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Small Animal Studies > Urinary > Flashcards

Urinary Flashcards

1
Q

Define polydipsia

A

Drinking over 100ml/kg/24hours

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2
Q

What is the different between uraemia and azotaemia

A

Uraemia: Clinical syndrome from loss of kidney function, involving multiple metabolic derangements
Azotaemia: Abnormal concentration of urea, creatinine and other nitrogenous compounds in the blood

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3
Q

Name 3 ways increased phosphate affects calcium?

Renal secondary hyperparathyroidism

A
  1. Increases the production of PTH (mobilises calcium from bone and increases reabsorption in the gut)
  2. Binds to calcium, decreasing the ionized concentration
  3. Decreases calcitriol (inhibitor of PTH release)
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4
Q

What 3 hormones does the kidney produce?

A
  1. Renin
  2. Erythropoietin
  3. 1,25-dihydroxyvitamin D
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5
Q

What type of anaemia would you expect in CKD?

A

Normocytic normochromic non-regenerative

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6
Q

How much loss (%) of functioning nephrons is implied by azotaemia?

A

At least 75%

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7
Q

Define:

  1. Pollakiuria
  2. Stranguria
  3. Dysuria
  4. Incontinence
A
  1. Increased frequency of urination
  2. Straining to urinate
  3. Difficulty urinating
  4. Inappropriate dribbling of urine during the storage phase
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8
Q 
What UPC (urine protein: creatinine ratio) indicates proteinuric?
What indicates glomerulonephropathy?
A

> 0.5 (dogs)
0.4 (cats)
3 (glomerulonephropathy)

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9
Q

Name two diseases that may cause glucose in the urine

A
  1. Diabetes mellitus

2. Fanconi syndrome

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10
Q

In which disease may you see ketones in the urine?

A

Diabetes mellitus

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11
Q

In which species is bilirubiuria ALWAYS abnormal?

What 3 things can it indicate?

A

Cat

Anorexia, hepatic disease, haemolysis

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12
Q

How can you tell the difference between haematuria and haemoglobinuria?

A

Haematuria: RBCs will sediment out on centrifugation

Will remain pink in haemoglobinuria

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13
Q

What are normal SGs for cats and dogs?

A

Cats > 1.035

Dogs > 1.030

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14
Q

Which type of urine cast is ALWAYS pathological?
What does it indicate?
Which type of urine cast is most common in cats, and not significant?

A

Waxy
Chronic tubular injury
Lipid

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15
Q

What are the 4 phases in the pathophysiology of AKI?

A
  1. Initiation
  2. Extension
  3. Maintenance
  4. Recovery
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16
Q

Which 2 stages of the pathophysiology of AKI may be clinically silent?
Which stage would you often see azotaemia and uraemia?

A

Initiation + extension

Maintenance

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17
Q

What type of urine and SG would you expect in renal disease?

A

Isosthenuric

1.008-1.012

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18
Q

What clinical sign would you expect in ethylene glycol toxicity, and what would you see on urine examination?

A

CNS signs

Calcium oxalate monohydrate crystals

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19
Q

What would you expect potassium levels to be in CKD vs AKI?

A

CKD: low/normal
AKI: hyperkalaemia

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20
Q

What are two antidotes to ethylene glycol poisoning?

When do they need to be given?

A

4-methylpyrazole (fomepizole)
3 hours in cats
Ethanol
Within 8 hours

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21
Q

What is oliguria?

How should you adjust IVFT if it occurs?

A

Urine output of <2ml/kg/hour

Reduce IVFT, place urinary catheter, start diuretics

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22
Q

What does hyperkalaemia cause? Is it in CKD or AKI?

What are 4 ways to correct it?

A

Bradycardia, AKI

  1. Fluid therapy
  2. Calcium gluconate (doesn’t low potassium but antagonises cardiac effects)
  3. Dextrose (stimulates insulin secretion)
  4. Sodium bicarbonate
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23
Q

What anti-hypertensive should be AVOIDED in AKI?

