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Year 3 renal > SA renal disease > Flashcards

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

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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

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3
Q

What can cause hyperkalaemia?

A
  • cell destruction as most intracellular

- acidosis from azotaemia causes K+ out of cell

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4
Q

How is non-neurogenic incontinence categorised?

A 
congenital
overflow
stress
urge
paradoxical
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5
Q

What is the common signalment for urethral sphincter mechanism incontinence (USMI)?

A

medium - large breed
post neutering
female
dogs

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6
Q

What do you see with urethral sphincter mechanism incontinence?

A
  • urine leakage when recumbent

- may have a caudally positioned bladder neck

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7
Q

how can you medically manage urethral sphincter mechanism incontinence?

A

increase urethra tone with oestrogens/testosterone and alpha agonists

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8
Q

how can you surgically manage urethral sphincter mechanism incontinence?

A
  • colposuspension
  • urethropexy
  • prosthetic sphincter
  • collagen inj
  • vas deference pexy
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9
Q

what is colposuspension and what is it used for?

A

suturing vagina to pupic tendon

  • manage USMI
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10
Q

what is the common presentation for an ectopic ureter?

A

female

dogs

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11
Q

what are the signs of an ectopic ureter?

A

continuous urine dribbling
urine scalding
UTI

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12
Q

What is an ectopic ureter?

A

When ureter bypassed bladder and enters urethra or vagina

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13
Q

What is the difference in location of cat and dog ectopic ureters?

A

Dog - more likely intramural

Cat - more likely extramural

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14
Q

How do you manage an ectopic ureter?

A

intramural - neo-ureterocystostomy

extramural - uretral transection and implantation

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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

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16
Q

what is genito-urinary dysplasia?

A

congenital development abnormality affecting vagina and urethra

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17
Q

How can bladder hypoplasia cause urinary incontinence?

A

small bladder so overflows

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18
Q

How can bladder atony cause urinary incontinence?

A

-tight junctions in bladder wall disrupted so get atony and urine retention so overflows

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19
Q

how can you manage bladder atony?

A
  • indwelling catheter
  • reduce urethral tone
  • improve bladder tone
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20
Q

What are some juvenile causes of urinary incontinence?

A 
ureteral ectopia
USMI
genitorurinary dysplasia
bladder hypoplasia
intersexuality
previous urachus
neuro disease
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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
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22
Q

what are clinical signs of FLUTD?

A 
haematuria
stranguria
pollakiuria
dysuria
licking of penis/prepuce
inappropriate urination
vocalisation
hiding
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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

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24
Q

What are some underlying causes of FLUTD?

A 
CKD
hyperthyroid
DM
urolithiasis
bladder neoplasia
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25
Q

What are risk factors for iFLUTD?

A 
persian
obese
young
neutered
sedentary
dry food
stress
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26
Q

what are some theories for i FLUTD?

A
  • infectious
  • crysalluria
  • vesicourachal diverticular (bladder outpouchings)
  • interstitial cystitis
  • neurogenic inflammation
  • deficient GAG layer
  • neuroendocrine imbalance
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27
Q

What is the only proven therapy for iFLUTD?

A

canned wet food

increase water intake

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28
Q

Why dont we treat i FLUTD?

A

spontaneously get better in 3-7 d anyway and recurrs

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29
Q

What can you try giving for iFLUTD?

A

synthetic GAGs
antidepressant amitriptyline
analgesia

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30
Q

What are common pathogens for UTI?

A 
e.coli
staph
strep
enterococcus
klebsiella
proteus

-horse and cattle - corynebacterium

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31
Q

what is the common route of infection for a UTI?

A

ascending faecal or skin flora

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32
Q

what are the pathogenicity factors needed for a UTI pathogen?

A

fimbriae to avoid flushin
complement resistant
haemolysin production and iron chelating ability
flagella to climb up tract

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33
Q

What are the normal defence mechanisms to a UTI?

A 
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
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34
Q

What factors can increase the risk of a UTI?

