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Internal medicine (small) > Renal function/integrity (Yr 4) > Flashcards

Renal function/integrity (Yr 4) Flashcards

1
Q

what are the functions of the kidney?

A

excretion of waste
control of body fluid balance (pressure, electrolytes, acid-base)
production of hormones (erythropoietin, calcitriol, renin)

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2
Q

what is calcitriol?

A

active form of vitamin D

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3
Q

what is excreted by the nephron?

A

urea
creatinine
potassium
hydrogen
phosphate
ketones/lactate

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4
Q

what is conserved by the nephrons?

A

water
amino acids/proteins
glucose
bicarbonate
sodium/chloride
magnesium/calcium

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5
Q

what are the three parts of a urinalysis?

A

USG
dipstick
sediment

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6
Q

what needs to be measured to determine if the kidneys are working effectively?

A

glomerular filtration rate

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7
Q

how can glomerular filtration rate be measured accurately in practice?

A

exogenous creatinine clearance (this is rarely done)

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8
Q

how can GFR be indirectly measured in practice?

A

urea or creatinine

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9
Q

how will urea and creatinine change if GFR decreases?

A

will both increase as they aren’t being filtered

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10
Q

how are urea and creatinine differed?

A

urea is made in the liver from ammonia and can be reabsorbed
creatinine is constantly produced by muscle and not reabsorbed

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11
Q

where is creatinine made?

A

muscles (constantly produced)

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12
Q

is creatinine or urea a better marker for GFR?

A

creatinine as it isn’t reabsorbed by the kidney and is less effected by other processes

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13
Q

what can cause increased urea?

A

decreased GFR
upper GI haemorrhages
recent meals
catabolism (fever, corticosteroids…)

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14
Q

what can cause decreased urea?

A

severe liver disease or portosystemic shunts
low protein diet
aggressive fluid therapy
PUPD
young animals

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15
Q

what can cause increased creatinine?

A

decreased GFR
high muscle mass
high dietary protein

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16
Q

what can cause decreased creatinine?

A

reduced muscle mass

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17
Q

what is the name for increase urea and creatinine in blood?

A

azotaemia

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18
Q

what are the three causes of azotaemia?

A

pre-renal
renal
post-renal

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19
Q

what causes pre-renal azotaemia?

A

dehydration or decreased cardiac output

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20
Q

how can you tell azotaemia is pre-renal?

A

clinical evidence of dehydration/hypovolaemia
if USG is normal (adequately concentrated)
they should respond to fluid therapy

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21
Q

what is adequate concentration for USG?

A

dogs - >1.030
cats - >1.035

22
Q

how can you diagnose if an azotaemia is renal?

A

variable USG…
can be isosthenuric (1.008-1.012)
USG inadequately concentrated (<1.030 in dogs, <1.035 in cats)

23
Q

how can post-renal azotaemia be diagnosed?

A

lack of urine output, full bladder (painful)
usually hyperkalaemic

24
Q

how much nephron function needs to be lost for renal azotaemia to present?

A

75%

25
Q

what is a possible test for GFR that increases when there is less nephron loss (40%) so can detect disease earlier?

A

SDMA (not perfect… puppies/kittens)

26
Q

what are the three main electrolyte changes associated with the kidney?

A

phosphorous
potassium
calcium

27
Q

what does hyperphosphataemia reflect in animals with high dietary phosphorous content?

A

decreased GFR

28
Q

what can cause increased potassium?

A

fluid compartment shift in acidosis
decreased urinary output (anuria, oliguria, bladder rupture, obstruction)

29
Q

what can cause increased potassium?

A

increased urinary loss (CKD)
decreased food intake or GI loss

30
Q

where is urea made?

A

liver

31
Q

what is USG a measure of?

A

solutes in urine

32
Q

what is the USG of plasma?

A

1.010

33
Q

what is adequately concentrated urine in dogs and cats?

A

dogs >1.030
cats >1.035

34
Q

when would a sub-optimally concentrated urine be a cause for concern?

A

if the animal is dehydrated

35
Q

if USG is hyposthenuric (lower than 1.010) are the kidneys functioning normally?

A

yes - nephrons have to be functioning otherwise they would be isothenuric

36
Q

what is needed to accurately quantify proteinuria?

A

protein to creatinine ratio (UPCR)

37
Q

what are the three things that should be checked when you have diagnosed a proteinuria?

A

location
persistence
magnitude

38
Q

where can proteinuria be located to?

A

pre-renal
renal
post-renal

39
Q

what can cause a pre-renal proteinuria?

A

fever
systemic inflammation
haemoglobinaemia
myoglobinaemia

40
Q

what can cause a post-renal proteinuria?

A

UTI
nephrolithiasis
tumours of urinary tract

41
Q

is glucose a normal constituent of urine?

A

no (not normally present)

42
Q

what is ignored on a dipstick for urine?

A

nitrite
leucocytes

43
Q

what are casts?

A

cylindrical moulds of tubules composed of mucoproteins (plus cells)

44
Q

where can you localise the problem to if there are casts in the urine?

A

the actual kidney (tubules)

45
Q

when should urine be assessed for crystals?

A

only in fresh urine (older samples can develop crystals)

46
Q

what are the common crystals seen in urine?

A

struvite
urate
phosphate
calcium oxalate di/monohydrate
ammonium biurate
cystine

47
Q

what shape are struvite crystals?

A

coffin lid

48
Q

what substance makes struvite crystals?

A

magnesium ammonium phosphate

49
Q

what pH urine do struvite crystals form in?

A

alkaline

50
Q

what crystals are associated with ethylene glycol toxicosis?

A

calcium oxalate monohydrate

51
Q
A

Internal medicine (small) (33 decks)

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