Urogenital Flashcards
What is the equation for blood pressure?
Cardiac output (stroke volume x HR) X peripheral vascular resistance
Which cells detect low blood pressure within the RAAS ?
Juxtaglomerular cells of afferent arteriole of the glomerulus
Draw the RAAS
Angiotensinogen from liver – (renin secreted by kidney) –> angiotensin I – (ACE from lungs) –> angiotensin II –> aldosterone + increase resorption of sodium and water in proximal tubule + vasoconstriction
On which cells within the kidneys does aldosterone acts ?
Principle cells of collecting tubules (Na resorption and K excretion)
Intercalated cells of collecting tubules (H+ secretion)
Which one is the hormone that acts to decrease volume ? When is it secreted?
Atrial natriuretic hormone
Secreted by the heart in response to decrease volume
What are the characteristics of SIADH (4) ?
Hypotonic
Euvolemia
High urine sodium
High urine osmolality
What is the anion gap equation?
Na - (CL + HCO3)
Hyperchloric metabolic acidosis is due to the loss of which element?
Bicarbonate
From lower than stomach GI loss - diarrhea, renal tubular acidosis
Stretch of the bladder signal is conducted through which nerve?
Pelvic
The medulla blood supply is done through a structure called
Vasa recta
Describe the 2 types of cells within the late distal and collecting tubules
Principle cell
- resorption of Na and water (through ADH)
- Secretes potassium (through aldosterone)
Intercalated cells = acid base regulation
- type A ( resorption of potassium and secretes H+) –> If acidosis
- type B = opposite
What are the receptor effects of ADH?
Binds to V2 –> movement of aquaporin 2 to the luminal side (through AMPc and protein kinase)–> fuse with membrane to form water channels
Where is the urea passively reabsorbed from ?
Medullary collecting tubules
Especially with high concentration of ADH
On which receptor does desmopressin acts in the kidneys and which coagulation factor are also released?
V2 receptor
VW and 8
Which 3 changes occur in response to increased sodium intake ?
1) decrease aldosterone
2) increase GFR
3) decrease proximal tubular Na reabsorption
Both 2 and 3 leads to increased distal tubular flow rate
Where is magnesium stored ?
Mostly in bones and cells
Atrial natriuretic peptide acts on the kidneys and result in which 2 effects
Increases GFR
Decrease sodium reabsorption
Which reaction does carbonic anhydrase is involved with?
CO2 + H2O H2CO3
What are the 3 ddx of metabolic alkalosis ?
Diuretic
Excess aldosterone
Vomiting upper gastric content
Which medication can address metabolic alkalosis?
Ammonium chloride
PTH stimulates ans FGF23 inhibits the activation of which hormone?
Calcitriol
An acute kidney injury is defined by:
Increase in creatinine of > 0.3
Increase in creatinine more than 50% baseline
Oliguria of less than 0.5 ml/h/kg for more than 6 hours
The presence of low molecular weight proteins in the urine indicates damage to which segment of the kidneys?
Proximal tubule
What part of the kidney is affected by membranous glomerulopathy?
Immune complex in the basement membrane
What are the stages of AKI
1) initiation - pathological damage following injury
2) extension - ischemia, hypoxia and inflammation leading to apoptosis and necrosis
3) maintenance - azotemia and uremia
4) recovery
What are the 3 different mechanism of blood purification in dialysis system?
- diffusion (based on concentration of urea within dialyzer)
- convection (blood is exposed to positive transmembrane pressure)
- adhesion
Which bacteria causes emphysematous cystitis?
E.coli
What is the difference between UTI relapse and reinfection and persistent?
Reinfection : relapse with a different isolate (suggest decrease local or systemic immunity)
Relapse: same isolate (suggest persistent nidus)
Persistence: appropriate therapy fails to clear infection during or within 1 week after treatment
What is the size of stone where hydroretropulsion can be done ?
F cat : 5 mm
F dog: 15 mm
M cat: 1 mm
M dog: 1-3 mm
What is the treatment of low bladder capacity?
Antimuscarinic Tricyclic antidepressant (amipramine)
What is the treatment for detrusor instability?
Anticholinergic (emepronium)
What would be the treatment for urethral hypertonicity?
A-antagonist (phenoxybenzamime, prazosin-A1 or tamsulosin-A1)
What is the treatment for dyssynergia?
Diazepam
Dantrolen (inhibits calcium movement)
What are the potential treatments for bladder atony?
- bethanecol
- cholinesterase inhibitor (pyridostigmine)
- B blocking agents
- dopamine antagonist
- prostaglandins
- prokinetic
Which ureter is most commonly affected with circumcaval ureter?
Right
What are the 3 ways to help prevent cystine stones ?
Limit protein and sodium intake
Thiola (binds to cysteine to form soluble complex)
Neutering
What is the mechanism of cysteine stones ?
Failure of tubular reabsorption of cysteine (through SLC3A1 mutation)
*** Cats can also have neurological signs from lack of arginine
Which gram bacteria usually results in pyelonephritis?
Negative (E.coli) because possess adhesion molecules
Which bacteria is primarily associated with encrusted cystitis?
Corynebacterium urealyticum
Which 2 medications can help prevent calcium oxalate stones?
Potassium citrate
Hydrochlorothiazide (enhance tubular reabsorption of calcium)
What are the 2 ways to prevent urate stones formation?
Allopurinol (care for xanthine)
Reduce purine intake
What is the mechanism behind urate stones formation?
Inefficient transport of uric acid into hepatocytes leading to increased allantoin (from PSS or SLC2A9 mutation)
Which are the 2 purine based stones?
