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Year 4 equine > Urinary > Flashcards

Urinary Flashcards

1
Q

Normal equine urine output

A

50-60 ml/kg/day

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2
Q

Measures for poor kidney function

A

Leukocytosis
Anaemia due to reduced erythropoietin production in kidneys
Inflammatory markers
Azotemia
Bun: creatinine alterations (<10:1 with ARF, >15:1 with CRF)
Electrolytes
Protein
Albumin
Muscle enzymes
Glucose

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3
Q

Is serum BUN or serum creatinine more sensitive for decrease in GFR

A

Serum creatinine

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4
Q

What happens to USG in prerenal azotemia

A

Increases - hypersthenuric

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5
Q

Do horses with intrinsic renal azotemia develop hyposthenuria

A

No as kidney cannot actively dilute urine

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6
Q

What can the BUN: creatinine be reliably used to differentiate

A

Prerenal from renal azotemia

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7
Q

Hypercalcemia and hypophosphatemia are most commonly seen with which kidney disease

A

Chronic renal failure

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8
Q

What value is hyposthenuria

A

<1.008

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9
Q

What values are isosthenuric

A

1.008-1.014

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10
Q

What values are hypersthenuric

A

> 1.014

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11
Q

What is the normal usg range for a horse

A

1.025-1.045

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12
Q

Why can you get false + protein on reagent strips

A

Equine urine is alkaline and strips are made for acidic urine

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13
Q

What is the most common thing to see n sediment exam

A

Dicalcium phosphate

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14
Q

How should you measure water intake in the horse

A

Turn off automatic waterers, keep on own, measure volumes drank across 3-5 24h periods and take average

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15
Q

What are causes of myoglobinuria

A

Exertional rhabdomyolysis
Post anaesthetic myopathy
Atypical myopathy
Immune mediated myopathies
Nutritional myopathies
Toxic myopathies

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16
Q

What are causes of hemoglobinuria

A

Equine infectious anaemia
Immune mediated
Toxins (red maple leaf, copper, wild onion)

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17
Q

What are causes of haematuria

A

Exercised induced
Urolithiasis
UTI/pyelonephritis
Idiopathic renal haematuria
Idiopathic haemorrhagic cystitis
Urethral rents
Neoplasia

