Urinary/Renal Flashcards
What percentage of dogs with AKI had volume responsive, intrisnt, vs unclassified?
39% volume responsive
51% intrinsic
10% unclassified
How is magnesium correlated with FGF23? How is magnesium correlated with renal disease?
Mg is inversely associated with FGF-23
Low Mg in 12% of cats with CKD, associated with increased risk of death
how does fractional excretion of electrolytes differ depending in cause of kidney injury?
intrinsic AKI: higher fractional excretion of electrolytes (2.39 I-AKI vs 0.24 VR)
increased FE of electrolytes in non-survivors (1.6 vs 0.6)
what are risk factors for death in dogs with AKI?
AKI IRIS Grade
FE electrolytes
urinary output
How does antimicrobial resistance differ in dogs with biofilm forming E coli UTI vs non-biofilm forming E coli UTI?
biofilm former, lower likelihood of MDR than non-biofilm forming
What percent of E coli are capable of forming biofilms?
52.6%
Does container type matter when measuring UPC?
no difference in glass, plastic, or homopolymer polypropylene
What parameter can be used in an equation to predict GFR in cats? How does this formula compare to actual GFR?
Pelvic circumference
poor agreement
eGFR = 0.408+(243.11xcreat^-1)-(0.014xpelvic circumference cm)
What are factors associated with decreased survival in dogs with CKD?
BSC <4/9, muscle atrophy, increased creatinine, hyperphosphatemia, increased UPC, increased calcium phosphorus product, increased FGF-23
What component of sedivue has poor agreement for UA
epithelial cells
What are NOT associated with positive post op urine cultures in cats with SUB/stents?
CKD, renal implant type, post op u-cath
Less chance of positive culture if treated with post op abx
What percent of cats with SUBs/Stents have positive urine culture pre-discharge?
What bacteria is most common
25%
Enterococcus most common
What percent of dogs with proliferative urethritis had positive FISH?
53%, most had negative urine culture
no association with inflammation type
How does UPC and USG correlate?
weak negative correlation between UPC and USG, but UPC cannot be accurately predicted from USG
What bacteria are most commonly susceptible to vancomycin?
Enterococcus (30%)
Methicillin-resistant Staphylococcus aureus (22.2%)
Methicillin-resistant Staphylococcus pseudintermedius (5.6%)
What percentage of dogs/cats had AKI when being treated for vancomycin?
16.7%, though could not be definitively linked to vancomycin
What is the sn and sp of creatinine and SDMA to predict decreased GFR? (1.3 and 14 cut off)
90% sensitive
creatinine 90% sp
SDMA 87% sp
How does cystatin C compare to SDMA and creatinine for predicting GFR?
Sn is 72%, much less than creat and SDMA
What % of dogs with CKD had positive urine culture? (all dogs and stage 1)
What percent showed clinical signs?
Most common isolate?
All CKD: 32%
stage 1: 28%
8% show clinical signs
more likely if female or isosthenuria
67% E coli
What is a risk factor for candiduria in dogs and cats?
Administration of antibacterial drugs in the 30 days before diagnosis
Cats: lower urinary tract disease
How does urinary NGAL:creat ratio differ in dogs with progressive vs stable CKD?
higher in dogs with progressive CKD compared to stable CKD
Not able to differentiate stable CKD and pre-renal azotemia
How does the microbiome in cats with CKD compared to healthy cats?
cats with CKD have decreased fecal bacterial diversity and richness
What microbiome biomarker is different in cats with CKD?
indoxyl sulfate higher in cats with CKD compared to controls (increase starts in stage 2, not difference between stages)
No difference in p-cresol sulfate
How many dogs with ureterocele had imperforate or stenotic ureteral orifice?
13/14
What are clinical signs of ureterocele? How many dogs did these signs resolve in post laser ablation?
incontinence: 9/13, resolved in 8/9
pollakiuria: 3/13. resolved in all
How are amino acid levels associated with PLN?
lower in dogs with PLN: leucine, threonine, histidine, glycine, proline, asparagine, tyrosine, o-hydroxyproline, serine; lower sums of essential and nonessential AA
how is FGF-23 associated with renal function? What other plasma biomarker is associated?
FGF-23 increased with decreasing renal function
plasma indoxyl sulfate
How does mannitol impact FE of sodium/urea, GFR, and urine production?
short lived increase in FE of sodium and urea, increased in urine production after bolus injection
No change in GFR
In dogs with MPGN, what factors differ if C6 positive vs C6 negative
Positive more likely: thrombocytopenic, azotemic, hyperphosphatemic, neutrophilic, hematuric, glycosuria, pyruia with negative UCS
What percent of cats with FIC had recurrent within 6 months (with or without UO). how does meloxicam change recurrence?
