Urinalysis & Renal

Question 1

ADH

Answer 1

Hypthalamus –> posterior pituitary –> AHD release –> DCT and collecting duct –> increased urine concentration

release triggered by-
increased plasma sodium
hypovolemia
hypotension

Question 2

Diabetes Insipidus

Answer 2

low ADH
Too much water released
polyuria and polydipsia

Question 3

Addisons

Answer 3

high potassium –> aldosterone release

low aldosterone

Question 4

Diabetes Mellitus

Answer 4

increased blood glucose
glucose in urine
increased volume
increased USG and osmolality

signs - weight loss, polyphagia, lehtargy, cataracts

mix up with stress hyperglycemia in cats

Question 5

stranguria

Answer 5

straining to pass urine

lower urinary or genital tract
obstructive or non-obstructive
bladder inflammation
bladder atony
urinary tract obstruction
caliculi or mineralised masses

Question 6

hematuria

Answer 6

blood in urine

macro or micros
iatrogenic
pathological
genital source
coagulopathies - look for hemorrhage at other sites
pigmenturia - hemoglobinuria or myoglobinuria
gross - >150 RBCs/hpf
occult - >5 RBCs/hpf

Question 7

dysuria

Answer 7

difficult/painful urination

Question 8

pollakiruria

Answer 8

frequent urination insmall amounts

Question 9

periuria

Answer 9

urination at inappropriate sites

Question 10

anuria

Answer 10

failure of urine production at kidneys

Question 11

oliguria

Answer 11

reduction of urine production by kidneys

Question 12

polyuria

Answer 12

increased urine production

Question 13

polydipsia

Answer 13

increased thirst

2x normal maintenance drinking - around 100ml/kg/day

Question 14

Free catch

Answer 14

ideally mid flow

pros - easy, owner can do, non-invasive, non-traumatic, modified cat litter
cons - manual expression can rupture bladder, contamination

Question 15

Cystocentesis

Answer 15

pros - don’t have to wait or force, easy in cats, aseptic - culture, better tolerated than catheter, easy, low risk of iatrogenic hematuria and infection
cons - some experience needed, needs enough urine in bladder, may cause rupture if severe disease or clotting problems, risk of hitting other organs - sample contamination

Question 16

Catheterisation

Answer 16

pros - low contamination risk, don’t have to wait
cons - needs experience, easier in males, infection, hematurria, mucosal damage, contamination from lower urinary tract

Question 17

USG

Answer 17

Normal ranges
dogs - 1.015-1.045
cats 1.035-1.060

hypostheniuria - <1.008 - actively diluting
isosthenuria - 1.008-1.012 - neither diluting or concentrating
hypersthenuria - >1.012 - actively concentrating
dehydration - >1.030

Question 18

pH

Answer 18

high - UTI - urease producing bacteria
low - UTI - acid-producing bacteria

Question 19

dipstick - bilirubin

Answer 19

RBC breakdown

Question 20

dipstick - haem/blood

Answer 20

presence of hemoglobin - or alkaline urine can lyse RBCs (false positive)

Question 21

dipstick - glucose

Answer 21

diabetes mellitus or stress induced hyperglycemia

Question 22

dipstick - ketones

Answer 22

diabetes mellitus

Question 23

dipstick - protein

Answer 23

kidney damage

Question 24

Crystals

Answer 24

struvite - most common
cystine - hexagonal
calcium oxalate dihydrate - envelope
calcium oxalate monohydrate - picket fence
bilirubin - orange-brown spikes
ammonium biurate - round
amorphous - random shape - urates in acidic urine, phosphates in alkaline

Question 25

Nephrolith

Answer 25

kidney calculus

often asymptomatic, pain, pyuria, pyrexia, PUPD

Question 26

Ureterolith

Answer 26

ureter calculus

renomegaly, renal failure, PUPD

Question 27

Cystolith

Answer 27

bladder calculus

lower urinary tract signs, sometimes palpable, PUPD

Question 28

Urethroliths

Answer 28

urethra calculus

lower urinary tract signs, abdominal discomfort, licking at penis/vagina

most likely to be emergency

Question 29

Urolithiasis - imaging

Answer 29

radiograph -
radiopaque - struvite, calcium oxalate, calcium phosphate
radiolucent - ammonium urate, cystine

