Urinary/Renal Flashcards
1
Q
What percentage of dogs with AKI had volume responsive, intrisnt, vs unclassified?
A
39% volume responsive
51% intrinsic
10% unclassified
1
Q
How is magnesium correlated with FGF23? How is magnesium correlated with renal disease?
A
Mg is inversely associated with FGF-23
Low Mg in 12% of cats with CKD, associated with increased risk of death
2
Q
how does fractional excretion of electrolytes differ depending in cause of kidney injury?
A
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)
3
Q
what are risk factors for death in dogs with AKI?
A
AKI IRIS Grade
FE electrolytes
urinary output
4
Q
How does antimicrobial resistance differ in dogs with biofilm forming E coli UTI vs non-biofilm forming E coli UTI?
A
biofilm former, lower likelihood of MDR than non-biofilm forming
5
Q
What percent of E coli are capable of forming biofilms?
A
52.6%
6
Q
Does container type matter when measuring UPC?
A
no difference in glass, plastic, or homopolymer polypropylene
7
Q
What parameter can be used in an equation to predict GFR in cats? How does this formula compare to actual GFR?
A
Pelvic circumference
poor agreement
eGFR = 0.408+(243.11xcreat^-1)-(0.014xpelvic circumference cm)
8
Q
What are factors associated with decreased survival in dogs with CKD?
A
BSC <4/9, muscle atrophy, increased creatinine, hyperphosphatemia, increased UPC, increased calcium phosphorus product, increased FGF-23
9
Q
What component of sedivue has poor agreement for UA
A
epithelial cells
10
Q
What are NOT associated with positive post op urine cultures in cats with SUB/stents?
A
CKD, renal implant type, post op u-cath
Less chance of positive culture if treated with post op abx
11
Q
What percent of cats with SUBs/Stents have positive urine culture pre-discharge?
What bacteria is most common
A
25%
Enterococcus most common
12
Q
What percent of dogs with proliferative urethritis had positive FISH?
A
53%, most had negative urine culture
no association with inflammation type
13
Q
How does UPC and USG correlate?
A
weak negative correlation between UPC and USG, but UPC cannot be accurately predicted from USG
14
Q
What bacteria are most commonly susceptible to vancomycin?
A
Enterococcus (30%)
Methicillin-resistant Staphylococcus aureus (22.2%)
Methicillin-resistant Staphylococcus pseudintermedius (5.6%)
15
Q
What percentage of dogs/cats had AKI when being treated for vancomycin?
A
16.7%, though could not be definitively linked to vancomycin
16
Q
What is the sn and sp of creatinine and SDMA to predict decreased GFR? (1.3 and 14 cut off)
A
90% sensitive
creatinine 90% sp
SDMA 87% sp
17
Q
How does cystatin C compare to SDMA and creatinine for predicting GFR?
A
Sn is 72%, much less than creat and SDMA
18
Q
What % of dogs with CKD had positive urine culture? (all dogs and stage 1)
What percent showed clinical signs?
Most common isolate?
A
All CKD: 32%
stage 1: 28%
8% show clinical signs
more likely if female or isosthenuria
67% E coli
19
Q
What is a risk factor for candiduria in dogs and cats?
A
Administration of antibacterial drugs in the 30 days before diagnosis
Cats: lower urinary tract disease
20
Q
How does urinary NGAL:creat ratio differ in dogs with progressive vs stable CKD?
A
higher in dogs with progressive CKD compared to stable CKD
Not able to differentiate stable CKD and pre-renal azotemia
21
Q
How does the microbiome in cats with CKD compared to healthy cats?
A
cats with CKD have decreased fecal bacterial diversity and richness
22
Q
What microbiome biomarker is different in cats with CKD?
A
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
23
Q
How many dogs with ureterocele had imperforate or stenotic ureteral orifice?
A
13/14
24
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
25
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
26
how is FGF-23 associated with renal function? What other plasma biomarker is associated?
FGF-23 increased with decreasing renal function
plasma indoxyl sulfate
27
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
28
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
29
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
30
How does EDTA impact cats with SUBS
resolves mineralization and obstruction from mineral
31
How much does USG change with proteinuria and glucosuria?