24%, no difference with addition of meloxicam
How does EDTA impact cats with SUBS
resolves mineralization and obstruction from mineral
How much does USG change with proteinuria and glucosuria?
Negliable impact
how is SDMA impacted by dialysis?
for each 10% increase in urea reduction, 6.2 decrease in SDMA
SDMA is dialysable
What is the difference between minimum and maximum USG in healthy dogs? (day to day variability)
0.015
how is SDMA associated with FGF23?
cats with increased SDMA concentrations have higher FGF-23 concentrations, weakly positively correlated
How is miR-16 associated with renal injury?
upregulated if pyelonephritis compared to CKD, ureteral obstruction, and subclinical bacteriuria
How is NGAL associated with AKI in dogs?
higher in dogs with AKI, regardless of AKI grade, did not differ based on VR-AKI and I-AKI, higher in dogs with inflammatory AKI
How can NGAL be used to differentiate between VR-AKI and I-AKI
urinary NGAL normalized to urine creatinine concentration higher in I-AKI
Sn and Sp of SDMA >14 and >18 for 40% decrease in GFR in non-azotemic dogs?
SDMA >14: 90% sn, non specific
SDMA >18: 90% sn, 83% sp
cut off of 18 is optimal
What can be used to estimate GFR prior to development of azotemia?
Iohexol clearance
What fecal SCFA is higher in cats with CKD?
fecal isovaleric acid higher in cats with CKD, particularly in late stage disease
In cats with CKD, how does the amount of BCFA correlate with azotemia? what does this suggest?
Weakly correlated with creat, BUN, and pCS concentration
Suggests malassimilation of proteins in cats with CKD
What is the most common cause of urinary incontinence in cats?
Spinal cord disease most common, associated with poor outcome
What percentage of cats have a voiding disorder vs storage disorder?
53% voiding disorder, 47% storage disorder
What % of cats with urinary incontinence have a UTI?
39%
What is the outcome for cats with urinary incontinence
42% regained continence
8% improved with treatment
50% remained incontinent or were euthanized
How do preprandial and postprandial calcium urinary mini Schnauzers with urolithiasis differ compared to Schnauzers without urolithiasis?
Fasted: urolith formers have higher Uca/Cr ratio
UCa/Cr 0.06: Sp 93% and sn of 56%
postprandial: no different
How does liver-type fatty acid binding protein correlate with serum creat and SMDA?
Weak correlation
What percentage of proteinuric dogs had positive urine culture and what perfect of positive urine culture had active sediment? What does this mean for when a urine culture should be performed in proteinuric dogs?
6.7% had positive urine culture
60% had active urine sediment
perform urine culture if active sediment or if lower urinary tract disease
How does stress impact UCCR and proteinuria?
No change in UPC
UCCR significantly higher from in hospital vs at home collection
Does it make a difference clinically in culture and sensitivity results if urine samples are plated immediately?
no clinical change in preplating, most amount of discrepancies were midstream samples
How are urine hemojuvelin and u-hemojuvelin-to-creatinine ratio correlated with renal disease?
both are correlated with BUN, creatinine, phosphate, low HCT, and alb.
Stage 3 and 4 CKD higher u-hemojuvelin and u-hemojuvelin-to-creatinine ratio compared to stage 1 and 2
In female dogs with recurrent UTIs, how many had hooded vulvas? How many dogs had abnormalities on cystoscopy and what were they?
33/48 had hooded vulva
45/52 had abnormalities
mucosal edema (most common)
vestibulovaginal septal remnant
lymphoid follicles
Short urethral
Ectopic ureter
How is cortical thickness associated with CKD?
Cortical thickness is decreased in cats with CKD (all stages), negatively correlated with disease severity
Sn: 90%, Sp 94.7%
What gene transcription products are higher in cats with CKD? What process are these related to?
HIF1A, MMP2, MMP7, MMP9, TIMP1, TGFB1. Fibrotic markers
VEGFA lower
What is the weight cut off for precision of 3D ultrasound measurement of urinary bladder volume?
5.5 kg
What is the MST of cats hospitalized for AoCKD? the What is the survival to discharge?
58% survived to discharge
MST 66 days
Longer hospitalization longer in survivors
what are the most common causes of AoCKD in cats?
Ureteral obstruction (11%)
Ischemia (9%)
pyelonephritis (8%)
Unknown 66%
What ultrasonographic finding is more likely to be associated with CKD than medullary rim sign?
thick hyperechoic ill-defined band
Only 40% of cats with medullary rim sign had kidney disease
74% with medullary band had kidney disease
Prevalence of hypertension (>160 and >180) in dogs hospitalized with AKI?
75% hypertensive
56% severely hypertensive