SA renal disease Flashcards
1
Q
what does a USG below 1.008 tell you?
A
the tubules are functioning as have enough capacity to actively dilute
2
Q
What does having azotaemia and a USG below 1.008 tell you?
A
renal dysfunction - has enough nephrons to actively dilute so has enough to remove urea/creat - therefore azotaemia is from reduced GFR and dodgy CD
3
Q
What can cause hyperkalaemia?
A
- cell destruction as most intracellular
- acidosis from azotaemia causes K+ out of cell
4
Q
How is non-neurogenic incontinence categorised?
A
congenital overflow stress urge paradoxical
5
Q
What is the common signalment for urethral sphincter mechanism incontinence (USMI)?
A
medium - large breed
post neutering
female
dogs
6
Q
What do you see with urethral sphincter mechanism incontinence?
A
- urine leakage when recumbent
- may have a caudally positioned bladder neck
7
Q
how can you medically manage urethral sphincter mechanism incontinence?
A
increase urethra tone with oestrogens/testosterone and alpha agonists
8
Q
how can you surgically manage urethral sphincter mechanism incontinence?
A
- colposuspension
- urethropexy
- prosthetic sphincter
- collagen inj
- vas deference pexy
9
Q
what is colposuspension and what is it used for?
A
suturing vagina to pupic tendon
- manage USMI
10
Q
what is the common presentation for an ectopic ureter?
A
female
dogs
11
Q
what are the signs of an ectopic ureter?
A
continuous urine dribbling
urine scalding
UTI
12
Q
What is an ectopic ureter?
A
When ureter bypassed bladder and enters urethra or vagina
13
Q
What is the difference in location of cat and dog ectopic ureters?
A
Dog - more likely intramural
Cat - more likely extramural
14
Q
How do you manage an ectopic ureter?
A
intramural - neo-ureterocystostomy
extramural - uretral transection and implantation
15
Q
What is the success rate of ectopic ureter surgery and what are some risks?
A
only 50% resolve
risk of ascending inf, bladder oedema, dysuria
16
Q
what is genito-urinary dysplasia?
A
congenital development abnormality affecting vagina and urethra
17
Q
How can bladder hypoplasia cause urinary incontinence?
A
small bladder so overflows
18
Q
How can bladder atony cause urinary incontinence?
A
-tight junctions in bladder wall disrupted so get atony and urine retention so overflows
19
Q
how can you manage bladder atony?
A
- indwelling catheter
- reduce urethral tone
- improve bladder tone
20
Q
What are some juvenile causes of urinary incontinence?
A
ureteral ectopia USMI genitorurinary dysplasia bladder hypoplasia intersexuality previous urachus neuro disease
21
Q
what are some adult causes of urinary incontinence?
A
USMI prostatic disease neuro disease urogenital neoplasia fistulae bladder atony cystitis detrusor instability pelvic masses
22
Q
what are clinical signs of FLUTD?
A
haematuria stranguria pollakiuria dysuria licking of penis/prepuce inappropriate urination vocalisation hiding
23
Q
What is different in the causes of FLUTD in younger and older cats?
A
older cats - an underlying cause is generally found
young cats - often idiopathic and episodic
24
Q
What are some underlying causes of FLUTD?
A
CKD hyperthyroid DM urolithiasis bladder neoplasia
25
What are risk factors for iFLUTD?
```
persian
obese
young
neutered
sedentary
dry food
stress
```
26
what are some theories for i FLUTD?
- infectious
- crysalluria
- vesicourachal diverticular (bladder outpouchings)
- interstitial cystitis
- neurogenic inflammation
- deficient GAG layer
- neuroendocrine imbalance
27
What is the only proven therapy for iFLUTD?
canned wet food
| increase water intake
28
Why dont we treat i FLUTD?
spontaneously get better in 3-7 d anyway and recurrs
29
What can you try giving for iFLUTD?
synthetic GAGs
antidepressant amitriptyline
analgesia
30
What are common pathogens for UTI?
```
e.coli
staph
strep
enterococcus
klebsiella
proteus
```
-horse and cattle - corynebacterium
31
what is the common route of infection for a UTI?
ascending faecal or skin flora
32
what are the pathogenicity factors needed for a UTI pathogen?
fimbriae to avoid flushin
complement resistant
haemolysin production and iron chelating ability
flagella to climb up tract
33
What are the normal defence mechanisms to a UTI?
