Urology Flashcards
LOFTUS progression of CKD signs
high SDMA > isosthenuria > high creatinine
hypertension
LOFTUS histopathology of CKD
inflammation ( glomerular and/or tubular)
lymphoma
amyloidosis
fibrosis
LOFTUS clinical pathology signs of CKD
increasing SDMA. creatinine, high P, low D3, 2* hyperparathyrioidism
U/S - enlargement (acute), misshapen, smaller (chronic), cystic, stones
LOFTUS criteria for IRIS CKD staging
creatinine level, SDMA level, USG, UPC ratio, BP, imaging abNLs – all based on trends and presentation (healthy visit vs signs of disease)
LOFTUS cornerstones of CKD mgmt
*P restriction
*omega 3 FAs
*antioxidants
*dietary protein restriction
BP mgmt - amlodipine»_space; ace inhibitor
avoid nephrotoxic drugs
adjust doses for all drugs eliminated via kidneys
maintain hydration (cats picky)
hypokalemia
metabolic acidosis
chronic anemia (give EPO)
LOFTUS four categories of proteinuria with some examples
pre renal - stress, exercise, paraneoplasic
glomerular - ICGN, amyloid, neoplasia, non ICGN =immune complex glomerulonephritis (like lyme)
tubular - fanconi’s, CKD, inf dz, neoplasia
post-renal - UTI, neoplasia, cystitis, repro dz
LOFTUS six main causes of glomeular dz
amyloidosis inflammation (glom nephritis) sclerosis (2ndary to trauma/injury) familial glom nephritis autoimmune (lupus) idiopathic (minimal change glomerulopathies)
LOFTUS why use enalipril/benazipril and amlopidine for proteinuria
ACEi - preferential efferential arteriole vasodilation, decreasing GFR unless paired with B antagonist
Amlopidine - preferential afferent vasodilation, increasing GFR
both decrease pressure in the glomerulus, pushing through less protein
benefit of SSA
what it is
is this the best indicator of urine protein concentration?
detects globulins and bence jones proteins
sulfo salicylic acid
no, 24 hr urine protein is most accurate or UPCR
what are bence jones proteins and what is the disease cause them to appear?
product of plasma cells found in urine in patients with multiple myeloma
MM = neoplasia of plasma cells
lists some causes of hypertension
- pheochromocytoma
- cushings
- hyperthyroid
- DM
- renal disease (pathologic raas activation)
lists common tx for renal derived hypertension
- dietary sodium restriction
- ACE inhibitors enalapril or benazapril
- amlodipine ( B antagonist)
medical mgmt of urate stones
- diet:high sodum, low purine, acidifying diet with bicarb PO supp. high Na drives thirst and duiresis to decrease urine osmolarity
- allopurinol to inhibit uric acid production, but maybe increase pathologically to produce xanthine stones
four components of nephrotic syndrome
- hypoalbuminemia
- pathologic proteinuria
- hypercholesterolemia
- third space fluid sequestration
name some comorbities that that are associated with UTIs in cats/dogs
cushings, DM, CKD, IVDD, u cath hx, obesity, incontinence, urolithiasis, hyperthyroidism, P/U hx
which comes first the uti or the stone?
generally all stones act as the nidus for infection, except for struvite usually forming secondary to infection only in dogs.
- differentiate between pollakiuria and polyuria
- also dysuria, stranguria, periuria
- pollakiuria - increased frequency of urination
- polyuria - increased total volume
- stranguria - decreased ability to empty the bladder
- dysuria - painful, burning
- periuria - cats urinating outside of the box/ in abn spots
what parameter is used to identify true infections on free catch vs cystocentesis urine sample
free catch = >100k CFU/mL
cystcentesis = >1k CFU/mL
define MIC, MBC, MPC and breakpoint
MIC - minimum inhib conc
MBC - min bactericidal conc
MPC - mutant prevention conc
breakpoint - highest available conc given the acceptable dose range
dx and tx of sporadic cystitis
dx - <3 confirmed bacterial cystitis cases in the past year
tx - often empirical abx, narrow spectrum, culture if resistant before re-prescribing
dx and tx of recurrent bact cystitis
dx - >3 episodes within a year or 2 episodes <3 months apart
tx - culture for abx choice gold standard to determine if the bact is persistent or new. tx to clinical resolution, not urine sterility
Struvite:
Characteristics
mechanism of formation
treatment/mgmt
- Mg NH4 P = MAP, may also have Ca apatitem ammonium acid urates, #2 most common
- in dogs often bacteria present first –> alkalize urine –> decreased ion solubility
- st/ox diets (beware of non-maintenance diets), avoid urine stasis, acidify urine, urease inhibitors for dogs
Ca oxalate:
Characteristics
mechanism of formation
treatment/mgmt
- mono vs dihydrate different stones. #1 most common. in cats: often renal or ureteral. requires excess Ca and oxalate (vitamin c)
- hypercalcemic disorders vs non-hypercalcemic disorders
- control Ca and vitamin C intake (non essential in dogs/cats anyway)
cystine:
Characteristics
mechanism of formation
treatment/mgmt
- d penicillamine, alkalinize urine, increase water intake, low purine diet
