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Clinical Pathology > Renal Function (dilini) > Flashcards

Renal Function (dilini) Flashcards

1
Q

What does the kidney excrete?

A

Urea, creatinine, K+, H+, NH4+, PO4+

Ca2+ (equine, rabbit)

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2
Q

What does the kidney conserve?

A

Na+, Cl-, HCO3-, Ca2+, Mg2+, Glucose, Amino acids, Water

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3
Q

How would you define GFR and what factors influence it?

A

The rate fluid moves from plasma to glomerular filtrate.
Influenced by: hydrostatic pressure in Bowman’s space, plasma oncotic pressure, renal plasma flow (blood vol, cardiac output).

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4
Q

In what breed of dog is GFR naturally higher?

A

Greyhounds

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5
Q

What is the normal GFR for dogs and cats?

A

Canine: 3-5ml/min/kg
Feline: 2.5-3.5ml/min/kg

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6
Q

How do you measure GFR and what can you detect?

A

Measure clearance of a substance that is neither reabsorbed nor secreted (inulin, creatinine).
Can detect a 20% decrease in renal function.

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7
Q

How can you evaluate tubular integrity?

A

Urine specific gravity, tubular proteinuria, water deprivation test, exogenous ADH, fractional excretion, biomarkers

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8
Q

How can you evaluate glomerular integrity?

A

Creatinine, urea, GFR assessment, glomerular proteinuria

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9
Q

What percentage of nephrons must be non-functional before a decrease in creatinine is seen?

A

75%

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10
Q

Is creatinine or urea more efficient for diagnosing chronic renal failure?

A

Creatinine

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11
Q

Biosynthesis of creatinine involved which two organ systems?

A

Renal and hepatic.

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12
Q

How is urea excreted?

A

Primarily renal excretion in most animals.

Ruminants also salivary and rumen excretion.

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13
Q

What is azotemia?

A

Increased serum urea and/or creatinine concentration.

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14
Q

What other parameter must always be assessed with azotemia and for what reason?

A

Urine specific gravity - to determine if azotemia is pre renal or renal.

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15
Q

Concentrated urine with azotemia indicates that it is….?

A

Pre-renal azotemia

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16
Q

Pre renal azotemia can be caused by what?

A

Processes prior to the kidneys - dehydration, hypovolemia, decreased cardiac output / cardiac insufficiency, high protein diets, haemorrhage into GIT

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17
Q

Poorly concentrated urine indicates what kind of azotemia?

A

Renal azotemia

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18
Q

What can cause renal azotemia?

A

Congenital abnormalities, renal ischemia/necrosis, neoplasia, inflammation, infection, toxins

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19
Q

What causes post renal azotemia and what USG will accompany it?

A

Failure to excrete urine. Any USG may accompany.

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20
Q

What is N-acetyl-B-glucosaminidase (NAG) and what is it useful for?

A

A proximal tubule lysosomal enzyme useful for detecting tubular injury - amount may be directly correlated with severity.

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21
Q

Outline the general parameters of diminished renal reserve

A

Approx 50% GFR, no azotemia, unable to tolerate additional insult

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22
Q

Outline the general parameters of Chronic Renal Insufficiency

A

20-50% GFR, azotemia, polyuria, anemia

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23
Q

Outline the general parameters of Chronic Renal Failure

A

20-25% GFR, azotemia, cannot regulate ECF (oedema), hypocalcaemia, metabolic acidosis, overt uraemia

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24
Q

Outline the parameters of End Stage Renal Disease

A

> 5% GFR, terminal stages of uraemia

25
Q

What are the main causes of Chronic Renal Failure in dogs?

A

chronic tubulointerstitial nephritis, chronic polynephritis, chronic glomerulonephritis, amyloidosis, familial renal diseases, hypercalcaemic nephropathy, chronic obstruction

26
Q

What are the main causes of Chronic Renal Failure in cats?

A

chronic tubulointerstitial nephritis, chronic pyelonephritis, chronic glomerulonephritis, amyloidosis, polycystic kiney disease, neoplasia, granulomatous interstitial nephritis

27
Q

What are the main causes of Chronic Renal Failure in cattle?

A

chronic pyelonephritis, chronic interstitial nephritis, amyloidosis, renal infarction due to sepsis, renal vein thrombosis, leptospirosis, renal lymphoma

28
Q

What are the main causes of Chronic Renal Failure in horses?

