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sam2 > urology and nephrology > Flashcards

urology and nephrology Flashcards

1
Q

functional unit of the kidney

A

nephron

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2
Q

abnormal increase in the concentration of non protein nitrogenous wastes in blood

A

azotemia

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3
Q

causes of pre renal azotemia

A 
dehydration
hypoadrenocorticism 
cardiac disease 
shock 
hypovolemia
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4
Q

causes of renal azotemia

A 
parenchymal disease 
infections 
cysts 
inflammation
neoplasias
toxins
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5
Q

post renal azotemia causes

A

blockage – bladder / urethral

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6
Q

T/F

azotemia is uremia

A

false

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7
Q

renal failure occurs when kidneys are no longer able to maintain

A

regulatory function
excretory function
endocrine function

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8
Q

renal failure occurs at what percent damage

A

> 75%

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9
Q

The constellation of clinical signs and biochemical abnormalities associated with critical loss of functional nephrons

A

uremia

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10
Q

T/F

the glomerular fitration rate is diretly related to renal functional mass

A

true

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11
Q

gold standard glomerular function test

A

scintigraphy

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12
Q

where is urea synthesized

A

liver

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13
Q

where is urea excreted

A

kidney

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14
Q

T/F

urea is an accurate way to estimate the GFR

A

false - The constellation of clinical signs and biochemical abnormalities associated with critical loss of functional nephrons will lead to false positives

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15
Q

creatinine is dependent on

A

muscle mass

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16
Q

creatinine excretion

A

unchanged by the kidneys

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17
Q

serum concentrations of creatinine increase with

A

reduced renal clearance

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18
Q

serum creatinine concentrations decrease with

A

lower muscle mass

old patients with cachexia

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19
Q

which is a better indicator of GFR:
urea
creatinine

A

creatinine

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20
Q

azotemia does not develope until GFR has decreased to ___%

A

25%

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21
Q

The constellation of clinical signs and biochemical abnormalities associated with critical loss of functional nephrons

A

cystatin C

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22
Q

T/F

cystatin C is freely filtered by the glomerulus

A

true

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23
Q

SDMA detected at what % decline in GFR

A

40%

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24
Q

a methylated form of the amino acid arginine, which is produced in every cell and released into the body’s circulation during protein degradation

A

SDMA

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25
Q

SDMA sensitivity

A

100%

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26
Q

creatinine specificity

A

100%

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27
Q

creatinine sensitivity

A

17%

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28
Q

SDMA specificity

A

91%

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29
Q

best method for urine collections

A

cystocentesis

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30
Q

gold standard measurement of urine concentration

A

osmolality

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31
Q

falsely increases the concentration of urine

A

glucosuria

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32
Q

measures concentration of urine relative to plasma

A

urine specific gravity

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33
Q

urine SG

1.000 - 1.007

A

hyposthenuric

<300mOsm

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34
Q

urine SG

1.008 - 1.012

A

isostenuric

=300 osmo

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35
Q

urine SG

1.013 - 1.030

A

minimally concentrated urine

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36
Q

urine SG

1.013 < 1.022

A

inadequately concentrated urine

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37
Q

urine SG for an adequately concentrated dog

A

> 1.030

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38
Q

urine SG for an adequately concentrated cat

A

> 1.035

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39
Q

cats UPC proteinuric

A

> 0.4

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40
Q

dogs UPC proteinuric

A

> 0.5

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41
Q

most common urinary bact

A

e coli

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42
Q

blood in the urine

A

hematuria

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43
Q

red to brownish urine without intact RBC

A

pseudohematuria

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44
Q

T/F

signs of dysuria are commonly associated with renal hematuria

A

FALSE – unless concurrent with lower urinary tract disease, it uncommon

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45
Q

client complains that the dog has a history of pollakiuria or stranguria … what is this a feature of

A

lower urinary tract disease

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46
Q

normal urine output per hour

A

1-2ml/kg/hr

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47
Q

T/F

renal carcinoma is more common in dogs than cats

A

true

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48
Q

T/F

renal lymphoma is usually unilateral

A

FALSE - bilateral

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49
Q

T/F

renal lymphoma commonly causes renal azotemia

A

true – also has a tendency to spread to the CNS

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50
Q

what percent of cats with renal lymphoma go into remission?

