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Urinary Pathophysiology > Urinalysis part 2 > Flashcards

Urinalysis part 2 Flashcards

1
Q

what does hemoglobin bound to haptoglobulin cause?

A

hemolyzed plasma

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2
Q

where does excess unbound hemoglobin go?

A

urine
+/- hemoglobin casts
+/- damage to proximal tubular cells

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3
Q

what happens with acute syndrome of copper toxicity in sheep?

A

bolus of excessive amounts: feed/pastures
severe gastroenteritis and then hemolysis

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4
Q

what happens in chronic syndrome of copper toxicity in sheep?

A

days to weeks: low molybdenum/sulfur intake and/or hepatotoxic plants
precipitating stressors lead to disease

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5
Q

what do horses and camelids need to ingest to get red maple toxicosis?

A

wilted leaves of Acer rubrum

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6
Q

what does copper and red maple leaves cause to red blood cells?

A

oxidative injury
methemogloninemia
intravascular hemolysis due to oxidation
Heinz bodies due to denaturation of oxidized hemoglobin: extravascular hemolysis

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7
Q

what is a common cause of hemolysis in dogs?

A

zinc toxicity

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8
Q

what does zinc cause in dogs?

A

oxidation through inhibition of protective enzymes
possible multi-organ damage

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9
Q

what are some causes of intravascular hemolysis other than heavy metals and red maple?

A

infectious disease
immune mediated
red blood cell metabolic defects
envenomation

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10
Q

what is rhabdomyolysis?

A

muscle necrosis

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11
Q

what can be seen with rhabdomyolysis?

A

muscle enzymes elevated in serum: creatine kinase and AST

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12
Q

is anemia and hemolytic serum present with rhabdomyolysis?

A

not usually

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13
Q

in whom is pigment nephropathy common in?

A

large animals

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14
Q

what causes pigment nephropathy?

A

hemoglobin and myoglobin being broken down
nephrotoxic heme protein

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15
Q

what are the mechanisms of pigment nephropathy?

A

tubular obstruction by casts
tubular cells ingest hemoglobin
increased synthesis of vasoconstrictive molecules

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16
Q

_____________ can be toxic to renal tubules- cause of AKI
especially in humans and large animals

A

myoglobin

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17
Q

your patient has a positive heme (blood) reaction and red blood cells in the sediment. what is the best interpretation for these findings?

A

hemorrhage in the urinary tract
artifact if did cystocentesis (hit capillary)

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18
Q

your patient has a positive heme (blood) reaction, but there are no red blood cells in the sediment. what is the best interpretation for these findings?

A

skeletal muscle necrosis and myoglobinuria
intravascular hemolysis (red blood cells breaking down within blood vessels) and hemoglobinuria

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19
Q

where does bilirubin originate from?

A

destruction of old worn-out red blood cells by macrophages in the spleen

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20
Q

only _____________ bilirubin can cross the glomerular wall

A

conjugated

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21
Q

why can unconjugated bilirubin not cross the glomerular wall?

A

bound to albumin: too large
albumin already too large to cross

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22
Q

is bilirubin normal to have in the urine of most species?

A

no

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23
Q

in what species is some bilirubin normal in the urine? what amount?

A

dogs and ferrets with highly concentrated urine
trace to 1+

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24
Q

renal epithelium in ____________ can conjugate bilirubin

A

male dogs

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25
Q

what are some causes of bilirubinuria?

A

hemolysis
hepatic disease
bile duct obstruction

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26
Q

what does extravascular hemolysis (increased rate) lead to?

A

anemia
bilirubinuria
jaundice
icteric serum

27
Q

what is the rate-limiting step of elimination of bilirubin?

A

gall bladder excreting conjugated bilirubin

28
Q

what does increased intravascular hemolysis lead to?

A

anemia
bilirubinuria
jaundice
increased bilirubin
hemoglobinuria
hemolyzed serum

29
Q

what does hepatic disease lead to?

A

bilirubinuria
jaundice
icteric serum
increased liver enzymes

30
Q

what does biliary obstruction lead to?

