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ACVIM Generals Revision > Renal/Urinary Clinical > Flashcards

Renal/Urinary Clinical Flashcards

1
Q

Most common canine uroliths and sex predisposition

A 
CaOx = male
Struvite = female
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2
Q

Breed predisposition to rate and cysteine stones?

A 
EBD = urate + cysteine 
Dalmation = urate
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3
Q

What size urolith can be removed by voiding urohydropropulsion?

A

<3mm stones

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4
Q

Which stones are amenable to medical dissolution?

A

Struvite, urate, xanthine, cysteine

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5
Q

Dietary management of CaOx prevention.

A

Dilute USG
Maintain pH >8.0
Consider KCi, Hydrochlorathiazide
Avoid high sodium, protein
Avoid phosphorus restriction

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6
Q

Urease producing organisms

A

Streptococcus
Proteus
Ureoplasma
Corynebacterium
Klebsiella

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7
Q

Drugs that can be used to acidify urine in dogs with struvite urolithiasis

A

L-methionine
Ammonium chloride

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8
Q

Genetic defect of breeds that form urate stones

A

SLC2A9 (urate transporter)

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9
Q

Purine degredation pathway

A
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10
Q

Urine pH to aim for for xanthine and urate dissolution?

A

Alkaline

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11
Q

Urine pH to aim for for cysteine uroliths

A

Alkaline

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12
Q

CaOx monohydrate crystals

A

Dumbells and pickets

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13
Q

CaOx dihydrate crystals

A
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14
Q

Struvite crystals

A
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15
Q

Urate crystals

A

Amorphous, speculated globules with and without spicules

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16
Q

Cysteine crystals

A
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17
Q

Xanthine crystals

A
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18
Q

Crystals that may be amorphous

A

Calcium phosphate carbonate
Brushite
Calcium phosphate apetite

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19
Q

Stones that may be spikey

A

Calcium oxalate dihydrate can be spiculated

Silica is the other one.

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20
Q

Radiolucent stones

A

Lucency of:
Cysteine, urate, xanthine

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21
Q

Dumbells and pickets

A

CaOx monohydrate crystals

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22
Q
A

CaOx dihydrate crystals

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23
Q
A

Struvite crystals

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24
Q

Amorphous, speculated globules with and without spicules

A

Urate crystals

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25
Q
A

Cysteine crystals

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26
Q
A

Xanthine crystals

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27
Q

Lucency of:
Cysteine, urate, xanthine

A

Radiolucent stones

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28
Q

Amino acids involved in abnormal cysteine transporters

A

COLA
Cystine
Ornithine
Lysine
Arginine

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29
Q

Genetic basis of abnormal cysteine transport

A

genetically heterogeneous (autosomal recessive- SLC3A1, autosomal dominant-SLC3A1 & SLC7A9, and sex linked/androgen responsive

Three genetic groups
Type 1 (autosomal recessive) = Labrador, Newfoundland, Landseers, Scottish Terriers = SLC3A1, autosomal recessive
Type 2 (autosomal dominant) = Australian cattle dogs (SLC3A1) and mn pinschers (SLC7A9)
Type 3 (androgen responsive) = Mastiff, Bulldogs, Kromfohrländer and Irish Terrier

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30
Q

Innervation of the bladder and urethral sphincters

A

Pelvic nerve (S1-S3) = parasymphathetic innervation to the bladder (muscarinic receptors)

Hypogastric nerve (L1-L4) = syphathetic innervation to the bladder (beta3) and internal urethreal sphincter (alpha)

Pudendal nerve (S1-S2) = somatic.

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31
Q

Where is the micturition centre located?

A

In the pons.

32
Q

Which nerve is the main afferent (sensory) nerve in the urinary tract?

A

The pelvic nerve.

33
Q

How to tell the difference between UMN bladder and detrusor atony?

A

UMN bladder is difficult to express

Detruser atony will also have a large bladder but should be easily expressed.