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18
Q

Treatment for haemaglobinuria

A

Treat primary disease
+/- IV fluids

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19
Q

Treatment for UTI/pyelonephritis

A

Antimicrobials

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20
Q

Treatment for idiopathic renal haematuria

A

Supportive care+/- blood transfusion

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21
Q

Treatment for idiopathic hemorrhagic cystitis

A

Nsaids
TMPS

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22
Q

Treatment for urethral rents

A

Benign neglect
If causing anaemia or not resolving then surgery

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23
Q

Treatment for renal neoplasia

A

Unilateral nephrectomy or surgical removal/chemotherapy dependent on location

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24
Q

Overall best diagnostics for urinary disease

A

History and endoscopy

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25
Signalment more prone to urolithiasis
Geldings due to long urethra
26
Diagnosis of cystic calculi of the bladder
Rectal palpation Cystoscopy Rectal ultrasound
27
Treatment of cystic calculi of the bladder
Surgery/lithotripsy Manual removal of those under 10cm in the mare
28
Clinical signs of cystic calculi of the bladder
Dysuria Stranguria Pollakiuria Haematuria
29
Clinical signs of urethral calculi
Acute obstruction Colic. Posturing Anuria Blood at orifice
30
Diagnosis of urethral calculi
Urethroscopy Pass urinary catheter Abdominocentesis for bladder rupture
31
Treatment of urethral calculi
If upper - perineal urethrotomy Lower - transendoscopic or surgical retrieval
32
Clinical signs of nephroliths
Often none Sometimes colic Intermittent or persistent haematuria
33
Diagnosis of nephroliths
Often incidental at PM Plasma biochemistry for CRF if bilateral Pigmenturia
34
Treatment for nephroliths
Surgery +/- lithotripsy
35
What does a red/brown pigmenturia with clear supernatant at the beginning of urination indicate
Haematuria from distal urethra
36
What does a red/brown pigmenturia with clear supernatant throughout urination indicate
Kidney/ureter/bladder haematuria
37
What does a red/brown pigmenturia with clear supernatant at the end of urination indicate
Bladder/proximal urethral haematuria
38
What does brown/red urine, discoloured after centrifuging with pink serum colour indicate?
Haemaglobinuria
39
What does brown/red urine, discoloured after centrifuging with normal serum colour and increased CK indicate?
Myoglobinuria
40
What does orange urine, haem -, bilirubin+ indicate
Liver disease
41
What does orange urine, haem -, bilirubin - indicate
Drugs eg rifampin
42
What is CKD
Chronic, irreversible damage of the kidneys over 3 months in duration
43
What is the pathogenesis for CKD
Acute kidney injury Maladaptive repair Progressive scarring
44
What are the two pathways acute kidney injury can take
Adaptive repair to resolution Or Maladaptive repair to progressive scarring
45
Clinical signs of primary tubulointerstitial disease
Weightloss, pupd, central oedema
46
Pathology associated with primary tubulointerstitial disease
History/clinical signs Increased creatinine and hypercalcemia Urinalysis - usg 1.009-1.014 and cytology of casts, tubular casts, neoplastic cells and leukocytes Dipstick or proteinuria
47
What can transabdominal ultrasound of kidneys show
Nephroliths Kidney size
48
What is best to do when requiring a kidney biopsy
Refer it
49
What does primary glomerular disease show
Glomerular nephritis Immune complex deposition
50
How to manage CKD
Avoid toxic insults Plenty of fresh water Dietary management (low carb, low salt, balanced protein)
51
Definition of polydipsia
Water consumption over 70-100ml/kg/day
52
Affects on normal water intake
Temperature Humidity Level of exercise Lactation
53
Normal urine production
15-30ml/kg/day
54
Define polyuria
>50ml/kg/day
55
Physiological causes of PUPD
Excessive protein consumption Excessive salt consumption Drugs eg glucocorticoids, furosemide, a-2 agonists
56
Pathological causes of PUPD
Apparent psychogenic polydipsia PPID Chronic renal failure Hepatic insufficiency Sepsis/endotoxaemia Renal medullary washout Diabetes mellitus/insipidus
57
How do you diagnose APP
Through exclusion
58
Why does app occur
Boredom when stabled leading to polydipsia
59
Management of APP
Restrict salt intake Restrict water intake
60
Clinical signs of PPID
Pupd in 76% of cases Long curly coat Weight loss/muscle wastage Potbelly Regional adiposity Laminitis Etc
61
Difference between neurogenic and nephrogenic DI
Neurogenic - inadequate ADH secretion Nephrogenic - decreased sensitivity to circulating ADH
62
Difference between type 1 and type 2 DM
Type 1 - insulin dependent - lack of production Type 2 - insulin independent - high insulin but tissues insensitive
63
Causes of iatrogenic pupd
IV fluids Diuretics Corticosteroid therapy Sedation with a2 Excessive dietary salt
64
How does the water deprivation test differentiate app from di
App will concentrate urine DI will not
65
What is the modified water deprivation test
Allow water consumption of 40ml/kg/day in spread out amounts Measure serum urea, creatinine and usg every 6 hours Continue for 2-3 days USG>1.020 = APP
66
Serum ADH change after WDT
Normal is 1-2pg/ml After 24h WD should increase to 4-8pg/ml Failure to increase shows central DI
67
ADH response test
Differentiates central and nephrogenic DI Central concentrates urine after exogenous ADH Nephrogenic has little or no response
68
When is AKI common
In hospitalized horses
69
Definition of ARF
Advanced decline in GFR over days to hours Clinical signs and pathology associated with this
70
Causes of ARF
Haemodynamic Nephrotoxic Uncommon - interstitial nephritis - obstructive nephropathy Rare - acute glomerulopathies
71
Predisposing diseases to ARF
D+ SIRS/mods Myopathies
72
Clinical signs of ARF
Predisposing disease Colic Fever Urine output
73
Clinical pathology of ARF
History, clinical signs and lab findings Increased creatinine USG - 1.008-1.016 Urine dipstick - proteinuria - haeme Serum electrolytes - hyponatremia - hypochloremia - variable potassium
74
What are renal biopsies useful for
Learning aetiology Prognosticator
75
Treatment for ARF
Cease nephrotoxic drugs Manage primary disease IVFT
76
Prognosis for ARF
Haemodynamic - if primary disease in treated and perfusion improves Nephrotoxic - dependent on urine output and improved serum creatinine Oliguric and anuric - poor to guarded, increased if converted to polyuria

Year 4 equine (20 decks)

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