Negliable impact
32
how is SDMA impacted by dialysis?
for each 10% increase in urea reduction, 6.2 decrease in SDMA
SDMA is dialysable
33
What is the difference between minimum and maximum USG in healthy dogs? (day to day variability)
0.015
34
how is SDMA associated with FGF23?
cats with increased SDMA concentrations have higher FGF-23 concentrations, weakly positively correlated
35
How is miR-16 associated with renal injury?
upregulated if pyelonephritis compared to CKD, ureteral obstruction, and subclinical bacteriuria
36
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
37
How can NGAL be used to differentiate between VR-AKI and I-AKI
urinary NGAL normalized to urine creatinine concentration higher in I-AKI
38
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
39
What can be used to estimate GFR prior to development of azotemia?
Iohexol clearance
40
What fecal SCFA is higher in cats with CKD?
fecal isovaleric acid higher in cats with CKD, particularly in late stage disease
41
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
42
What is the most common cause of urinary incontinence in cats?
Spinal cord disease most common, associated with poor outcome
43
What percentage of cats have a voiding disorder vs storage disorder?
53% voiding disorder, 47% storage disorder
44
What % of cats with urinary incontinence have a UTI?
39%
45
What is the outcome for cats with urinary incontinence
42% regained continence
8% improved with treatment
50% remained incontinent or were euthanized
46
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
47
How does liver-type fatty acid binding protein correlate with serum creat and SMDA?
Weak correlation
48
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
49
How does stress impact UCCR and proteinuria?
No change in UPC
UCCR significantly higher from in hospital vs at home collection
50
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
51
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
51
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
52
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%
53
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
54
What is the weight cut off for precision of 3D ultrasound measurement of urinary bladder volume?
5.5 kg
55
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
56
what are the most common causes of AoCKD in cats?
Ureteral obstruction (11%)
Ischemia (9%)
pyelonephritis (8%)
Unknown 66%
57
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
58
Prevalence of hypertension (>160 and >180) in dogs hospitalized with AKI?
75% hypertensive
56% severely hypertensive
59
Prevalence of proteinuria and hypertensive retinopathy of dogs hospitalized with AKI?
16% hypertensive retinopathy
77% proteinuric
60
How is fluid overload in dogs related to outcome and blood pressure?
If fluid overloaded at presentation-more likely to be hypertensive
If did not survive to discharge, more likely to have fluid overload
No association of BP with grade of AKI, oligo/anuria, survival to discharge, proteinuria, duration of hospitalization
61
Incidence of Focal segmental glomerulosclerosis in dogs biopsied for proteinuria?
26%
62
MST of dogs with Focal segmental glomerulosclerosis and what factors are associated with shorter survival times?
MST 258 days
creat more than 2.1 and alb <2 risk factors
63
What neurologic signs can dogs with grape and raisin toxicity present with? Prognosis?
73% had forebrain, cerebellar, or vestibular signs
50% survived
64
What are risk factors for enterococcal bacteriuria in dogs? what are comorbidities association with presence of enterococcus?
history of recurrent bacteriuria
Comorbidities: LUT abnormalities, urolithiasis, LUT neoplasia
65
How can 15-F2-isoprostanes be used to help diagnose urothelial carcinoma?
not useful. Similar in dogs with LUTD and dogs with UC
66
How does 3D ultrasound compare to 2D ultrasound when estimating bladder size?
3D ultrasound underestimates bladder size, but still accurate
67
How does vitamin D differ in dogs with PLN vs healthy dogs?
lower concentrations of vitamin D metabolites.
Urine 25(OH)D-to-creatinine ratio: negatively correlated with albumin and positively correlated with UPC
25OHD and 24,25OH2D: positively correlated with albumin
24,25OH2D: negatively correlated with UPC
68
What percentage of dogs treated with telmisartan and enalapril developed azotemia?
31% of dogs
69
how does telmisartan improve UPC compared to enalapril?
% change in UPC is greater in telmisartan vs enalapril (65% vs 35%)
70
How does calcifediol supplementation impact vitamin D metabolites in dog with chronic kidney disease?
