UROLOGY 2 & 3: KIDNEY DISEASE Flashcards
Kidney disease is considered chronic when it ahs been present for how long?
at least 3 months
is chronic kindey disease reversible?
what about acute kidney disease?
chronic: no
acute: yes
Describe the significance of super nephrons in CKD
remaining nephrons will try to compensate for damaged ones, leading to vicious cycle n long term damage
common causes of kidney disease?
- Drugs/Medications
- Toxins
- Infection
- Inflammation
- Hypoperfusion
- Acute kidney injury
- Metabolic events
- Thromboembolic events
What are common clinical signs of Chronic Kidney Disease?
- Polyuria and polydipsia
- Decreased appetite/anorexia
- Weight loss [due to protien loss through urine]
- Vomiting
- Muscle weakness[due to K+ loss in urine]
- Anaemia
- Constipation [due to dehydration]
high BP
What are some other possible differntial for PU/PD?
“Diabetes mellitus,” “Hypoadrenocorticism,” “Hyperadrenocorticism,” “Hypercalcaemia,”
“Pyometra,”
“Hepatic disease,”
“Hyperthyroidism,”
“Medications” (steroids, diuretics), “Diabetes insipidus,”
“Psychogenic polydipsia(some of these r a diagnosis of exclusion)
clinical signs of CKD appear after loss of funciton to what % of total kidney nephrons?
66%
How is Chronic Kidney Disease diagnosed?
- Haematology
- Serum biochemistry
- Urinalysis
- Blood pressure measurement
What are the stages of CKD according to IRIS?
- Stage 1: No clinical signs
- Stage 2: Mild clinical signs
- Stage 3: Increasing clinical signs
- Stage 4: Severe clinical signs
What are some main things to be managed in CKD?
dehydration
cachexia
diet
hyperphosphataemia
proteinuria
urinary tract infections
hypokalaemia
anaemia
high BP
What are 2 ways that CKD dehydration can be managed? [a bit obvious]
water provision [how do they like their water
fluid therapy [likely @ home by owner]
What are some aspects of CKD presciption diets?
less protien
less phophate
more calorie dense (fattY)
wet food
possibly omega 3, B vitamins, pottasium, anti-oxidants, etc
What care should be given regarding WHEN to introduce prescription diets for CKD?
do not introduce during hospital: will get ptsd and not want to eat it
What is a broad cause and treatment of hyperphosphataemia due to CKD?
casue: GFR decreases, blood phophate increases
tx: phosphate binders that stick to phosphate in food n prevent digestion of it
how can hyperphosphataemia lead to rubber jaw disease in CKD?
hyperphosphataemia.
now Ca:P ratio needs to be maintained
calcium leaching form bone and increase in PTH
can excessively leach calcium, rubber jaw
what are potential treatments of protienuria due to CKD?
how do they work?
what is a potential side effect to them?
ACE (angiotensin converting enzyme) inhibitos
dialation to efferent arterioles, reducing amount of protien that is pushed out
potential SE is systemic vasodialation
What is a proteinuria tx drug that may be used in cats?
amlodipine besylate
[calcium chanel blocker, arteriolar dialation]
Why would CKD lead to UTIs?
bc urinary sphincters are always open due to always peeing
[urine] is not high enough to kill off bacteria
What is given is severe cases of anaemia due to CKD?
What about less severe cases?
blood transfusion
ESA (erythtocyte stimulating agent)
What is Acute Kidney Injury (AKI)?
AKI is characterized by a sudden reduction in renal function that is potentially reversible
Which species has better prognosis of CKD?
cats
What are the 4 stages of Acute Kidney Injury?
Briefly describe them
- Initiation [exposure to causal agent]
- Extension [inflammation n hypoxia leading to nephron damage]
- Maintenance [irreversable nephron damage]
- Recovery [repair n regeneration of nephrons]
What are common clinical signs of Acute Kidney Injury?
- PUPD
- Anuria
- Lethargy
- Vomiting/diarrhoea
- Weakness
- Altered mentation
- Abdominal pain
What are some diagnostic techniques to look for AKD?
What test can rule out hypoadrenocorticism as a differential?
basal cortisol
Emergency treatment of AKD focused on which two electrolyte imbalances?
hyperkalaemia
hypocalcaemia
What is the emergency treatment for hyperkalaemia in AKI?
Calcium gluconate and fluid bolus
What is the emergency treatment for hypocalcaemiain AKI?
Calcium gluconate
Should hypovolaemia in AKD be corrected with gradual fluid or fluid boluses?
bolus
What is a healthy urine output when measured by catheter?
1ml/kg/hr
What is Proteinuria?
Proteinuria is the loss of protein through the tubules due to underlying inflammation, leading to nephron damage and CKD
What are the two types of Renal Tubular Acidosis?
- Type I: Distal tubule failure to excrete acid
- Type II: Proximal tubule failure to reabsorb bicarbonate
Which type of renal acidosis is less severe acidosis, less rare, and less severe hypokalaemia?
Type II proximal tubule
[because the distal tubule compensates]
Fanconis syndrome affects which specific part of the kindey?
proximal tubule
what are clinical signs of fanconis syndrome?
inability to absorb various substances in kindey:
glucose in urine[check blood glucose to rule out diabetes]
PUPD [water following glucose]
alkaline urine with acidosis
What is the prognosis for cats with CKD compared to dogs?
Cats better
What condition is also known as Alabama Rot?
Cutaneous Renal Glomerular Vasculopathy
Briefly describe the symptoms, onset time, and prognosis of alabama rot
severe cutaneous sloughing
in 1-2 days
poor prognosis
What is renal dysplasia
abnormal development of renal tissue. progressive till end stage
What is renal agenesis?
absence of one kidney. maybe have no clinical signs (remember 66%)
why does polycystic kidney disease affect kidney function?
takes up space and there isnt enough normal kidney tissue to do the job
What is pyelonephritis?
Is it usually ascending or descending?
Where in the kidney is it established
infection of kidney
ascending
in pelvis/medulla
What are the two types of pyelonephritis infections and the symptoms of each?
acute
-PUPD
-anorexia
-vomiting
-pain
-pyrexia
-shock
chronic
-PUPD
-cystitis
-weight loss
What are some diagnostic technques used for pyelonephritis?
haematology
serum biochem
urine analysis
urine culture
lepto testing
ultrasound
Describe the treatment for pyelonephritis
-correct hypotension/dehydration
-analgesia
-fluids
-treat co-morbidities
-anti-nausea & anti-emetics
-antibiotics [emperical, then specific with results]
A potential treatment of pyelonephritis is a nephrectomy. Why is this a last resort?
Want to ensure that the damaged kidney is not contributing to kidney function. Becasue without it, patient becomes a CKD case (down to 50% function)
what is the difference in proteinuria and protein losing nephropathy?
proteinuria is a symptom: any amount of protein in urine
PLN is a SIGNIFICANT amount of protein in urine. more severe. is a condition
What are some signs of PLN?
reduced oncotic pressure
hypertension
significant UP:C
lipid imbalance
thromboembolic disease
Diabetes insipidus is a failure to respond to which hormone?
Leads to what?
ADH
loses ability to concentrate urine
What would the SG look like in diabetes insipidus?
SG like water
massively thirsty
What is primary renal glucosuria?
how is this similar and different from fanconi’s syndrome?
proximal tubule cannot reabsorb glucose
[in fanconis, proximal tub cannot absorb anything]
Glucosuria without hyperglycaemia could be a sign of what condition?
Primary Renal Glucosuria