A

ACEi

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24
Q

Name an anti-emetic

A

Maropitant

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25
Q

What is a UTI?

What species and sex are they most common in?

A

Adherence, multiplication and persistence of an infectious agent within the urinary system
Female dogs

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26
Q

What is sporadic bacterial cystitis?

What is subclinical bacteriuria?

A

Bacterial infection + clinical signs

Bacterial infection with NO clinical signs

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27
Q

What number of WBCs per hpf indicates a UTI?

A

> 5

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28
Q

What are your first line antimicrobial treatments for sporadic bacterial cystitis?

A

Amoxicillin, cephalexin, trimethoprim

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29
Q

What is the definition of CKD?

A

Structural or functional abnormalities of one or both kidneys that have been there for 3 months or longer

30
Q

Which is reversible, AKI or CKD?

A

CKD is an irreversible, slowly progressive disease

31
Q

Which type of CKD do cats get compared to dogs?

A

Dogs: Glomerular disease
Cats: tubulointerstitial disease

32
Q

What 2 things does increased phosphate initiate in CKD?

A
  1. Metastatic calcification

2. Secondary hyperparathyroidism

33
Q

Name 3 drugs that can be used to control hypertension

A
  1. ACEi
  2. Telmisartan
  3. Amlodipine
34
Q

In which stage should you start a renal diet in cats?

In this stage, what should phosphate levels aim to be?

A

Stage 2

< 1.5mmol/l

35
Q

When should you start a renal diet in dogs?

A

Stage 3

Stage 2: If proteinuric or phosphate > 1.5mmol/l

36
Q

What are 2 ways to reduce phosphate?

A 
Renal diet
Phosphate binders (e.g. Ipakitine, pronefra)
37
Q

Name 2 appetite stimulants

A

Mirtazapine

Capromorelin

38
Q

Name the treatment for gastric ulcers

A

Sucralfate

39
Q

Give two ways of reducing gastric acid secretions

What stage of CKD would you want to use these in?

A

Omeprazole
H2 antagonists (cimetidine, ranitidine)
Stage 3

40
Q

Which 2 oral drugs could you use to control metabolic acidosis?

A

Sodium bicarbonate

Potassium citrate

41
Q

What phosphate levels should you aim for in each stage of CKD?
Stage 2
Stage 3
Stage 4

A

Stage 2 < 1.5mmol/l
Stage 3 < 1.6mmol/l
Stage 4 < 1.9mmol/l

42
Q

What can you used to control anaemia?

What is the risk of this?

A 
EPO supplement (Darbopoetin) and iron supplement
May induce anti-EPO antibodies, causing refractory severe anaemia
43
Q

What are three ways of minimising progression of CKD?

A
  1. Renal diet
  2. Control/reduce proteinuria
  3. Control blood pressure
44
Q

What is a risk factor for uraemia and death in CKD?

A

Proteinuria

45
Q

What is the signalment for FLUTD?
Which breed appears predisposed?
Which sex is more prone to obstruction?

A

Young/middle aged (2-6 years old) neutered cats
PERSIAN
Males

46
Q

What are 4 predisposing factors for FLUTD?

A

Obesity
Multi-cat household
Dry diet
Indoor/sedentary

47
Q

What are two causes of Feline Interstitial Cystitis?(feline idiopathic cystitis)

A
  1. Altered neurotransmission to and from the bladder, causing neurogenic inflammation
  2. Reduced GAG (glycosaminoglycan) layer of bladder
48
Q

How is the HPA axis involved in FIC?
What is the difference in ACTH stimulation test between FIC and healthy cats?
How does this affect stress?

A

HPA axis isn’t fully functional and smaller adrenal glands
Decreased cortisol response in ACTH stimulation test
FIC cats have an altered response to stress!

49
Q

What is the most common cause of obstruction in cats and in which sex?

A

Urethral plugs

Males

50
Q

What is the difference in urolithiasis involving struvite uroliths, in cats and dogs?