A 
urethral obstruction
spinal disease
bladder atony
poor husbandry
ectopic ureters
USMI
catheterisation
neoplasia
old cats with dilute urine
DM
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35
Q

how do you diagnose a UTI?

A

sample and culture on blood agar

> 200 colonies or > 100,000 CFU/ml = UTI

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36
Q

What does recrudescent mean?

A

same strain (treatment failure)

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37
Q

what does recurrence mean?

A

new strain

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38
Q

what what level is bacteria in urine considered an infection?

A

> 10^5/ml

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39
Q

What are some common abx for UTIs?

A

ampicillin
potentiated sulphonamides
cefalexin

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40
Q

what are some clinical signs of chronic kidney disease?

A 
PU/PD
anorexia
wt loss
vom
halitosis
ptyalism
constipation
abnormal kidneys
large bladder
dehydration
pale mm
oral ulcers
depressed
lethargic
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41
Q

What are some infectious causes of kidney disease in dogs and cats?

A

dogs : pyelonephritis, lepto

cats : pyelonephritis, FIP

42
Q

what is a metabolic cause of kidney disease?

A

hypercalcemic nephropathy

43
Q

what are some neoplastic causes of kidney disease?

A

primary renal tumour
lymphoma
mets

44
Q

what are some congenital causes of kidney disease?

A

amyloidosis

polycystic kidney disease (persians)

45
Q

what are some other causes of kidney disease?

A

obstructive disease
glomerulonephritis
toxins

46
Q

what are 2 maladaptive mechanisms that form with chronic kidney disease?

A

renal secondary hyperparathyroidism

glomerular hypertension and hyperfiltration

47
Q

How can you control renal secondary hyperPTH?

A

dietary phosphate restriction

intestinal phosphate binding drugs

48
Q

how can you control glomerular hypertension and hyperfiltration?

A

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
Q

what are some things that can increase morbidity in chronic kidney disease?

A 
hypokalaemia
acidosis
anaemia
UTI
hydration status
systemic hypertension
50
Q

Why may patients in chronic kidney disease be hypokalaemic?

A

diuresis without supplementation
kaliuresis
decreased feed intake

51
Q

how can chronic kidney disease cause non regenerative anaemia?

A 
EPO deficient
blood loss
reduced RBC lifespan
uraemic inhibitors of erythropoesis
iron deficiency
52
Q

what are patients in chronic kidney disease more likely to get a UTI?

A

urine not hyperosmolar so not as bacteriocidal

53
Q

Why do you want to ensure adequate hydration status with chronic kidney disease?

A

prevents pre-renal azotaemia

54
Q

what is acute renal failure?

A

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
Q

What is acute kidney injury?

A

abrupt decline in kidney function with acute increases in creatining and/or acute decline in urine output. Patient may not be azotaemic

56
Q

does urine output = GFR?

A

NO

so much tubular modification

57
Q

what is oliguria?

A

<0.25 ml/kg/h

58
Q

what is polyuria?

A

> 5ml/kg/h

59
Q

What patients are at risk from developing hospital acquired ARF?

A 
renal disease
dehydrated / hypovolaemic / hypotensive
sepsis/fever/hyperthermia
systemic disease / multi organ failure
prolonged anaesthesia
drug therapy
60
Q

What are the 3 ways to classify azotaemia?

A

pre-renal
renal
post-renal

61
Q

what is pre-renal azotaemia?

A

reduced renal perfusion = reduced GFR = azotaemia
OR
increased production of nitrogenous waste

62
Q

How can the USG help determine is renal or pre-renal azotaemia?

A

Cats - if >1.035 then pre-renal

Dogs - if >1.030 then pre-renal

63
Q

Would urine sodium be high with renal or pre-renal azotaemia?

A

renal (>20 mmol/l)

64
Q

Which type of azotaemia would respond well to fluids?

A

pre-renal

65
Q

What are the 3 groups of causes of renal azotaemia?

A
  • tubular necrosis
  • acute glomerulonephritis
  • interstitial nephritis
66
Q

What 2 things can cause tubular necrosis (leading to renal azotaemia)?

