
Proteinuria

A

Acute renal failure

76
Q

What is the etilogy of chronic renal fialure in cats

A

Irreversible chronic interstitial fibrosis

77
Q

Cat with..

Poor BCS
Dehydration
Polyuria
Hypertensive

Non-regenerative anemia
Azotemia
Hyperphosphatemia
Hypokalemia 
Metabolic acidosis

Polyuria
Isosthenuria

A

Chronic renal failure

78
Q 
Abdominal effusion 
Serum electrolyte imbalances 
-azotemia (increased BUN)
-hyperkalemia
-hyponatremia
-hypochloremia
A

Uroabdomen

(Hyperkalemia and hyponatremia due to urine on serosal surfaces -> sodium moves out of abdominal cavity and potassium diffuses into the GI)

RUSVM Clinical Pathology (18 decks)

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