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Y4 SA - Urogenital > Tests for renal function and integrity > Flashcards

Tests for renal function and integrity Flashcards

1
Q

Which substances do the kidneys work to conserve?

A
  • Water
  • Amino acids/proteins
  • Glucose
  • Bicarbonate
  • Sodium
  • Chloride
  • Calcium
  • Magnesium
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2
Q

Which substances do the kidneys work to excrete?

A

Urea
Creatinine
Potassium
H+ ions
Phosphate
Ketones and lactate

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3
Q

What are the functions of the kidney?

A

Excretion of waste
Control of body fluid balance (volume and composition)
- Electrolytes
- Acid-base
- Blood pressure
Production of hormones

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4
Q

Which hormones are produced by the kidney?

A

Erythropoietin
Calcitriol (active Vit D)
Renin (part of the RAAS)

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5
Q

Name the functional unit of the kidney

A

Nephron

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6
Q

Which structures make up the nephron

A

Glomerulus
PCT
LOH
DCT
CD

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7
Q

Describe the process of glomerular filtration

A
  • Water and solutes move across glomerular capillaries and into the nephron
  • Glomerular filtration in health dependent upon renal plasma flow
  • All blood components except: cells, proteins larger than albumin, most lipoproteins
  • Restricted by size, and to a lesser extent charge
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8
Q

Which blood tests can be used to assess renal function?

A

Biochemistry
- Nitrogenous wastes (urea, creatinine)
- Electrolyte balance (Na, K, Cl, Ca, PO4)
Haematology
Blood gas analysis

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9
Q

Which urine tests can be used to assess renal function?

A

Always: USG, dipstick, sediment
Maybe: UPC ratio (if proteinuria)
Rarely: fractional excretions of electrolytes

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10
Q

In practice GFR is indirectly estimated using?

A

Urea or creatinine

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11
Q

Describe the main features of urea

A

Made in liver from ammonia
Can be reabsorbed
Urea is a good marker for severity of clinical signs

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12
Q

Describe the main features of creatinine

A
  • Produced in muscle in a constant process
  • Filtered by glomerulus, not reabsorbed (this is what makes it a better marker)
  • Concentration depends also on muscle mass
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13
Q

How are the levels of urea and creatinine altered when there is a decreased GFR?

A

Both of these increase if there is a decreased GFR as they are not being filtered out fast enough

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14
Q

What is the main cause of an increase in urea?

A

Decreased GFR

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15
Q

List some possible causes of mild urea increases

A

Upper GI haemorrhage
High protein meal
Recent meal
Catabolism (e.g. fever, corticosteroids)

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16
Q

List the causes of a decreased urea

A
  • Severe liver disease or portosystemic shunt
  • Low protein diet
  • Aggressive fluid therapy
  • PU/PD
  • Young animals
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17
Q

What are the 3 possible causes of increased creatinine?

A

Decreased GFR
High muscle mass (mild increase)
High dietary protein

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18
Q

Decreases creatinine is due to?

A

Reduced muscle mass

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19
Q

Define azotaemia

A

An abnormal concentration of urea, creatinine and other nitrogenous compounds in the blood

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20
Q

What is the cause of pre-renal azotaemia?

A

Due to dehydration or decreased cardiac output: clinical evidence of dehydration and or hypovolaemia – signs of heart failure, shock, etc

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21
Q

How is the USG affected by pre-renal azotaemia?

A

Maximally concentrated urine specific gravity
>1.030 in dogs
>1.035 in cats

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22
Q

How is pre-renal azotaemia treated?

A

Fluid therpay

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23
Q

What is the cause of renal azotaemia?

A

Kidney problem

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24
Q

How is the USG affected by renal azotaemia?