A

60%

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51
Q

very useful tool for investigating renomegaly

A

ultrasounds

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52
Q

main cat breed affected by polycystic kidney disease

A

persian

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53
Q

acute renal failure

A

Decreased GFR leading to the retention of nitrogenous wastes

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54
Q

T/F

the term acute kidney injury implies it can be reversed

A

true

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55
Q

T/F

acute renal failure can be caused by pre,renal,post

A

true

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56
Q

what is the RIFLE criteria of AKI

A 
risk
injury
failure 
loss
end stage kidney disease

**based on proportion of serum creatinine increases and urine output decreases

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57
Q

what iris grade:

blood creatinine < 1.6mg/dl

A

grade 1

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58
Q

what iris grade:

blood creatinine 1.7-2.5 mg/dl

A

grade 2

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59
Q

what iris grade:

blood creatinine 2.6-5.0

A

grade 3

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60
Q

what iris grade:

blood creatinine 5.1-10 mg/dl

A

grade 4

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61
Q

what iris grade:

blood creatinine >10.0mg/dl

A

grade 5

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62
Q

what are some examples of etiologies of acute kidney injury

A 
hypoxia 
ischemia 
dehydration
hypotension
hypoadrenocorticism
heat stroke 
hypoperfusion
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63
Q

renal etiologies of AKI

A 
hypoperfusion
>1 week long obstruction
vasoconstriction
thrombosis and DIC 
infectious causes 
immune mediated 
neoplasia 
secondary to systemic inf
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64
Q

list 3 nephrotoxins that will cause acute renal injury

A

ethylene glycol
NSAIDS
aminoglycosides

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65
Q

what can urine leakage lead to

A

uroabdomen

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66
Q

etiologies of post renal AKI

A

urine leakage or obstruction

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67
Q

what are the 4 phases of acute renal failure

A

initial
extension
maintenance
recovery

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68
Q

this phase of ARF does not present with clinical signs, it is definable by a decrease in urine output and an increase in creatinine

A

initial / onset phase

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69
Q

what usually triggers the onset of ARF

A

an ischemic event

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70
Q

T/F

the initial/onset stage of ARF is early enough that intervention is not necessary

A

FALSE

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71
Q

phase of ARF defined by compromised Na:K pumps, loss of cellular brush boarders, and continued hypoxia

A

extension phase

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72
Q

this phase of ARF lasts 1-3 weeks and urine is an ultrafiltrate

A

maintenance

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73
Q

this phase of ARF is heralded by polyuria and extreme Na loss

A

recover - can take weeks to months to recover

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74
Q

what is a risk factor of intrinsic renal failure

A

anesthesia

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75
Q

what is abnormal urine output

A

< 0.5 ml/kg/hr

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76
Q

treatment of ARF

A

FLUIDS
maintain the fluid balance
correct shock and dehydration

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77
Q

fluid to correct shock in canine

A

60-90ml/kg over 60 minutes

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78
Q

fluid to correct shock in feline

A

45ml/kg over 60 minutes

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79
Q

dehydration correction calculation

A

%dehydrated x BW = liters over 6 to 12 hours

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80
Q

oliguria treatments

A

– Mannitol
– Furosemide
– Dopamine
– Calcium channel blockers

no EBM that these work – give FLUIDS

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81
Q

osmotic diuretic that scavenges free radicals and decreases cellular swelling

A

mannitol

contraindications are anuria and dehydration

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82
Q

Loop diuretic – Inhibits the Na-K-2CL symporter in thick ascending loop of Henle. It will decrease the Na-K ATPase pump – reducing oxygen requirements

A

furosemide

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83
Q

when you give furosemide how long until urine output should increase

A

within 2-60 minutes

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84
Q

furosemide contraindications

A

dehydration
lethargy
tachycadia
ototoxicity

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85
Q

dopamine is not effective in this species

A

cas

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86
Q

Fenoldopam use

A

increases urine output

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87
Q

calcium channel blockers MOA

A

pre-glomerular vasodilation

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88
Q

standard of care in leptospirosis

A

calcium channel blockers

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89
Q

definitive treatment for ARF

A

Extracorporeal renal replacement therapy (ERRT)/ dialysis

or peritoneal dialysis

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90
Q

ethylene glycol specific tx

A

4-methylpyrazole/ fomepizole – Within 8 hours of ingestion

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91
Q

NSAIDS specific tx

A

misoprostal - PGE analogue

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92
Q

leptospirosis specific tx

A

penicillins and doxycyline

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93
Q

pyelonephritis tx

A

Culture, fluoroquinolones or TMS (4-6 weeks)