Increase in serum calcitriol, 25OHD2, 24,25,OH2D
71
How does calcifediol supplementation impact other markers of CKD (ex. PTH, FGF-23, ect)
FGF-23 increased by day 84
no change in creat, calcium, phosphorus, PTH, UCa/Cr or fractional excretion of calcium. no dog developed ionized hypercalcemia
72
what are the most common causes of AoCKD in dogs?
inflammatory 30%
pyelonephritis 15%
Ischemic 7%
Unknown 45%
73
What is MST of AoCKD in dogs? What is associated with survival?
MST 105 days
Mortality 35%
IRIS AKI grade at presentation associated with survival
RR, CK, and serum creatinine on presentation also associated with survival
Etiology and creat at discharge not predictors of long-term survival
74
If treated, does having a positive urine culture impact progression of CKD or survival in cats?
no difference in survival or disease progression, even if multiple incidences of positive urine culture
75
How are SDMA and creatinine associated with GFR in cats? what is the sn and sp of each?
SMDA and creat are both correlated with GFR with similar sensitivity. Creatinine is more specific for detecting GFR decline.
Creat: sp 94-96%
SDMA: 75-76%
76
What % of dogs with proliferative urethritis had a history of UTI?
73%
77
Median time to re-obstruction for dogs with proliferative urethritis? What is associated with decreased risk of re-obstruction (first treatment) and after second treatment?
no effacement: 101 days (100% of dogs re-obstructed)
effacement: 687 days (57% of dogs re-obstructed)
After effacement, longer duration of patency if stent placed (843 days compared to 452 days)
78
what biochemical changes are risk factors for increasing total calcium?
lower baseline potassium and lower baseline phosphorus
Total calcium is associated with progression of CKD
79
how do ampicillin pharmacokinetics differ in azotemic vs non azotemic dogs?
peak concentration, half-life, and AUC greater in azotemic dogs
slower clearance of ampicillin
80
sn, sp, PPV, and NPV or point of care (rapid immunoassay) dipstick to determine bacteriuria in dogs with clinical signs of UTI?
Sn 89%
Sp 100%
PPV: 100%
NPV: 92%
81
If a cats develops hypercalcemia while eating a renal diet, how can iCa be normaliezd?
switch to a moderately restricted phosphorus diet (1.5 g/Mcal vs 0.8 g/Mcal)
82
Sn and SP of uL-FABP (liver type fatty acid-binding protein) for CKD detection?
What other disease processes is uL-FABP increased in
Sn 100%
Sp 93.2%
increased in hyperthroid cats
83
is NGAL useful in cats to detect CKD?
no
84
In cats, how has the frequency of calcium oxalate and struvite stones changed over time?
What is the third most common stone type?
decreased in CaOx over time (51.1% to 37.7%), increase in Struvite over time (41.8% to 54.5%)
Urate, third most common stone type
85
What percent of stones from male intact dogs are cystine stones?
70.3%
85
In dogs, what percentage of stones are calcium oxalate and what percentage are struvite? how have these changed over time?
47% CaOX, 43.6% struvite
CaOx decreased over time (49.5% to 41.8%)
86
Can the urinary microbiome be cultured via conventional methods?
no, need next generation sequencing
87
How is BUN/creatinine helpful for determining GI bleeding?
only increased if overt GI bleeding
no difference if occult bleeding when compared to controls, cannot determine if upper vs lower GI bleeding
88
Adverse events of telmisartan?
self limiting GI signs in 5 dogs
two dog developed medication limiting azotemia
89
in proteinuric dogs treated with telmisartan, how did creatinine, potassium, and arterial blood pressure differ at any time point in 12 months of treatment in non-azotemic dogs?
no significant changes
only 2 dogs developed azotemia
90
Normal bladder volume?
0.2-0.4 mL/kg
91
What imaging modality is better at detecting ureteral obstruction in cats, US or nonenhanced CT?
non-enhanced CT superior
Pelvic size >5mm
maximal ureteral diameter >3 mm associated with ureteral calculi
92
How can iCa be predicted based on total or adjusted calcium?