Urate and xanthine
Feline ectopic ureters are mostly extra or intramural?
Extra
What is the main bacteria involved in prostatitis?
E.colo
Which antibiotics can be use with prostatitis?
TMS, chloramphenicol, fluoroquinolones
What is cystatin C?
Low molecular weight proteins filtered at glomerulus and resorbed by megalin-mediated endocytosis at the proximal tubule.
Can be affected by thyroid and neoplasia
What are the 4 components of nephrotic syndrome?
Hypoalbuminemia
Hyperchlolesterolemia
Proteinuria
Edema
On ultrasound, which condition causes the kidney to be hyperechoic? To have perirenal fluid?
Ethylene glycol
Leptospirosis, lymphoma
Those parasites affect which organ?
Stephanurus dentalus
Capillaria plica or Felis
Dioctophyma renale
Kidneys
Which vasopressor should I use with AKI
Vasopressin - affects efferent arteriole
norepinephrine affects the afferent arteriole causing decreased GFR
Which medication can be given in AKI from leptospirosis?
Diltiazem
What mechanism is use in CRRT?
Diffusion and convection
Why does CKD results in metabolic acidosis?
- Decrease reabsorption bicarbonate
- Increased excretion of H+ (with ammonia)
- increased anion gap (urea)
How much does kidney function have to be affected for the SDMA to increase?
30% decline in GFR
What are the side effects of aluminum phosphorus binders?
Microcytosis
Neurology
Constipation
What are the 3 ways of looking at renal biopsies?
TEM (transmission electron microscopy)
IFM (immunofluorescent microscopy)
Light microscopy
Lyme disease is associated with which type of glomerulopathy?
Membranoproliferative
What are the the histopathological characteristics of membranoproliferative glomerulonephritis?
Thickened capillaries
Mesangial hypercellularity
Railroad appearance
Mediated by C3 immunity
Which type of glomerulopathy is the most common in dogs ? In cats
Dogs: Membranoproliferative
Cats: membranous nephropathy
What are the clinical characteristics of membranous nephropathy?
More common in young males
Massive proteinuria and nephrotic syndrome
What are the unique histopathological traits of membranous nephropathy ?
Antibodies on subepithelial side
Lack of inflammation
C5b-9 membrane attack complex
Thickened basal membrane with spikes
What are the histopathological characteristics of proliferative glomerulopathy?
Endocapillary or mesangial hyperplasia secondary to proliferation of endothelial cells
IgG or IgM basement membrane and mesengium
Immunoglobulin A nephropathy can be associated with which diseases?
Enteric or hepatic diseases
Extracellular deposition of fibrils formed by polymerization of proteins with B-pleated sheet confirmation is associated with which disease?
Amyloidosis
What are the histopathological characteristics of amyloidosis?
Diffuse glomerular deposit that are apparent on Congo red and can also be seen in walls of blood vessels and interstitial tissues
What is the histopathological characteristic of minimal change nephropathy?
Marked podocyte effacement
What is considered as a favorable response to treatment with proteinuria?
> 50% reduction in UPC
25% sustained reduction in creatinine
50% sustained improvement in albumin
Hypertension is most commonly associated with which type of glomerulopathy?
Membranoproliferative
The persistent loss of carnitine in the urine can lead to which disease?
DCM
What is the maximum reabsorption capacity of the glucose in the proximal tubule?
Dogs: 180-220
Cats: 260-310
Which solutes are abnormally absorb with Fanconi syndrome?
Glucose, cysteine, bicarbonate, sodium, potassium and urate
Describe type II (proximal) RTA and its treatment
Inability to prevent loss of bicarbonate because of a defect in the basolateral membrane transporter
Potassium citrate
Describe type I (distal) RTA and its treatment
Inability to excrete H+
Potassium and sodium citrate
Which metabolic conditions can lead to nephrogenic diabetes insipidus?
Hypokalemia and hypercalcemia
Which 2 abnormalities can lead to ADH secretion?
Hyperosmolality
Hypovolemia
What are possible treatment for nephrogenic diabetes insipidus?
Limit protein and sodium intake
Thiazide diuretic
Hereditary nephritis can be seen in which 2 breeds?
Samoyed (COL4A5 mutation). Bad prognosis in male, slower progression in female (X-linked)
Cocker spaniel (COL4A4 mutation). Autosomal recessive
In both cases, immunostaining will lead to abnormal pattern of type 4 collagen
Which cancers have been associated with neutering?
Prostatic Bladder Lymphoma in male golden OSA HSA
What are the treatments for mammary hyperplasia?
OVH (takes up to 6 months do remission) Progesterone blocker (aglepristone)
Which 6 infections can lead to abortion in dogs?
Brucella, toxoplasma gondii, neospora, herpesvirus type 1, parvovirus and cryptosporidium canos
Which 5 infections can lead to abortion in cats ?
FeLV, panleukopenia, herpesvirus, FIV and toxoplasmose
Which antibiotics should be used to treat mastitis or metritis
Clavamox or cephalexin
Which hormone causes endometrial hyperplasia and pyometra?
Progesterone
What is the medical management of pyometra?
Amoxicillin
Prostaglandins
+/-
Progesterone receptor blocker
Which neoplasm is the most common in the penis?
SCC
Sperm agglutination can be seen with which disease?
Brucella
Which mutation leads to polycystic kidney disease in Persian?
PKD1
In minimal change disease, lesions on glomeruli are present only with which type of histopathological evaluation?
Transmission electron microscopy
Normal on light microscopy and immunofluorescence