```
normal micturition flushing
uretheral seal
uretheral ep
urethral peristalsis
prostatic antibacterial fraction
longer urethral lenght
ureterovesical valves
Ab production by mucosa
surface GAG layer
mucosal anitmicrobial properties
bacterial interference
exfoliation of cells
urine pH
high conc urine
```
34
What factors can increase the risk of a UTI?
```
urethral obstruction
spinal disease
bladder atony
poor husbandry
ectopic ureters
USMI
catheterisation
neoplasia
old cats with dilute urine
DM
```
35
how do you diagnose a UTI?
sample and culture on blood agar
>200 colonies or > 100,000 CFU/ml = UTI
36
What does recrudescent mean?
same strain (treatment failure)
37
what does recurrence mean?
new strain
38
what what level is bacteria in urine considered an infection?
>10^5/ml
39
What are some common abx for UTIs?
ampicillin
potentiated sulphonamides
cefalexin
40
what are some clinical signs of chronic kidney disease?
```
PU/PD
anorexia
wt loss
vom
halitosis
ptyalism
constipation
abnormal kidneys
large bladder
dehydration
pale mm
oral ulcers
depressed
lethargic
```
41
What are some infectious causes of kidney disease in dogs and cats?
dogs : pyelonephritis, lepto
| cats : pyelonephritis, FIP
42
what is a metabolic cause of kidney disease?
hypercalcemic nephropathy
43
what are some neoplastic causes of kidney disease?
primary renal tumour
lymphoma
mets
44
what are some congenital causes of kidney disease?
amyloidosis
| polycystic kidney disease (persians)
45
what are some other causes of kidney disease?
obstructive disease
glomerulonephritis
toxins
46
what are 2 maladaptive mechanisms that form with chronic kidney disease?
renal secondary hyperparathyroidism
| glomerular hypertension and hyperfiltration
47
How can you control renal secondary hyperPTH?
dietary phosphate restriction
| intestinal phosphate binding drugs
48
how can you control glomerular hypertension and hyperfiltration?
ACE i
- preferentially dilate efferent a so reduce flomerular capillary pressure and reduce flomerular capillary permeability to protein -- less proteinuria = better prognosis
Ca channel blockers in cats
49
what are some things that can increase morbidity in chronic kidney disease?
```
hypokalaemia
acidosis
anaemia
UTI
hydration status
systemic hypertension
```
50
Why may patients in chronic kidney disease be hypokalaemic?
diuresis without supplementation
kaliuresis
decreased feed intake
51
how can chronic kidney disease cause non regenerative anaemia?
```
EPO deficient
blood loss
reduced RBC lifespan
uraemic inhibitors of erythropoesis
iron deficiency
```
52
what are patients in chronic kidney disease more likely to get a UTI?
urine not hyperosmolar so not as bacteriocidal
53
Why do you want to ensure adequate hydration status with chronic kidney disease?
prevents pre-renal azotaemia
54
what is acute renal failure?
clinical syndrome characterised by the sudden onset of haemodynamic, filtration and excretory failure of the kidneys and subsequent accumulation of metabolic toxins and dysregulation of fluid, electrolyte and acid-base balance
55
What is acute kidney injury?
abrupt decline in kidney function with acute increases in creatining and/or acute decline in urine output. Patient may not be azotaemic
56
does urine output = GFR?
NO
| so much tubular modification
57
what is oliguria?
<0.25 ml/kg/h
58
what is polyuria?
>5ml/kg/h
59
What patients are at risk from developing hospital acquired ARF?
```
renal disease
dehydrated / hypovolaemic / hypotensive
sepsis/fever/hyperthermia
systemic disease / multi organ failure
prolonged anaesthesia
drug therapy
```
60
What are the 3 ways to classify azotaemia?
pre-renal
renal
post-renal
61
what is pre-renal azotaemia?
reduced renal perfusion = reduced GFR = azotaemia
OR
increased production of nitrogenous waste
62
How can the USG help determine is renal or pre-renal azotaemia?
Cats - if >1.035 then pre-renal
Dogs - if >1.030 then pre-renal
63
Would urine sodium be high with renal or pre-renal azotaemia?
renal (>20 mmol/l)
64
Which type of azotaemia would respond well to fluids?
pre-renal
65
What are the 3 groups of causes of renal azotaemia?
- tubular necrosis
- acute glomerulonephritis
- interstitial nephritis
66
What 2 things can cause tubular necrosis (leading to renal azotaemia)?
Ischaemia - hypovol, decreased effective circulating volume, thrombosis, renal vasoconstriction
Toxins - Abx, chemo, NSAIDs, ACE-i, IV contract, hypercalcaemia, grapes, ethylene glycol, heavy metals, snake venom
67
What 2 things can cause interstitial nephritis (leading to renal azotaemia)?