34
Q

Tiopronin

Indications

MoA

Side effects/Contraindications

A

Indication = treatment for cysteine urolithiasis when medical management and castration have failed

MoA = chelates cysteine

Side effects: agranulocytosis, aplastic anaemia, thrombocytopenia, IMHA, proteinuria

AVOID IN CATS

35
Q

Potassium Citrate

Indications
MoA
side effects

A

Alkalinisation of urine, treatment of metabolic acidosis

MoA: - citrate converts to HCO3 in the liver, citrate can also complex with calcium

Side Effects: GI, hyperkalaemia, bitter taste

36
Q

Phenylpropanolamine

MoA

Side effects

A

Indirect stimulation of alpha receptors (and to some degree beta) through release of nEP and inhibition of nEP re-uptake within the synapse.

Side effects:

  • Hypertension (mild and transient)
  • can also get all the signs you would expect with a phaeo
37
Q

Bethanecol

Indications

MoA

Side effects

A

Detrusor atony, may also reduce urethral resistance in some conditions. Can also be used as a upper GI prokinetic (reduces LES tone)

MoA = muscarinic stimulation.

Side effects: cholinergic (SLUDG-M)

38
Q

Prazosin

Indications

A

Indications: reflex dysnergia, urethral spasm,

Alpha-1 antagonist

Side effects - hypotension is the main one to worry about

39
Q

Tamsulosin

A

Also urethral spasm (reflex dysnergia)

alpha-1a antagonist (may be more specific to the urethra than Prazosin)

40
Q

Baclofen

A

Centrally acting skeletal muscle relaxant

GABAb agonist.

Care in cats or seizure disorders

41
Q

Cholinergic side effects

A

SLUDGE-M

Salivation

Lacrimation

Urination

Defecation

GI disress

Emesis

Miosis

42
Q

Basic categories of DDx causing PU/PD

A

Primary PD

CDI

NDI; primary

NDI;secondary

Osmotic

Reduced medullary tonicity

Other/Unknown

43
Q

At what bodyweight loss is maximum ADH release stimulated?

A

5%

44
Q

Why does hypoadrenocorticsm cause PU/PD?

A

There is a lack of urinary sodium reabsorption and resultant medullary washout.

45
Q

How does hyperadrenocorticism result in PU/PD?

A

Psychogenic

Alters release and action of ADH

46
Q

Polyuria in AKI?

A

Reduced sodium resorption. Attempt to eliminate retained solutes.

47
Q

Why does PU occur in CKD?

A

There is a disruption of normal medullary architecture.

Remaining nephrons suffer from osmotic diuresis.

48
Q

Which urinary crystals are associated with ethylene glycol toxicity>

A

Calcium oxalate monohydrate

49
Q

What miscellaneous tools can help you to deterimine AKI from CKD?

A

X-ray of the mandible to look for lamina dura loss
US of PT to look for hypertrophy
Measure carbamylated haemoglobin (theorhetical)
Renal biopsy

50
Q

In what circumstances may dogs and cats be azotaemic but retain urine concentrating ability even when a renal cause for the azotaemia is present?

A

Cats can just do this with CKD

Dogs with glomerular disease may retain concentrating ability but be azotaemic

51
Q

IRIS CKD Staging (dogs and cats)

A
52
Q

IRIS AKI grading

A
53
Q

Calculation for urinary clearance

A

Clearance = (Urine flow rate x Concentration of solute in the urine)/concentration of solute in plasma.

54
Q

Plasma clearance

A

Dose of substance/AUC*

*The auc is determined by taking several times measurements.

55
Q

How are the following substances handled by the kidneys?
Urea
Creatinine
SDMA
Cystatin C

A
  • Urea = freely filtered and passively reabsorbed
  • Creatinine = freely filtered, small amount is secreted
  • SDMA = moslty freely filtered (=> more linear relationship with GFR)

Cystatin C = freely filtered, actively reabsorbed (should be low concentration in the urine)

56
Q

What protein is mainly detected by the urine dipstick? What is the lower limit of detection?