A

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
Q

What 2 things can cause interstitial nephritis (leading to renal azotaemia)?

A
  • pyelonephritis

- leptospirosis (shed in urine, treat with penicillins, can become a carrier)

68
Q

How can you treat acute renal failure?

A

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
Q

what is post-renal azotaemia?

A

reabsorbing urine from ruptured bladder into blood or backing up from obstruction causing reduced GFR

70
Q

What can cause primary PD?

A 
psychogenic PD
high osmolality 
hypotensive
DM
toxins
oral/dental disease
hyperAC
liver disease
71
Q

What are structural causes of primary PU?

A

renal failure
pyelonephritis
neoplasia

72
Q

what are functional causes of primary PU?

A 
DI
DM
hypo/hyper AC
pregnancy
hypertension
pyometra
hypokalaemia
73
Q

How does hyperAC cause PU/PD?

A
  • 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
Q

What is hyper Ac common with in cats?

A

DM

75
Q

How do you diagnose hyperAC?

A
  • ACTH stim test
  • low dose dex to diagnose
  • high dose dex to pit/adrena
  • US adrenal
76
Q

How does liver disease cause pu/pd?

A

less urea made so less conc gradient so get PU

77
Q

How do you diagnose hepatic encephalopathy?

A

bile acid stim test

78
Q

how does central DI cause pu/pd?

A

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
Q

how do you diagnose central DI?

A

water deprivation test

80
Q

What is desmopressin?

A

synthetic ADH

81
Q

How do you diagnose psychogenic PD?

A

water deprivation test

82
Q

What is the most common presentation for psychogenic PD?

A

young big male dogs

83
Q

How does pyelonephritis cause pu/pd?

A
  • endotoxin reduced tubular sensitivity to ADH

- inflammtation damages conc gradient

84
Q

How does hypercalcaemia cause pu/pd?

A
  • 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
Q

What are transient causes of hypercalcaemia?

A

hypoAD
hyperproteinaemia
haemoconcentration
hyperlipidaemia

86
Q

what are pathological causes of hypercalcaemia?

A
  • malignancy - PTHrP
  • hyperPTH
  • hyperVitD
  • renal failure
  • raisin/grape
  • granulomatous disease
  • skeletal lesions
87
Q

How do you diagnose hypercalcaemia?

A

First recheck blood Ca

test ionised Ca

88
Q

What is oliguria?

A

less than normal urine output

89
Q

What is normal urine output?

A

15-45 ml/kg/day

90
Q

What are upper UT signs?

A 
PU/PD
abnormal renal palpation
oliguria / anuria +small bladder
halitosis
oral ulcers
haematuria
91
Q

What are lower UT signs?

A 
dysuria
pollakiuria
oliguria/anuria + distended / ruptured bladder
urinary incontinence
haematuria
abnormal bladder palpation
abnormal external genitalia
92
Q

What should free catch urine not be used for?

A

culture as its contaminated

93
Q

When should cystocentesis not be done?

A

if have a coagulopathy

bladder tumour

94
Q

What does the macula densa do?

A

senses CL- and signals to glomerulus to control GFR

95
Q

where does aldosterone act?

A

distal tubule

96
Q

What are some effects of angiotensin 2?

A

constrict efferent

increase sodium and water absorption

97
Q

what are some effects of aldosterone?

A

increase sodium reabsorption
increased potassium secretion
regenerate bicarb

98
Q

Why are NSAIDS and Cox inhibitors bad for kidneys?

A

Renal PG are naturetic (salt losing) so they can exacerbate salt and water retention

99
Q

Which diuretics are fast acting but short duration?

A

loop diuretics

100
Q

which diuretics lose most of filtered load?

A

Loop - 25%

thiazide - 10%

101
Q

Where do thiazide diuretics work?

A

early DCT

bind to Cl- site on Na/Cl

102
Q

Where do potassium sparing diuretics work?

A

CD and inhibit aldosterone

Year 3 renal (7 decks)

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