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94
Q

complications associated with hyperkalemia

A

bradycardia
sinus arrest
muscle weakness
ileus

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95
Q

normal blood bicarb in a dog

A

18-25 mEq/L or mmol/l

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96
Q

normal blood bicarb in a cat

A

17-22 mEq/L or mmol/l

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97
Q

tx hypocalceima

A

calcium gluconate 10%

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98
Q

what drugs should be avoided in ARF

A

ace inhibitors - they will inhibit arterial vasoconstriction

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99
Q

hypertensive BP

A

> 180 mmHg systolic

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100
Q

what are these

Metoclopramide, maropitant

A

antiemetics

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101
Q

what are these

Ondansetron, metoclopramide

A

prokinetics

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102
Q

Geriatric dog on chronic NSAID that receive a general anesthesia without fluid support

A

ARF

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103
Q

Dog with pancreatitis and hypotension from SIRS

A

ARF

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104
Q

Cats with repeated episodes of previous LUTD that develop

acute obstruction

A

ARF

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105
Q

time frame that defines chronic renal disease

A

> 2 months

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106
Q

prevalence of CKD in cats

A

1-3%

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107
Q

prevalence of CKD in dogs

A

.5-1.5%

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108
Q

T/F

polycystic kidney disease is a degenerative cause of CKD

A

FALSE – developmental

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109
Q

what metabolic disturbance can cause chronic kidney disease

A

hypercalcemia

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110
Q

what percent of kidney failing leads to renal insufficiency and concentrating urine impairment

A

> 66%

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111
Q

azotemia develops at this percentage nephron failure

A

75%

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112
Q

how does CKD cause anemia

A

failure to synthesize erythropoetin

113
Q

how does CKD cause uremic gastritis

A

failure to catabolize peptide hormone gastin

114
Q

this species may suddenly become blind due to CKD

A

cats – hypertensive retinopathies

115
Q

primary route of phosphate excretion

A

kidneys – so with renal impairment there is hyperphosphatemia

116
Q

what stages of CKD will show increased phosphate

A

stages 3 and 4 – compensatory mechanisms have failed

117
Q

effects of hyperphosphatemia

A

secondary renal hyperparathyroidism

118
Q

what is not an independent risk factor in cats with chronic renal disease

A

plasma phosphate levels – only rises when creatinine rises

119
Q

what is telmisarten

A

an angiorensin receptor blocker –

120
Q

2 drugs you can give in proteinuria

A

acei - benazepril

ARB - telmisarten

121
Q

percent of patients with CKD that are hypertensive

A

20%

122
Q

treat pyelonephritis

A

UTI
antibiotics for 4-6 weeks based on culture and sensitivity
must have renal excretion and UTT penetration
repeat the culture 1 week post treatment for residual infections

123
Q

anti emetic that is a serotonin antagonist

A

ondansetron

124
Q

anti emetic that is a dopamine antagonist

A

metoclopramide

125
Q

NK antagonist anti emeti

A

maropitant

126
Q

proton pump inhibitors that can treat vomiting and nausea

A

omeprazole and pantoprazole

127
Q

H2 blockers for vomiting

A

famotidine, ranitidine, cimetidine

128
Q

what is sucralfate

A

a gastric mucosal protectant

129
Q

appetite stimulate for cats

A

Cyproheptadine (periactin)

mirtazapine - cats and dogs

130
Q

what iris stage is renal diet likely beneficial in

A

stage 2,3,4

2 and higher cats
3 and higher dogs

131
Q

non-regenerative anemia symptomatic erythropoeitin therapy in animals with a PCV lower than?

A

<20%

132
Q

T/F

anabolic steroids are treatment of choice for renal failure

A

FALSE – no evidence

133
Q

hypertensive BP

A

160-179

134
Q

normotensive BP

A

< 150

135
Q

hypertensive drug for cats

A

calcium channel blocker amlodipine

136
Q

hypertensive drug for dogs

A

acei - enalepril

benazepril

137
Q

inhibit conversion of angiotensin I to angiotensin II

A

ace inhibitors

138
Q

Limit pro-fibrotic effects angiotensin II on the kidneys

A

ace inhibitors

139
Q

Shown to reduce proteinuria (cats and dogs)

A

ace inhibitors - benazepril

140
Q

T/F

ace inhibitors will prolong the survival time in renal failure

A

false - no proven improvement

141
Q

iris stage 4 survival time in dogs and cats

A

dogs - 30 days

cats - 35 days

142
Q

in a dog with >20 PCV do not need ____

A

darbopoeitin

143
Q

physiological causes of proteinuria

A

strenuous exercise
seizures
fever
stress

144
Q

pre-renal causes of proteinuria

A

Abnormal concentrations of proteins been presented to the

kidneys (MM)