Low adjusted calcium useful for detecting ionized hypocalcemia
93
How might calcium oxalate stones have a genetic cause?
polymorphism in gene (rs852900542) resulting in vitamin D metabolism variance (TT genotype=lower urinary calcium:creat)
94
How does desmopressin impact dogs recieving steroids?
decreased PU/PD, increase in USG, hyponatremia occurs
95
for dogs with struvite stones, how many dogs achieved dissolution and after how long?
what is a risk factor for non dissolution?
-58%, median 35 days
-uroliths containing >10% struvite mineral more common in non-dissolution group
-urine pH, number of uroliths, and maximum stone diameter does NOT impact stone dissolution
-dissolution more likely if recieving abx
96
Most common AE in dogs with struvite stone dissolution?
urinary obstruction, but most dogs obstructed before trial initiation
97
An FGF-23 of what is associated with shorted time to develop hyperphosphatemia in dogs with CKD?
FGF23>528
98
% of cats discharged with SUBs placed in Wulliemin 2021?
94%
99
Outcome for cats with SUBs placed?
53% alive at mst of 821 days, 52% died
100
Complications SUBs?
Infection most common (26%)
Luminal obstruction 17% (mean time 204 days)
kinking 10% (mean time 54 days)
101
In cats with big kidney little kidney, what clinical findings are more likely
higher BUN, creatinine, WBC, lower HCT, USG, pH
102
predictors of survival in cats with ureteral obstruction
BUN, creat, lower body temperature
103
How does a moderately protein and phosphorus restricted diet impact cats with CKD in stage 1 and 2?
Low protein/low phosphorus: creat decreases, total calcium and FGF23 increase
moderate protein/moderate phosphorus: calcium and phosphorus remained static, FGF-23 decreased.
104
What renal biomarkers can predict development of AKI?
uHSP70/uCr, uGGT/uCr, and uIL-6/uCr
105
How are TLI and fPL impacted by azotemia?
fPL no impact
TLI increased
106
What biochemical parameter is a risk factor for CaOx stones?
hypertriglyceridemia
107
What percent of dogs were continent after cystoscopic laser ablation with addition of medications?
67.7% of dogs
108
How many dogs undergoing CT had renal infarction and what was the most common location?
3.15%
Caudal pole most common, best seen on sagittal plane
109
Factor associated with decreased risk of repeat catheterization at 48 hours for cats with UO?
10% re-UO if indwelling
14.8% re-UO if catheter placed an immediately removed
110
Survival rate of dogs with AKI?
66% (2/3)
60% who were dialyzed survived
Positive association between death and AKI
Higher fatality with anuria
111
Etiology of AKI in dogs?
Ischemic/inflammatory 58%
infectious 8%
Nephrotoxin 6%
other 5%
Hospital acquired AKI in 9%
112
How many cats with CKD (+/- SUB) had iron deficiency?
14%
113
What cut off of Corpuscular hemoglobin of reticulocytes can be used for predicting iron deficiency? Sn and sp?
15.9
Sn: 67%
Sp: 82%
114
Prevalence of positive urine culture in dogs with inactive sediment?
3.4%, E coli most common
115
Risk factors of nephrolithiasis in cats with CKD?
higher total calcium and protein restricted diet
116
How does nephrolithiasis impact outcome of CKD?
not related to progression of CKD
117
What components of intrarenal RAAS are different in cats with CKD compared to healthy cats?
CKD had higher angiotensinogen, higher angiotensin I, lower levels of ACE
Indicates intrarenal RAS activation
118
How does anti-neoplastic chemotherapy impact positive urine culture?
no evidence that it is a predisposing factor, most positive urine cultures were subclinical bacteriuria
119
mean time to urethral obstruction with urethral occluder? What caused the obstruction?
884 days
Fibrous capsule associated with artificial sphincter, obstruction resolved with surgery, associated with infection
120
MST of dogs following AKI?