Ultrasound - hard to spot

Question 30

PUPD - signs (6)

Answer 30

needing to go out more frequently
having accidents
long stream of urine
filling bowl more frequently
at bowl more often
puddle drinking

Question 31

primary polyuria with secondary polydipsia

Answer 31

more common

primary central diabetes insipidus - hypothalamus dysfunction, lack of ADH
primary nephrogenic diabetes insipidus - inability of DCT to respond to ADH - due to mutation
secondry nephrogenic diabetes insipidus - inability of DCT to respond to ADH - reduced sensitivity - ecoli toxins or Addisons
osmotic diuresis - diabetes mellitus, CKD, liver disease, medications
reduced medullary concentration gradient - fluid therapy, corticosteroids, addisons, liver failure

Question 32

Primary polydipsia with secondary polyuria

Answer 32

cerebrocortical disorders - lesion affecting thirst centre
psychogenic
endocrine disorders

Question 33

CKD

Answer 33

signs - hallitosis, decreased BCS, inappetance, oral ulcers

lost nephrons –> reduced water reabsorption

diagnosis - renal azotemia, non-regen anemia, hypokalemia, hyperphosphatemia, USG low, proteinuria

Question 34

pyelonephritis

Answer 34

inflammation of renal pelvis

loss of nephrons –> eventual CKD

signs - lower UT signs, hematuria, pollakiuria, stranguria, spine pain, renomegaly, pyrexia, lethargy

diagnostics - US, left shift in inflammatory leukogram, urine culture and sensitivity

Question 35

Pyometra

Answer 35

infection in progesterone primed uterus - usually ecoli

open and closed type - purulent discharge or lethargy, pyrexia, inappetence, vomiting, diarrhoea

diagnostics - left shift leukogram, azotemia, ultrasound

Question 36

hyperthyroidism

Answer 36

over production of thyroid hormones

signs - poor condition, weigh loss, v++, d++, hyperactivity and weirdness, tachycardia, heart murmur, gallop rhythm, thyroid goitre

diagnostic - ALT and T4 increase

Question 37

hyperadrenocortisim (cushings)

Answer 37

signs - polyphagia, pot belly, tinning skin, coat changes

diagnostics - high ALP, low USG, ACTH stimulation, low dose dexmethadone suppresion test, urine cortisol:creatinine ratio (rule out not confirm)

Question 38

hypoadrenocorticism (addisons)

Answer 38

loss of adrenal cortical cells

signs - vague, GI signs, collapse, shock

diagnostics - Na:K under 23, ACTH stim

Question 39

hypercalcemia

Answer 39

range of conditions but usually result of neoplasia

increase total calcium in blood

Question 40

hepatic disease

Answer 40

increased liver enzymes (ALP, ALT, GGT), decreased urea, cholesterol albumin and glucose, bile acid stim test, imaging

Question 41

Azotemia

Answer 41

accumulation of non-protein nitrogenous compounds in blood - urea and cretinine

Question 42

uremia

Answer 42

azotemia that is causing clinical signs of renal failure

Question 43

renal disease - pre-renal

Answer 43

reduced renal blood flow
expected USG >1.030
increased urine volume
resolves with fluid therapy
dehydration, hypovolemia, hypotension, shock

Question 44

renal disease - renal

Answer 44

reduced GFR
expected USG - 1.007-1.013
azotemia sustains after fluid therapy
dehydration

Question 45

renal disease - post renal

Answer 45

defective excretion distal to nephron
obstruction or rupture of urinary tract
dysuria
usually reversible unless renal component with nephron damage

Question 46

Causes of renal disease (3)

Answer 46

glomerular (excretory) dysfunction - BUN, creatinine
metabolism failure - insulin, glucagon, GH
failure to synthesise - erythropoieitin, calcitrol

Question 47

acid-base homeostasis

Answer 47

kidneys reabsorb bicarb in PCT
excrete metabolic acid load at DCT

dysfunction –> lost bicarb in urine –> reduced acid secretion –> metabolic acidosis