145
Q

renal causes of proteinuria

A

defective renal function or inflammation of renal tissue

146
Q

post renal causes of proteinuria

A

inflammation in the ureter, bladder, urethra, or prostate

147
Q

proteinuria is first detected by

A

dipstick

148
Q

what can cause false negatives of proteinuria

A

acidic urine and bence jones proteinurise

149
Q

gold standard to quantify proteinuria

A

24 hour measurement

150
Q

which will lose more proteins in proteinuria:

glomerular pathology or tubular pathology

A

glomerular

UPC > 2

most significant proteinuria – protein losing nephropathy

151
Q

if UPC is > 8 consider…

A

amyloidosis

152
Q

Group of conditions where immune-complexes are deposited in the glomeruli

A

glomerulonephritis

**more common in dogs

153
Q

glomerulonephritis cause in these breeds:

Shar-pei, Beagle, Abyssinian and Siamese

A

amyloidosis

154
Q

first step investigating glomerulonephritis

A

infectious disease screening – rule out borrelia, heart worm, ehrilichia, leishmania

155
Q

when taking BP how many readings on average

A

5

156
Q

lost through the glomerulus in glomerulonephritis and leads to hypercoag state

A

anti-thrombin – similar size to ALB

157
Q

how is hypercoag measured

A

thromoelastogrpahy

158
Q

what stage is kidney biopsy contraindicated for

A

stage 4 – too far gone

also contraindicated for coagulopathies

159
Q

nephrotic syndrome includes these 4 findings:

A

– Proteinuria
– Hypoalbuminemia
– Ascites/ edema
– Hypercholesterolemia

160
Q

Recommended as the first choice treatment for glomerulonephritis, rapid onset of action, low rate
of adverse drug reactions, but may cause vomiting

A

Mycophenolate mofetil

**immunosuppressive therapy

161
Q

benazepril excretion

A

100% liver

162
Q

enalapril excretion

A

50% liver

50% kidney

163
Q

Treating hypercoagulability

A

aspirin low dose
clopidogrel
and manage uremia

**DO NOT give diuretics unless they cant breathe

164
Q

most significant cause of renal disease and acute uremia of cats

A

Ureteral obstruction from calcium oxalate ureteroliths or non-mineralised debri

165
Q

ureteral obstruction is common in cats older than

A

7

166
Q

percentage false negatives on radiographs for ureteral obstructions

A

20-30%

calcium oxalate stones are most radiodense

167
Q

what 2 crystals are not seen on radiographs

A

urate and cysteine

168
Q

how sensitive is ultrasound to ureteral obstruction

A

70-80% – only seen 4-7 days following complete obstruction

169
Q

priciples ultrasound features of ureteral obstruction

A

hydronephrosis and dilatation of the proximal ureter

170
Q

incorporates ultrasound guided pyelocentesis and antegrade injection of positive contrast media into the renal pelvis and ureter to delineate the size and patency of the ureter

A

antegrade pyelonephography

171
Q

preferred imaging modality at specialist hospitals to confirm mineralisation and non-mineralised uroliths and the differential patency of the ureters

A

CT

172
Q

ureteral obstruction relaxant drugs

A

Prazosin and amitryptilline

173
Q

___% ureteral obstructions resolve alone in 3-4 days

A

20-30

174
Q

treating ureteral obstruction in a oliguric patient

A

mannitol, 0.5-1g/kg/day for 3 days

175
Q

T/F

Lithotripsy is good for dogs and cats

A

only dogs – cats are resistant to fragmentation becuase the particles are still too large to pass

176
Q

standard of care in ureteral obstructions

A

ureteral stents

soft polyurethane type catheters, they have double pigtail
design with multiple fenestrations along their length of the stent

