Renal review papers Flashcards
test strip urine leucocytes
reliability of reagent strips for detecting leucocytes in equine urine is unknown.
does not detect lymphos but only granulom leuc
protein on urine dipstick?
poorly sensitive and poorly specific
dont use
which problems can result in acidic urine in adults?
is reagent strip testing relieable?
- normal in foals
- Metabolic acidosis,
- proximal renal tubular acidosis and
- paradoxically, hypochloraemic metabolic alkalosis
Bilirubinuria may represent
negative energy balance,
haemolysis,
hepatic disease or
post hepatic obstruction.
is crea sensitive for renal insuff?
Serum creatinine levels are not a sensitive measure of renal disease as approximately 75% of nephrons may be nonfunctional before increases in serum levels are observed
beware that crea conc in the blood is directly correlated with muscle % of the body
SDMA for dignosis of kidney patho?
not yet published evidence that SDMA levels can be used to diagnose renal disease in the horse
produced by all nucleated cells and directly associated with GFR
What are the three most common electrolyte derangements in chronic renl failure?
Why?
hypercalcaemia (67%) ->
. Horses absorb excessive amounts of dietary calcium across the intestinal tract -> urinary calcium excretion is reduced with chronic renal failure (nothing to do with PTH)
hyponatraemia (65%),
hyperkalaemia (56%)
when GFR is reduced below a certain threshold, potassium excretion is reduced by an alternative mechanism and circulating potassium levels increase
specific gravity?
hyposthenuric
iso: 1.008-1.014
hyper
which level of protein is normal in urine?
urine protein: creatinine ratio (UPC)
range of 0.03–0.93
does blood GGT influence urine GGT?
Circulating levels of this enzyme should not affect urinary GGT levels as this enzyme is not filtered by the glomerulus
ACHTUNG, nornmal indicator of tubular damage BUT
urinary levels may also be increased in the presence of glomerular damage
Normal GGT: Cr ratios
when is there a relevant elevation?
<25 IU/g
clinical relevance of GGT: Cr ratios between 25 and 100 IU/g Cr remains debatable.
happens f.e. with aminoglycosides
other enzymes currently studied to detect renal damage?
NGAL secreted by tubular cells
NAG: proximal tubular lysosomal enzyme
Normal equine urine is usually rich in which crystals?
calcium carbonate crystals #rund/oval
with calcium oxalate being common too #quadrat
occasionally others: calcium phosphate, struvite ( längliche vierecke) or hydroxyapatite
Which observations in urine sediment lead to suspicion of renal disease?
- Granular casts (see in 10 magni)
- renal tubular epithelial cells
- > 8 leucocytes per high power field (40 magnification)
- > 8 erys per ….
fractional excretion of electrolytes is a useful diagnostic tool in the identification of patients with
Fanconi’s syndrome
= rare tubule disfunction that results in excess EXCRETION of
POTASSIUM
glucose
bicarb
phosphates
case report of 2 QH
can not be cured but controlled
VAKI staging system.
- Stage 0 : increase in sCr <150% from baseline
-
Stage 1 :
- increase of 150%-199% or
- sCr 0.3 mg/dL (≥26.5 μmol/L) from baseline
- Stage 2 : increase from 200-299% from baseline
-
Stage 3 :
- increase of ≥300% from baseline or
- absolute sCr 4.0 mg/dL (>354 μmol/L)
prevalence of hospital-acquired AKinjury
SAVAGE: 14.8% of 325 horses
presence of azotemia within 24 hours of admission or the development of an AKI while hospitalized
did not affect survival to discharge in this population of horses
DD hematuria
Cystolith, Nephrolithiasis
Exercise-induced haematuria
Haemorrhagic cystitis
Idiopathic renal haematuria (arabians)
infection: pyelonephritis, lepto
neoplasia
pyuria define
WBC of at least 10 WBCs/ mm3
or
<5 (some say 8) WBCs per high-powered field
Difference of findings between horses with hemorrhagic cystitic and bladder neoplasia
Horses with bladder neoplasia
lower hematocrits,
older,
more likely to be female,
more likely to have a mass detected on ultrasonographic examination of the bladder
cystitis resolves after 3-8 weeks
two main stimuli of thirst
increased plasma osmolality
hypovolemia/hypotension
true or false?
stressed horses produce less vasopressin
FALSE
during stress: 10 fold INCREASE
daily sodium requirement for a 500kg horse
6-12g
effect of dopamine on kidneys
has been shown to increase
renal blood flow and urine output by 30%-190%
useful in AKI