1322 days (may alive at time of last contact)
long term survival not associated with creatinine normalization
Etiology associated with long term outcome
121
% of dogs with normalization of creatinine after AKI (discharge and follow-up)
55% at discharge
20% during follow up
122
How is SDMA associated with AKI?
Increased in novel AKI, CKD, and AoCKD, correlated with creatinine
123
What should be considered in cats with positive urine cultures from SUBs?
migration to GI tract
124
Effect of autologous skeletal muscle progenitor cells to treat USMI?
positive response, still need adjunctive medications (all but 2 dogs)
125
How does short term calcifediol supplementation impact RAAS?
calculated ACE activity lower at month three, no other differences
126
Agreement of ultrasound and endoscopy for dogs with incontinence, stranguria, and recurrent UTI
Incontinence: 71%
Stranguria: 58% --> urethral strictures prominant endoscopic
Recurrent UTI: 87%
127
percent of dogs who developed AKI after furosemide for left sided CHF?
AKI in 48%, mostly grade I
reversible in 9 dogs/13
6 dogs survived over 1 year
128
Risk factors associated with AKI in dogs recieving furosemide?
High BP, oral administration after discharge
129
urinary NGAL in dogs with stable MMVD?
increased uNGAL, damage is subclinical, occurs in all stages
Increases with severity of MMVD
130
Difference in outcome in dogs and cats with PCCL vs open cystotomy?
NSD in surgical or anesthesia time
Hospitalization short for dogs, NSD in cats
131
How is serum uromodulin changed in dogs with CKD?
Lower in dogs with CKD, negatively correlated with Creatinine, BUN, SDMA.
Not associated with stage of CKD, but can be helpful to identify early CKD (AUC higher than SDMA for CKD diagnosis)
132
Percent of proteinuric dogs with successful proteinuria reduction after initiation of ACEi?
36%
133
Percent of dogs with RAAS inhibition with aldosterone breakthrough?
34-59%, not associated with proteinuria outcome
134
how does IV diltiazem impact renal function?
did not improve markers of renal function
135
Risk factors associated with increased clinical severity of NSAID toxicity?
increased time to presentation, higher baseline creat, absence of induced emesis
Ibuprofen > caprofen
136
Survival rate of NSAID toxicity?
99%
137
Interventions to improve outcome of NASID toxicity?
TPE: lower incidence of AKI
intralipid: slightly lower maximal creatinine concentration
138
Sn and sp of plasma normetanephrine and plasma metanephrine for dogs with pheochromocytoma?
plasma normetanephrine: sn 100%, sp 94% (RI >3.5)
plasma metanephrine: sn 73%, sp 94% (RI>2.5)
139
What change is needed for clinical significant for uNGAL and uKIM-1 compared to day to day variability?
>100% change in uNGAL
>60% change in uKIM-1
140
Should dogs with diabetes mellitus routinely have urine cultures?
no, typically sublincial
82% did not have LUTS
13% of dogs with no LUTS had a positive culture
141
How is capillary rarefaction associated with cats with kidney disease?
positively correlated with renal dysfunction
142
risk factors for higher risk of ureteral obstruction with nephrolithiasis?
female sex
Bilateral uroliths
younger age (<12)
Upper stones more likely in: British short hair, persian, Ragdoll, tonkinese
143
Incidence of hypercalcemia in cats with CKD and what is it associated with?
20%, associated with male sex, higher total calcium, higher potassium, lower PTH
144
Clinical factor associated with polymicrobial bacteriuria (E coli and enterococcus)? Resistance?
more likely polymicrobial in recurrent UTIs
E coli more frequently resistance to doxycycline and gentamicin
145
How does serum leptin correlate with blood pressure, CKD, and SDMA?
positive correlation
146
how is proteinuria associated with GBM formation?
higher proteinuria in dogs with GBM, proteinuria increased with severity of disease
147
how does the urinary microbiome differ in mini schnauzers with and without CaOx stones?
Acinetobacter, 2 Geobacillus variants, and Hydrogenophaga were overrepresented in the urine of urolith formers
148
What variation in vitamin D metabolism is present in dogs with hypercalciuric calcium oxalate stone formation?
decreased conversion of 25OHD to 24,25OH2D
149