177
Q

how are ureteral stents placed in dogs

A

cystoscopy - retrograde

178
Q

how are ureteral stents placed in cats

A

surgically - antegrade

179
Q

T/F

obstructed cat emergency - unblock the cat asap

A

false – stabilize the cat first, unblocking could kill them

give fluids for hyperkalemia

180
Q

anti stress pheromone for cats who get obstructed

A

feliway

181
Q

list the components of the lower urinary tract

A

bladder
urethra
prostate

182
Q

functions of the lower urinary tract

A

store and expel uring

183
Q

causes of Dysuria/Stranguria/Pollakiuria

A

irritation of the bladder
neoplasia
neuro disease

184
Q

dark yellow or orange urine

A

biliruinuria

185
Q

red/port wine urine

A

hematuria or pigmenturia

186
Q

pyuria

A

> 5 WBC/HPF, cysto urine

187
Q

most common microbial isolate in lutd

A

e.coli

gram positive cocci second most common

188
Q

T/F

most LUTD infections are single species microbial infections

A

TRUE (75%)

189
Q

most common route in infection in LUTD

A

ascending

190
Q

how to treat uncomplicated LUTD

A

amoxicillin and cephalosporins

10-14 days or HDSD enrofloxacin in dogs only

191
Q

what does crystalluria mean

A

urine has been saturated

192
Q

Magnesium ammonium phosphate hexahydrate

A

struvite

193
Q

treating struvites is the dog is able to urinate

A

with diet – target pH as acidic
could take 2-3 months
hills s/d

194
Q

calcium oxalate monohydrate associated with…

A

ethylene glycol tox

195
Q

small envelope shaped crystal makes urine acidic and is more common in males

A

calcium oxalate dihydrate

196
Q

T/F

calcium oxalates can be treated with diets to dilute and dissolve

A

FALSE – need surgery to remove/lithotripsy . they are spiny

197
Q

crystal commonly seen in dalmatians, black russian terriers, and english bulldogs

A

ammonium urate and xanthine

198
Q

T/F

ammonium urate and xanthine are radiolucent

A

true

199
Q

crystals seen in hepatic diseases such as PSS and cirrhosis

A

ammonium urate and xanthine

200
Q

what breed is the only one that can be given xanthine oxidase inhibitors

A

dalmatians -

allopurinol decreases uric acid production

201
Q

what should a diet do to the pH to treat ammonium urate and xanthine crystals

A

need to increase the pH (more basic) urea is acidic

202
Q

6 sided crystal

A

cystine

203
Q

uroliths Usually secondary to primary hyperparathyroidism

A

calcium phosphate uroliths

204
Q

what is the sensory neurotransmitter that is altered in feline idiopathic cystitis

A

substance P

205
Q

activates C-fibre vanilloid receptors

A

capsaicin

206
Q

what is a speculum exam

A

vagina

207
Q

signs of vaginitis appear when

A

6 weeks and 12 months old

208
Q

signalment for prostatic disease in dogs

A

males – intact except for neoplasia

209
Q

T/F

only intact males can get prostatic neoplasia

A

false – independent of neuter status

210
Q

disrupts DNA synthesis and repair

A

Topoisomerase inhibitor

211
Q

common neoplasia in the bladder/urethra

A

transistional cell carcinoma

212
Q

causes the bladder to contract/urinate

A

parasympathetics - Ach

pelvic nerve

213
Q

causes bladder to relax and fill up

A

sympathetics - Noradrenaline

hypogastric nerve

214
Q

where does the hypogastric nerve innervation come from

A

L1-4

215
Q

where does the pelvic nerve innervation come from

A

S1-S3

216
Q

diagnose:

dog with a large distended bladder that is difficult to express, and has a lesion above the sacral segment

A

detrusor areflexia with sphincter hyperreflexia

small volumes of urine

tx: baclofen

217
Q

dog with a large bladder, easily expressed, constantly leaks, and has a pelvic segment lesion

A

detrusor areflexia, and sphincter areflexia

rx: bethanecol and express bladder 3-4 times a day

218
Q

how doe detrusor atony occur

A

from overfill/obstruction
large flaccid bladder
normal neuro exam

219
Q

how will the neuro exam appear on the detrusor atony

A

normal

220
Q

the involuntary escape of urine during the storage phase of the urinary cycle

A

incontinence

221
Q

the most common etiology of urinary incontinence

A

urinary sphincter mechanism incompetence

222
Q

urinary sphincter mechanism incompetence (SMI) is responsible for what percentage of incontinence

A

85%

especially in the spayed females because it is due to lack of estrogen

223
Q

T/F

SMI is more prevalent in small breed female dogs

A

FALSE – large breeds

224
Q

what drug has similar effects to PPA but also has CVS side effects

A

ephedrine

225
Q

3 things seen on clinical exam with ectopic ureter

A

wet coat
inflamed perineum
excoriations

226
Q

treatment of choice for ectopic ureter

A

cystoscopic laser ablation

227
Q

what is seen on radiology with ectopic ureters

A

hydronephrosis

hydoureter

228
Q

a dog with proteinuria due to glomerular disease has what problem

A

renal disease

229
Q

A dog has isosthenuric urine (USG 1.008-1.012) without azotemia. What percentage of kidney is damaged?