A

Cats - Sterile

Dogs - Associated with bacterial infection (staphylococcus spp.)

51
Q

Which 2 types of drugs have been found to have NO positive effect in FIC?

What are 4 treatments of FIC?

A

Antibiotics and Corticosteroids

  1. Analgesia
  2. Reduce stress
  3. Dilute urine
  4. GAG supplements
52
Q

What analgesia is suitable for an FIC cat?

What should you avoid if renal function is compromised?

A

Buprenorphine (Vetergesic)

NSAIDs e.g. Meloxicam

53
Q

What is the hall mark of glomerulopathy?
How should you detect and quantify it?
What about tubulointerstitial disease?

A

Proteinuria >2
Detect by dipstick, quantify by UPC
Tubulointersitital tends to be < 2

54
Q

What is the gold standard of diagnoses of glomerulopathy?

A

Renal biopsy

55
Q

What is amyloidosis?

What is the average UPC?

A

Deposition of amyloid plaques in the glomeruli

Very high: 9

56
Q

What commonly occurs before amyloidosis is Shar-peis?

A

Shar-pei fever

Self-limiting hyperthermia and swollen joints

57
Q

What is the treatment for proteinuria?
How do they reduce proteinuria?
What is the risk with using them?

A

RAAS blockade
Vasodilation of the efferent arterioles, reducing GFR
May increase azotaemia

58
Q 
Which two drugs can you use to treat proteinuria and what class are they?
In dogs, which should you use first? (according to the cascade)
A

ACi: Benazepril
Angiotensin receptor blockers: Telmisartan
Benazepril should be used first, as Telmisartan is only licensed in cats

59
Q

Why shouldn’t you use NSAIDs in animals with reduced renal function?

A

Cause constriction of afferent arteriole

Potential further kidney damage

60
Q
  1. What should you do before using immunosuppressive medication to treat glomerulopathies?
  2. When is it indicated?
  3. What can it affect in the future?
A
  1. Seek specialist advice
  2. Indicated if animal is doing poorly on standard treatment or liver biopsy suggests immune-mediated disease
  3. It can affect the possibility of ever reaching a diagnosis in the future!
61
Q

What are patients with glomerulopathies at high risk from?

What is the treatment?

A 
Thromboembolism
Clopidogrel (antiplatelets)
62
Q

When should you treat systemic hypertension caused by glomerulopathy?
What are drug choices in dogs and cats?

A

BP > 160mmHg
Or evidence of end-organ damage
Dog: Benazepril (ACEi) then amlodipine
Cat: Amlodipine or telmisartan

63
Q

What causes oedema in glomerulopathies?
What is used to treat it?
What is the risk?

A

Renal sodium retention
Diuretics
Severe azotaemia

64
Q

Furosemide and Spironolactone are both diuretics. Which forms of oedema/effusion are each indicated for?

A

Furosemide: Pulmonary oedema and hyperkalaemia
Sprinolactone: Pleural or abdominal effusion

65
Q

What should you always start with if proteinuria is present?

A

Thromboprophylaxis: Clopidogrel

66
Q

When should you treat high systolic pressure?

A

Aim to be <160mmHg

Treat if persistently above 180mmHg or if evidence of end-stage organ damage

67
Q

When should you NOT give ACP?

A

Dehydrated or acutely unwell patients

68
Q

Which antibiotics would be most suitable for a dog with bacterial prostatitis?

A

Sulphonamides or fluoroquinolones (e.g. enrofloxacin)

Increased penetration

69
Q

What would be the earliest sign of volume overload in a dog receiving IVFT for oliguric acute kidney injury?

A

Increased respiratory rate

70
Q

What could you give for hypertension in AKI?

A 
Avoid ACEi (e.g. benazepril)
Amlodipine
71
Q

What would you see on biochemistry in Ethylene Glycol toxicity?

A

Very low calcium

Oxalate in ethylene complexes with calcium, reducing it

Small Animal Studies (10 decks)

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