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Clinical Pathology > UNIT 2 - Lecture 2: Urinary - Lab Evaluation > Flashcards

UNIT 2 - Lecture 2: Urinary - Lab Evaluation Flashcards

1
Q

What is azotemia?

A

Increase in BUN and/or creatinine

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2
Q

What is uremia?

A

Clinical syndrome with azotemic renal failure

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3
Q

What are the clinical signs of uremia?

A

PU/PD, V+, weight loss, depression

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4
Q

What is polyuria?

A

excessive urine production

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5
Q

What is polydipsia?

A

excessive thirst

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6
Q

What is oliguria?

A

little urine production

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7
Q

What is anuria?

A

no urine production

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8
Q

What are the 2 types of kidney injury/disease?

A

Acute kidney injury

Chronic kidney disease

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9
Q

What characteristics do ideal solutes for measuring GFR have? What are some examples?

A
  1. Freely filtered
  2. Not secreted
  3. Not resorbed

EX: inulin, iohexol, mannitol

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10
Q

What is routinely used to clinically assess GFR?

A

creatinine

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11
Q

Where is creatinine produced?

A

From normal muscle metabolism

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12
Q

What is the method of creatinine production?

A

Phosphocreatine –> creatine (+P) –> creatinine

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13
Q

Production and excretion of creatinine is fairly _____ with _____ individual variation.

A

constant, low

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14
Q

_____ is the most efficient, widely available indirect marker of GFR.

A

creatinine

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15
Q

___% of nephrons must be non-functional for renal azotemia to develop (elevated creatinine).

A

70-75%

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16
Q

T/F: Creatinine values are specific for renal disease

A

False; can increase with any cause of decreased GFR

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17
Q

What is the main nitrogenous waste in mammals?

A

BUN (urea)

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18
Q

Where is BUN synthesized and how?

A

By hepatocytes from ammonia generated by catabolism of AAs.

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19
Q

_____ flow rate will lead to _____ absorption of BUN.

A

Reduced, increased

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20
Q

What non-renal factors affect BUN in ruminants and horses?

A

Additional routes of excretion, dietary supplementation

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21
Q

What non-renal factors affect BUN in carnivores?

A

Mild post-prandial increase, high protein diet

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22
Q

What is the main non-renal factor that can affect serum levels of BUN?

A

GI hemorrhage

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23
Q

What is SDMA designed for?

A

Earlier detection of kidney disease in small animals

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24
Q

SDMA is reported to ID CKD _____ earlier in dogs and _____ earlier in cats.

A

9 months, 17 months

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25
Q

When do SDMA levels become elevated?

A

At 40% loss of renal function

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26
Q

SDMA is not affected by _____.

A

muscle mass

27
Q

What is pre-renal azotemia due to?

A

Decreased GFR from decreased kidney perfusion

28
Q

What is renal azotemia due to?

A

Decreased GFR from renal dysfunction

29
Q

What is post-renal azotemia due to?

A

Obstruction or rupture of the urinary tract

30
Q

What is the most common cause for pre-renal azotemia?

A

dehydration

31
Q

What is the most common site of obstruction/rupture that causes post-renal azotemia?

A

urethra

32
Q

What are some examples of obstruction of the urinary tract?

A

Ureterolithiasis, urolithiasis, feline urethral plug, neoplasia, prostatic disease

33
Q

Post-renal azotemia is often associated with marked _____kalemia and _____magnesemia.

A

hyperkalemia, hypermagnesemia

34
Q

How can you confirm uroperitoneum?

A

Compare creatinine [] of peritoneal fluid with creatinine [] of serum/plasma;

Perit fluid [] = 2x or more greater than plasma/serum []

35
Q

What is the minimum USG for azotemia in dogs?

A

>1.030

36
Q

What is the minimum USG for pre-renal azotemia in cats?

A

>1.035-1.040

37
Q

What is the minimum USG for pre-renal azotemia in horses?

A

>1.025

38
Q

What is the minimum USG for pre-renal azotemia in ruminants?

A

>1.025

39
Q

If USG is < expected values in the face of azotemia, what does that indicate?

A

Evidence of impaired renal concentrating ability

40
Q

What is the USG with renal azotemia?

A

isosthenuric (1.007-1.013)

41
Q

What are 3 causes for AKI?

A
  1. Decreased kidney perfusion from pre-renal causes
  2. Intrinsic renal disease (tubular necrosis, inflammation)
  3. Post-renal causes
42
Q

T/F: Magnitude of azotemia does not determine AKI vs. CKD.

A

True

43
Q

What urine volumes are common with AKI?

A

Oliguria or anuria

44
Q

What is the prevalence of CKD in dogs and cats?

A

Dogs = 0.5-1%

Cats = 1-3% (80% geriatric)

45
Q

In CKD, loss of urine concentrating ability occurs at ___ loss of functional renal mass.

A

~2/3

46
Q

In CKD, _____ may precede _____, which develops at ~3/4 loss of functional renal mass.

A

PU/PD, azotemia

47
Q

What are 2 reasons for the loss of urine concentrating ability in CKD?

A
  1. More solute than usual presenting to remaining nephrons –> high solute content –> solute diuresis
  2. Medullary hypertonicity is not maintained
48
Q

What are some risk factors for CKD?

A
  1. Breed
  2. Age
  3. Diet?
  4. Prior AKI
  5. Comorbidities
  6. Drugs
49
Q

What are 3 requirements for a concentrated urine?

A
  1. ADH must be present
  2. Distal nephron epithelial cells responsive to ADH
  3. Concentration gradient
50
Q

What are 4 extra-renal causes of impaired concentrating ability with pre-renal azotemia?

A
  1. ADH deficiency (central DI)
  2. Distal nephron epi cells not responsive to ADH (nephrogenic DI)
  3. Solute overload
  4. Decreased medullary hypertonicity
51
Q

In small animals with kidney disease, phosphorus is _____ due to _____.

A

increased, decreased GFR

52
Q

In ruminants with kidney disease, _____phosphatemia may occur, but there are other routes of P excretion such as the _____ and the _____.

A

hyper, saliva, rumen

53
Q

In horses with kidney disease, _____ P is common.

A

decreased

54
Q

In cattle, _____calcemia is common in renal disease.

A

hypo

55
Q

In horses, _____calcemia is common in renal disease and occurs with _____ GFR since kidney is primary route of excretion of Ca in horses.

A

hyper, decreased

56
Q

When should you calculate Ca x P and how is the product interpreted?

A

Calculate if hyperCa and/or hyperP are present;

If product > 70, patient is at risk for soft tissue mineralization

57
Q

Decreased GFR will result in _____magnesemia because Mg is primarily excreted by the kidneys.

A

hyper

58
Q

Increased amylase and lipase can mean that the GFR is _____.

A

decreased

59
Q

In dogs, cats, and horses, acute decrease in kidney function can result in _____K and _____ due to decreased excretion of K+ and H+.

A

hyper, acidemia

60
Q

Cattle tend to have _____K due to _____, _____ intake, or _____ salivary excretion.

A

hypo, alkalosis, decreased, increased

61
Q

Lactic acid is associated with _____.

A

dehydration

62
Q

What are uremic acids associated with?

A

azotemia/uremia

63
Q

When are phosophatic acids present?

A

If hyperP is present

Clinical Pathology (22 decks)

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