A

66%

230
Q 
A dog has azotemia and inadequately concentrated urine (USG <1.022) with dehydration. Which is not a differential diagnosis?
A)	Renal Failure
B)	Hyperadrenocorticism
C)	Linear foreign body
D)	Furosemide treatment
E)	Phenobarbitone therapy
A

C - linear foreign body

231
Q

In cardiac disease we employ angiotensin converting enzyme inhibitors (ACE inhibitors). What effect will this have on the kidney?

A

efferent vasodilator

232
Q

which is not an accurate direct measurement of GFR
A) Radioisotope clearance with renal scintigraphy
B) Inulin clearance test
C) Serum creatinine levels
D) Iohexal clearance test

A

C - this is indirect

233
Q

What statement is FALSE regarding symmetric dimethylarginine (SDMA)?
A) SDMA is almost exclusively excreted by kidneys
B) SDMA is good indirect measure of GFR
C) SDMA levels change depending on muscle mass and dehydration
D) SDMA is likely to reise before the creatinine levels rise

A

C

234
Q 
Which of the following hormones is NOT produced in the kidney?
A)	Renin
B)	Aldosterone
C)	Erythropoietin
D)	Calcitriol
A

B

235
Q 
Which one of the following is the least helpful indirect measure of GFR?
A)	Creatinine
B)	Cystatin C
C)	Urea
D)	Urine output
A

C - urea

236
Q 
Potential causes of hospital acquired AKI include all of the following except?
A)	Radiocontrast agent
B)	NSAIDs
C)	Gentamycin
D)	Leptospirosis
E)	Septic Shock
A

D- lepto

237
Q

A 4 year old Beagle presents to your clinic with acute anorexia. Biochemistry detects mild azotemia and BG of 7.5mmol/l (RI 3.3-5.5 mmol/l) and blood gas detected a metabolic acidosis. Urinalysis has the following abnormalities: USG: 1.022, glucose 1+, blood 1+, protein 1+, sediment: many RTE cells. What is the most likely problem?
A) Diabetic ketoacidosis
B) Acute renal disease
C) Cushing’s syndrome with a cute gastritis
D) Diabetes mellitus

A

B

238
Q

What is NOT a feature of acute renal tubular injury?
A) Renal tubular epithelial cells on sediment
B) Glucosuria
C) Proteinuria
D) High fractional excretion of sodium
E) Alkalosis

A

E

239
Q

Humpty, a Tonkinese 2 year old M(N), visits your clinic as the owner has read on the internet that Tiger lilies are toxic and she saw Humpty chewing some leaves that morning. You run some biochemistry and UA screening tests but all results are WNL. Which statement is correct?
A) He is in the initiation phase of AKI
B) He is in the extension phase of AKI
C) He is in the progression phase of AKI
D) It is unlikely that Humpty ingested the leaves and there is no reason to worry

A

A

240
Q 
Hansel, a 6 yr M(N) Bernese Mt dog, (50kg) arrives at our clinic. He is 10% dehydrated and azotemic. How much fluid do you need to administer to Hansel over the first six hours (dehydration and maintenance) t orehydrate him within 6 hours? Calculate the total fluid volume required over the 6 hours. Large dogs – maintenance fluids = 44ml/kg/day.
A)	1500
B)	2200
C)	5550
D)	8500
A

C

241
Q 
You find out from history that Hansel (50kg) drank ethylene glycol yesterday. You suspect AKD based on azotemia. Hansel is fully hydrated after 6 hours. You place an indwelling urinary catheter and he produces on average 20ml/hr. Hansel has?
A)	Polyuria
B)	Oliguria
C)	Anuria
D)	Pollakiuria
A

B

242
Q 
Hansel has oliguric renal failure. As part of his fluid calculation plan, the total insensible loss is:
A)	22 ml/kg/d
B)	44 ml/kg/d
C)	66 ml/kg/d
D)	88 ml/kg/d
A