A

bilirubinuria
jaundice
icteric serum
increased liver enzymes

31
Q

what in hepatic disease actually leads to accumulation of bilirubin?

A

excretion: conjugated (by liver) bilirubin accumulates

32
Q

most glucose is absorbed in _______________

A

proximal tubules

33
Q

when will you see glucosuria?

A

serum glucose exceeds renal threshold

34
Q

what is the renal threshold for serum glucose for most species?

A

180 mg/dl

35
Q

what are some things that can cause hyperglycemia that leads to glucosuria?

A

diabetes mellitus
hyperadrenocorticism
epinephrine secretion

36
Q

what are some things that can cause the proximal tubule to be unable to handle the normal load of glucose?

A

acute renal failure
congenital proximal tubular disorders

37
Q

what breeds are predisposed to hereditary renal glucosuria?

A

norwegian elkhounds
scottish terriers

38
Q

what does hereditary renal glucosuria cause?

A

defective proximal tubular transport of glucose

39
Q

what is fanconi syndrome caused by?

A

defect in multiple proximal tubule transporters

40
Q

is GFR normal in fanconi syndrome?

A

yes: not usually azotemic

41
Q

in fanconi syndrome, animals have high excretion of:

A

glucose
amino acids
bicarbonate
electrolytes (Na, Cl, K, Phos)

42
Q

who is hereditary fanconi syndrome common in?

A

basenjis

43
Q

what is the urine like with fanconi syndrome?

A

glucosuria with normoglyemia, +/- proteinuria, ketonuria
isosthenuric to minimally concentrated

44
Q

what can cause acquired fanconi syndrome?

A

chicken jerky treats
heavy metals
copper storage
chemicals

45
Q

what leads to cystinuria?

A

sex-linked or autosomal recessive defect in cysteine transport

46
Q

what causes hyperuricosuria?

A

missing transporter for uric acid uptake: liver, kidney

47
Q

what does hyperuricosuria lead to?

A

urate crystals in urine

48
Q

what is ketonuria caused by?

A

negative energy balance

49
Q

what are some conditions that can lead to negative energy balance?

A

bovine ketosis and hypoglycemia
pregnancy toxemia
diabetes mellitus
starvation

50
Q

what do the urine tests for ketonuria detect?

A

acetoacetic acid
also some for beta-hydroxybutyric acid

51
Q

what does the proximal tubule of the kidney do for acid/base regulation?

A

NaBicarbonate absorbed in proximal tubule:
carbonic anhydrase needed

52
Q

what do alpha intercalated cells in the collecting duct and distal convoluted tubule do to the blood and urine (overall)?

A

alkalinize blood
acidify urine

53
Q

what are some causes of aciduria?

A

diet: normal in carnivores
acidosis
hypokalemia (associated with alkalosis)

54
Q

hypochloremic metabolic alkalosis can be associated with ________________________

A

paradoxic aciduria

55
Q

hypochloremic metabolic alkalosis starts with loss/sequesteration of gastric fluid, which leads to:

A

dehydration
alkalosis
hypochloremia
hyponatremia
hypokalemia

56
Q

what are some causes of alkalinuria?

A

diet: normal in herbivores
urease producing bacteria
post-prandial
alkalosis
storage at room temperature

57
Q

what are the clinically important urease-producing pathogens?

A

Staphylococcus
Klebsiella
Pseudomonas
Proteus

58
Q

how do the kidney proximal tubules respond to dehydration?

A

increases absorption of Na and water
Na co-transported with HCO3-
worsens alkalemia, acidifies urine

59
Q

what makes up distal renal tubular acidosis- type I?

A

selective impairment of H+ secretion in collecting ducts

60
Q

why is it a problem that tubular cells ingest hemoglobin?

A

free heme creates oxygen radicals
membrane, mitochondria, DNA damage
methemoglobin more toxic than hemoglobin

61
Q

when can glucosuria occur secondary to renal disease?

A

acute renal failure
congenital proximal tubular disorders

62
Q

what is normal carnivore urine pH?

A

5.5-7.5

63
Q

what is normal herbivore urine pH?

A

7.0-8.5

Urinary Pathophysiology (11 decks)

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