A

Albumin, lower limit is 30mg/dL (0.3g/L)

57
Q

Reasons for false negative and false positive positive dipstick results

A

False positive:

  • Alkaline urine
  • Haematuria
  • Pyuria
  • Concentrated urine

False negative:

  • Acidic urine
  • Dilute urine
  • Bence-jones proteinuria
58
Q

What is the definition of microalbuminuria?

A

Urine albumin >1mg/dL but < the 30mg/dL on the dipstick.

59
Q

Why are the cut offs for UPC the numbers that they are? What are they and what does this mean?

A

Cat > 0.4, Dog >0.5 = 30mg/dL of albumin

>0.2 = microalbuminuria

60
Q

How many samples need to be taken for proteinuria to be considered persistent?

A

>3 samples > 2 weeks apart.

61
Q

What are the relationships between the following parameters and proteinuria?

Sample method

Environment

Haematuria

Pyuria

Bacturia

Day-today variability

A

No difference between cysto, midstream or free-catch

Higher in hospital vs. home

Only gross haematuria (>250 RBC/HPF)

Pyuria = minimal

Bacturia = minimal as ‘post-renal’ proteinuria is really a result of leakage of proteins from the blood from the inflammation in response to bacteria

Day-today variability: not of concern if <0.4.

62
Q

What sample media should be used for a renal biopsy?

A
  1. Formalin = light microscopy
  2. Gluteraldehyde = TEM
  3. Michel’s medium = immunoflourescence

Initially the specimen should be put into physiologic saline before being divided.

63
Q

What are the hallmark;s of the nephrotic syndrome?

A

Proteinuria

Hypoalbuminaemia

Hypercholesterolaemia

Peripheral oedema or cavitary effusion

64
Q

What do the following casts indicate?
Epithelial
Granular
Hyaline
Waxy
RBC

A

Epithelial = can be normal in low numbers, often come from the urethra etc.

  • Squamous = from the lower urethra and beyond
  • Transitional = from the renal pelvis up to the urethra

Granular = indicate partial cellular degeneration so tubular injury

Hyaline = usually from proteinaceous urine (protein that is present in the tubule so not post-renal)

Waxy = complete cellular degeneration

RBC = may indicate haemorrhage

It is possible that cellular, granular and waxy casts are different stages of the same problem.

65
Q

Which ketones are detected by the urine dipstick?

A

Acetoacetate (more sensitive to this - this is the first ketone produced)
Acetone

66
Q

What renal ultrasound finding is likely to reflect EG toxicity?

A

Very bright, large kidneys.

67
Q

What molecule likely contributes to hyaline casts in glomerular disease?

A

Tamm-Horsfall mucoprotein

68
Q

What is the approximate prevalence of IMGN in canine glomerular disease?

A

50%

69
Q

What type of glomerulonephritis is assocaited with Borrelia bungdorferi?

A

Membranoproliferative (MPGN)

70
Q

Components of Fanconi syndrome

A

Glucosuria

Aminoaciduria

Proteinuria

Phosphaturia

Hypophosphatemia

71
Q

What percentage of renal bicarbonate is reapsorbed by the proximal tubule?

A

80-90%

72
Q

Pathologic mechanism of proximal vs. distal RTA

A

Proximal = failure of basolateral Na/HCO3 echanger resulting in loss of HCO3

DIstal = failure of H+ ATPase most likely

73
Q

Main ways to differentiate proximal vs. distal RTA

A

Proximal = milder hyperchloraemic metabolic acidosis with appropriately acidic pH

Distal = more marked metabolic acidosis with paradoscially alkaline urine

Ammonium chloride challenge test

74
Q

What is the therapy for RTA?

A

Alkali therapy such as potassium or sodium citrate.

75
Q

How can assessing urea:creatinine ratio help in distinguishing causes of Azotaemia?

A

Urea:creatinine will be elevated if pre-renal due to the handling of these biomarkers in dehydration.

ACVIM Generals Revision (32 decks)

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