A

243
Q 
Hansel (50kg) has been on 2x maintenance for the last 12 hours but gaining weight and no change in urine output (20ml/h). You now decide to come up with a new fluid plan to prevent fluid overload. Hansel has no vomiting, diarrhea or stools. The total IVF (crystalloids that you administer is at the rate of \_\_\_\_\_\_\_\_ per hour? (insensible fluid losses = 22 ml/kg/d)
A)	25 ml/h
B)	66 ml/h
C)	100 ml/h
D)	200 ml/h
A

B

Insensible loss: 22ml/kg/d (22 x 50/24h) = 45.83ml/hr
Sensible loss: urine output: 20ml/hr, ongoing loss: no V+ or D+
Total fluids/h = 46ml + 20 ml = 66

244
Q 
Teddy, a 3 year old 12 kg Boston terrier male presents to your clinic after consuming ethylene glycol. You place the dog onto IV fluids and the dog is fully hydrated. On clinical examination you find that the dog is only producing 5ml of urine per hour. You have treated Teddy with 4-methylpyrazole. Choose the one correct fluid rate that should be administered to ensure that you do not fluid overload Teddy. Teddy is not vomiting and does not have diarrhea. Insensible fluid losses = 22ml/kg/day)
A)	27ml/h
B)	36ml/h
C)	16ml/h
D)	11ml/h
E)	2.5ml/h
A

C

245
Q

Felix has CRF. IRIS stage Felix. Creatinine 1.7mg/dl, UPC ratio of 0.35, and blood pressure is 182mmHg.
A) IRIS stage 1, proteinuric, hypertensive
B) IRIS stage 2, borderline proteinuric, severely hypertensive
C) IRIS stage 3, proteinuric, borderline hypertensive
D) IRIS stage 4, borderline proteinuric, borderline hypertensive

A

B

246
Q

A dog with CKD, IRIS stage II and UPCR of 0.4 and normotensive. Which is the correct classification?
A) IRIS stage III, non-proteinuria, normotensive
B) IRIS stage III, borderline proteinuria, normotensive
C) IRIS stage III, proteinuria, normotensive

A

B

247
Q 
A 5 year old male neutered Scottish terrier with IRIS stage III, borderline proteinuric and hypertensive, has persistent severe hypertension, has persistent severe hypertension (190mmHg) for 2 weeks with no target organ damage. What is your first choice of antihypertensive agent?
A)	Amlodipine
B)	Benazepril
C)	Propanolol
D)	Hydralazine
A

B

248
Q 
Renal diets have strong evidence to support their use due to the benefits of prolonged survival. When should you recommend starting a renal diet in a cat with CKD without proteinuria?
A)	In hospital 
B)	Stage I
C)	Stage II
D)	Stage III
E)	Stage IV
A

C

249
Q 
A 11 year old female Abyssinian with IRIS stage II, non-proteinuric and severe hypertension. What is your first choice of treatment?
A)	Amlodipine
B)	Benazepril
C)	Furosemide
D)	Propranolol
A

A

250
Q

Phoebe is an 8 year old daschund with early stage III, nonproteinuric and normotensive renal disease. PCV = 22%, and P levels are moderately elevated, Ca levels are normal and mildly decreased K levels. Phoebe is depressed and not eating. Which treatments would you recommend?
A) Renal diet, darbopoetin, mirtazapine
B) Darbopoetin, aluminum hydroxide and potassium supplementation
C) Renal diet, aluminum hydroxide, darbopoertin
D) Renal diet, aluminum hydroxide and mirtazapine

A

D

251
Q

Phoebe returned 4 weeks latr, you find moderate hypertension and rinalysis shows an E. coli UTI. What would you recommend? No sensitivity was available yet and no evidence of target organ damage.
A) Amlodipine and doxycycline
B) Benazepril and nitrofurantoin
C) Amoxycillin clavulanic acid, recheck BP in 7-10d time
D) Amikacin and enrofloxacin

A

C

252
Q

Dexter presents with the following:
1. Creatinine = 2.0mg/dl (normal <1.6mg/dl) – IRIS stage II
2. UPC ratio: 1.6 (Normal <0.2)
3. BP 162 mmHg (normal <180 mmHg)
Dexter is not eating and is lethargic, depressed, stressed and not moving around too much. Biochemistry found a hypokalemia. Which treatment regime would you recommend besides an appetite stimulant?
A) Enalapril and potassium supplementation
B) Amlodipine, renal diet and potassium supplementation
C) Telmisartan and K supplementation
D) Benazepril, renal diet and potassium supplementation