A

chronic glomerulonephritis, chronic interstitial nephritis, chronic pyelonephritis, amyloidosis

29
Q

What are the main clinical findings in an animal with chronic renal failure?

A

PU/PD, vomiting, anorexia, weight loss, lethargy

30
Q

How can you differentiate chronic from acute renal failure?

A

renal size, history of previous PU/PD, non-regenerative anaemia, weight loss & poor haircoat, parathyroid gland size, hypothermia, hyperkalemia

31
Q

What causes anaemia in chronic renal failure?

A

Inadequate erythropoetin (EPO) production, decreased RBC lifespan (damaged by substances no longer being cleared), decreased marrow response to EPO, decreased platelet function

32
Q

What occurs in Fanconi Syndrome and what is the first abnormality usually noted?

A

Impaired proximal renal tubular resorbtion. Glucosuria.

33
Q

In which breeds is Fanconi Syndrome hereditary?

A

Basenji, Schnauzer, Norweigen Elkhound, Sheltie

34
Q

What can cause induced Fanconi Syndrome?

A

Toxins (lead) or drugs (gentamycin, amoxil)

35
Q

What is the definition of urine specific gravity and what is it used to measure?

A

Ratio of weight of urine to weight of an equivalent volume of pure water. Measures renal tubular function.

36
Q

What are the causes of dilute urine?

A

renal failure, hypo/hyperadrenocorticism, hypercalcaemia, diabetes mellitus, hyperthyroidism, diuretic therapy, diabetes insipidus

37
Q

What can urine pH be used to assess?

A

Acid-base status and the ability of the kidneys to regulate acid-base balance

38
Q

What is the normal range for urine pH?

A

5.5-7.5

39
Q

How can dietary factors affect urine pH?

A

Herbivores usually have alkaline urine.

Carnivores usually have acidic urine.

40
Q

Is trace protein in urine significant?

A

Trace protein in concentrated urine is less significant than in dilute urine.

41
Q

What might give false positive Proteinuria results?

A

Alkaline urine, urea-producing bacteria, disinfectant residue

42
Q

What might give false negative proteinuria results?

A

Acidic/dilute urine, bence jones proteins

43
Q

What is proteinuria observed with?

A

Inflammation, haemoglobinuria, hematuria, myoglobinuria, pyuria, glomerular/tubular disease

44
Q

When might glucosuria be detected in an otherwise healthy cat?

A

When it is stressed

45
Q

What might cause a false positive result for glucosuria?

A

Contamination (H2O2, bleach), obstructed cats

46
Q

What might cause a false negative for glucosuria?

A

Ascorbic acid, tetracyclines, high concentrations of ketones, refrigerated urine

47
Q

What can cause blood glucose to exceed the urine threshold?

A

diabetes mellitus, shock, glucose fluids, anaesthesia, excessive glucocorticoids, stress

48
Q

What may be the cause when there is glucosuria with normal blood glucose levels?

A

renal tubular disease, primary renal glycosuria, pups and kittens

49
Q

Ketosis can be caused by?

A

Diabetes, insulinoma, high fat/low carb diets, prolonged fasting, pregnancy toaxaemia, primary ketosis in ruminants

50
Q

Is bilirubinuria ever normal?

A

Normal in dogs with a high specific gravity.

Never normal in cats at any specific gravity.

51
Q

What might cause false negative bilirubinuria results?

A

aged urine samples, exposure to UV light, ascorbic acid

52
Q

The urine blood strip test will react positively to what?

A

Red blood cells, free hemoglobin, free myoglobin

53
Q

What may cause a false positive urine blood strip test?

A

contamination (bleach, iodide, bromide), dog in heat, cystocentesis

54
Q

What might cause a false negative urine blood strip test?

A

Urine is not well mixed - RBCs sediment out quickly

55
Q

Hematuria indicates haemorrhage caused by?

A

inflammation, calculi, bleeding disorders, parasites, estrus, prostatic diseases, trauma, neoplasia

56
Q

Red and cloudy urine sample, after centrifugation becomes clear with sediment that reveals red cells

A

Hematuria

57
Q

Reddish-brown urine sample which does not clear after centrifugation. Patient clinically anaemic.

A

Hemoglobinuria

58
Q

Sample appears red but clears quickly with centrifugation. Sediment does not reveal any red blood cells.

A

Myoglobinuria

59
Q

What is the function of the kidneys?

A

To maintain extracellular fluid, eliminate wastes of normal metabolism and excrete xenobiotics & their metabolites.

Clinical Pathology (4 decks)

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