A
  • Isosthenuria (1.008-1.012) when >66% of nephrons lost = same concentration as plasma
  • USG inadequately concentrated (so > 1.012 but <1.030 in dogs and <1.035 in cats)
  • USG falls progressively
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25
What is the cause of post-renal azotaemia?
Failure of urine output Easy to diagnose Expect hyperkalaemia too
26
Name two other markers of GFR
SDMA = symmetrical dimethyl arginine Iohexol clearance
27
Describe SDMA as a GFR marker
May be useful for earlier detection of CKD - Increases with 40% reduction of GFR (75% needed for creatinine) Value only when creatinine is normal or borderline Results may be slightly higher in puppies, kittens, and greyhounds
28
How do the levels of phosphorus change when there is kidney disease?
Hyperphosphataemia - Reflection of decreased GFR in species with high dietary phosphorus content
29
Which spp is the exception to hyperphosphataemia in kidney disease?
Equine - tend to be HYPOphosphataemic with decreased GFR - low dietary phosphorus along with GI losses and increased renal loss
30
How do the levels of calcium change when there is kidney disease?
↑ or↓ total calcium - check iCa if available - Often increased total calcium - with normal to low ionized calcium
31
How do the levels of potassium change when there is kidney disease?
Increased: - Fluid compartment shift in acidosis - Decreased urinary output (bladder rupture, obstruction) Decreased: - Increased urinary losses (esp. in CKD) - Decreased food intake or GI losses
32
Does azotaemia mean there is an abnormal renal function?
Not always as this can be caused by other things
33
Define uraemia
- Not the same as azotaemia or increased urea. - Literally “urine in the blood” - Uraemia is the clinical syndrome that results from loss of kidney function, involving multiple metabolic derangements
34
What are the clinical signs of uraemia?
Vomiting, anorexia, weight loss, diarrhoea, anaemia, ulcerative stomatitis, muscle tremors, convulsions, coma
35
What is USG a measure of?
Solutes in urine
36
Where along the nephron is the USG of urine the same as plasma?
Glomerulus PCT
37
How would you interpret a USG over 1.030 (dogs) and 1.035 (cats)?
Adequately concentrated - Indicates functioning tubules (>2/3) *but cats can trick you - Supports dehydration if present
38
How would you interpret a USG of 1.012 - 1.029 (dogs) and 1.034 (cats)?
Grey area - May be normal if patient is hydrated - Is definitely abnormal in dehydration - Rule out extra-renal causes before blaming the kidney!!! - Examples: Hypercalcaemia, Addison’s disease, Drugs
39
How would you interpret a USG of 1.008 - 1.012?
Same Specific Gravity as Plasma May be normal if drinks a lot of water Is definitely abnormal if dehydrated Rule out extra-renal causes before blaming the kidney
40
How would you interpret a USG of 1.000 to 1.008?
Lower Specific Gravity than Plasma Requires functioning nephrons = clinically useful - Cushings - Diabetes - Hypercalcaemia
41
Is protein in urine normal?
Very small amount yes, more than 1+, no
42
Describe dipstick analysis for proteinuria
Must be interpreted in light of specific gravity: more significant if low USG
43
Which test should be used after finding high levels of protein on a dipstick test?
Urine protein to creatinine ratio test - more accurately quantifies proteinuria
44
How must a proteinuria be classified?
By: - location - persistence - magnitude
45
Describe locating the proteinuria
Rule out pre- and post-renal causes of proteinuria by examining the haematology and serum biochemistry as well as performing cystocentesis.
46
How can you assess the persistence of a proteinuria?
The presence of proteinuria should (ideally) be confirmed by taking three samples, two weeks apart
47
How can you assess the magnitude of a proteinuria?
The magnitude of the proteinuria should be confirmed using the UP:C >2.0 – Suggestive of glomerulopathy
48
List some possible causes of a pre-renal proteinuria
Fever Systemic inflammation Haemoglobinaemia Hypoglobinaemia
49
List some possible causes of a post-renal proteinuria
UTI Nephrolithiasis Tumours of the urinary tract
50
What are the proteinuria treatment threshold levels in dogs and cats?
Dogs >0.5 Cats >0.4
51
Describe the main features of a glucosuria
- Not normally present in urine - Glucosuria seen with serum glucose above: 10 mmol/l in dogs and 13-16 mmol/l in cats - If serum glucose normal, it could be due to failure of resorption by tubules: Renal glucosuria (e.g. Fanconi’s syndrome)
52
WBCs and bacteria seen on a sediment analysis indicate?
A urinary tract infection
53
What are casts?
- Cylindrical moulds of tubules composed of mucoproteins +/- cells - Occasional hyaline and granular casts may be normal
54
Granular, cellular and waxy casts indicate?
Tubular damage = clinically useful! - Indicate something is going on in the kidney – acute kidney injury
55
When can you look for crystals in urine?
Look in fresh urine - don’t look for crystals in a sample an owner brings in Lots of normal animals have crystalluria - not synonymous with urolithiasis!
56
What are struvite crystals
Coffin shape Magnesium ammonium phosphate Triple phosphate
57
Describe the significance of struvite crystals
Significance: - UTI - Urolithiasis - Or normal Form in ALKALINE urine Also in vitro
58
Describe the main features of amorphous crystals
Urate - Acidic pH - No clinical significance Phosphate - Alkaline pH - No clinical significance
59
Which crystals have a 'maltese cross' appearance?
Calcium oxalate dihydrate - can form in a standing urine sample
60
Which crystals have a 'picket fence' appearance
Calcium oxalate monohydrate
61
Are Calcium oxalate monohydrate crystals a significant finding?
Yes! Ethylene glycol (EG) toxicosis Absence does not rule it out
62
Describe the significance of ammonium biurate or uric acid crystals
Portosystemic shunts Liver disease Dalmatians
63
Cystine crystals are associated with?
Metabolic defect in the tubular reabsorption of cystine - Bulldogs, other breeds
64
List some possible urine contaminants
Pollen Mucus Fat droplets Sperm Conidia and amorphous debris from free catch Starch from gloves
65
What is the normal range of urine pH?
6-8
66
How can you confirm a bladder rupture from fluid obtained from the abdomen following trauma?
Measure creatinine content

Y4 SA - Urogenital (12 decks)

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