- pyelonephritis
| - leptospirosis (shed in urine, treat with penicillins, can become a carrier)
68
How can you treat acute renal failure?
1) prevent continued toxin exposure / give antidotes / treat underlying disease
2) correct fluid defecit
3) rectify acid base disturbances
4) attempt to increase urine output (mannitol, furosemide, dopamine for vasodilation, dilitiazem to dilate pre-glomerular arterioles)
5) assess nutrition
6) renal replacement therapy - haemodialysis etc
69
what is post-renal azotaemia?
reabsorbing urine from ruptured bladder into blood or backing up from obstruction causing reduced GFR
70
What can cause primary PD?
```
psychogenic PD
high osmolality
hypotensive
DM
toxins
oral/dental disease
hyperAC
liver disease
```
71
What are structural causes of primary PU?
renal failure
pyelonephritis
neoplasia
72
what are functional causes of primary PU?
```
DI
DM
hypo/hyper AC
pregnancy
hypertension
pyometra
hypokalaemia
```
73
How does hyperAC cause PU/PD?
- Not entirely sure
1) increase gluoconeogenesis causing hyperglycaemia and glucosuria so get diuresis
2) cortisol binds to aldosterone receptors and saturates them so inhibits them - get osmotic diuresis
3) Cortisol inhibits ADH secretion and action
74
What is hyper Ac common with in cats?
DM
75
How do you diagnose hyperAC?
- ACTH stim test
- low dose dex to diagnose
- high dose dex to pit/adrena
- US adrenal
76
How does liver disease cause pu/pd?
less urea made so less conc gradient so get PU
77
How do you diagnose hepatic encephalopathy?
bile acid stim test
78
how does central DI cause pu/pd?
no ADH so cant conc urine and urea isnt reabsorbed so get reduced conc, gradient again
-also at top of loop of henle NcCl pumped out against conc so filtrate is diluted
79
how do you diagnose central DI?
water deprivation test
80
What is desmopressin?
synthetic ADH
81
How do you diagnose psychogenic PD?
water deprivation test
82
What is the most common presentation for psychogenic PD?
young big male dogs
83
How does pyelonephritis cause pu/pd?
- endotoxin reduced tubular sensitivity to ADH
| - inflammtation damages conc gradient
84
How does hypercalcaemia cause pu/pd?
- inhibits response to ADH
- decreases NaCl absorption in loop of henle
- damages nephron by ca phosphate deposition
- renal afferent a vasoconstriction reducing the GFR (can lead to ischaemia and tubular dysfunction)
85
What are transient causes of hypercalcaemia?
hypoAD
hyperproteinaemia
haemoconcentration
hyperlipidaemia
86
what are pathological causes of hypercalcaemia?
- malignancy - PTHrP
- hyperPTH
- hyperVitD
- renal failure
- raisin/grape
- granulomatous disease
- skeletal lesions
87
How do you diagnose hypercalcaemia?
First recheck blood Ca
| test ionised Ca
88
What is oliguria?
less than normal urine output
89
What is normal urine output?
15-45 ml/kg/day
90
What are upper UT signs?
```
PU/PD
abnormal renal palpation
oliguria / anuria +small bladder
halitosis
oral ulcers
haematuria
```
91
What are lower UT signs?
```
dysuria
pollakiuria
oliguria/anuria + distended / ruptured bladder
urinary incontinence
haematuria
abnormal bladder palpation
abnormal external genitalia
```
92
What should free catch urine not be used for?
culture as its contaminated
93
When should cystocentesis not be done?
if have a coagulopathy
| bladder tumour
94
What does the macula densa do?
senses CL- and signals to glomerulus to control GFR
95
where does aldosterone act?
distal tubule
96
What are some effects of angiotensin 2?
constrict efferent
| increase sodium and water absorption
97
what are some effects of aldosterone?
increase sodium reabsorption
increased potassium secretion
regenerate bicarb
98
Why are NSAIDS and Cox inhibitors bad for kidneys?
Renal PG are naturetic (salt losing) so they can exacerbate salt and water retention
99
Which diuretics are fast acting but short duration?
loop diuretics
100
which diuretics lose most of filtered load?
Loop - 25%
| thiazide - 10%
101
Where do thiazide diuretics work?
early DCT
| bind to Cl- site on Na/Cl
102
Where do potassium sparing diuretics work?
CD and inhibit aldosterone