A

D

253
Q

Dexter needs a repeat blood pressure measurement, how would you get this? His forelimb circumference = 9cm.
A) Use a size 2 cuff, with oscillometric measurement
B) Use size 3 cuff with Doppler measurement
C) Use a size 4 cuff with oscillometric measurement
D) Use a size 5 cuff with Doppler measurement

A

B

254
Q

What is the mechanism of action of Telmisartan?
A) Angiotensin converting enzyme inhibitor
B) Calcium channel blocker
C) Alpha 1 blocker
D) Angiotensin receptor blocker

A

D

255
Q 
Which one of the following is NOT an independent risk factor for chronic renal disease in cats?
A)	Plasma creatinine
B)	Increased UPC ratio
C)	Plasma phosphate level
D)	Blood leukocyte count
A

C

256
Q 
Zed, a 5 year old CKCS 12kg comes into your practice with anorexia, 10% dehydration, weight loss and melena. Bloods find a severely elevated creatinine level and urinalysis finds a SG of 1.016. Maintenance fluids rate = 50ml/kg/d. You place Zed on IV fluids – what rate per ohur would you use for the first 6 hours to rehydrate him and maintain his fluids?
A)	200ml/h
B)	1200ml/h
C)	225ml/h
D)	145ml/h
A

C

257
Q 
Zed, a 5 year old CKCS 12kg, comes into your practice with anorexia, 10% dehydration, weight loss and melena. Bloods find a severely elevated creatinine level and urinalysis finds a SG of 1.016. Blood pressure is normal. What other medication is required besides an appetite stimulant?
A)	Benazepril and aluminum hydroxide
B)	Amlodipine and renal diet
C)	Omeprazole and sucralfate
D)	Metocopramide and renal diet
A

C

258
Q 
Zed’s urinalysis culture and UPC return from the lab. His UPC ratio = 0.9 and his culture is negative. What additional treatment would you recommend?
A)	Amlodipine
B)	Benazepril
C)	Diltiazem
D)	Mirtazapine
A

B

259
Q

Zed returns 2 weeks later. His creatinine level shows IRS stage III, his UPC is now borderline proteinuric and his blood pressure is still normal. His phosphorus level is normal. Would you recommend a renal diet?
A) True
B) False

A

A

260
Q

When does chronic kidney disease occur after pyelonephritis has occurred?
A) When >66% of nephrons are destroyed
B) When >75% of nephrons are destroyed
C) It has already started
D) Chronic kidney disease is unlikely to occur

A

C

261
Q 
Multiple myeloma and Bence-Jones proteinuria is an example of which category of proteinuria?
A)	Pre-renal
B)	Renal
C)	Post-renal
D)	Physiologic
A

A

262
Q 
What would be a contraindication for renal biopsy in the investigation of renal proteinuria?
A)	Hypoalbuminemia
B)	A breed with familial history
C)	IRIS stage IV azotemia
D)	Hypertension
A

C

263
Q

What is an example of immune-complex glomerulonephritis?
A) Shar pei amyloidosis
B) X linked hereditary proteinuria in Samoyed
C) Ehrlichiosis
D) Alport syndrome in Cocker spaniels

A

C

264
Q 
The complications of a glomerulonephritis syndrome include all of the following except?
A)	Hypertension
B)	Azotemia
C)	Hypoalbuminemia
D)	Hypocoagulable state
A

D

265
Q 
You have diagnosed immune complex glomerulonephritis (ICGN) in a 5 year old dog with diabetes mellitus. What is the most appropriate therapy?
A)	Prednisolone
B)	Mycophenolate mofetil
C)	Azathioprine
D)	Cyclosporin
A

B

266
Q 
What immunosuppressive protocol is least desirable for ICGN?
A)	Prednisolone
B)	Mycophenolate mofetil
C)	Mycophenolate + prednisolone
D)	Mycophenolate + azathioprine
E)	Mycophenolate + chlorambucil
A

A

267
Q

When is immunosuppressive therapy contraindicated for glomerular nephritis?
A) When cause of proteinuria not known
B) If no kidney biopsy to support ICGN diagnosis
C) If patient is azotemic
D) If patient is hypoalbuminemic
E) If patient is hypertensive

A

A

268
Q 
Peanut Butter, 7 year old MN DSH. Complaint: PU/PD, on clinical examination you palpate one large kidney. Most likely DDX is:
A)	Lymphoma
B)	Carcinoma
C)	Ureteral Obstruction
D)	PKD
A

C

269
Q 
PB has an abdominal US. The left kidney has hydronephrosis and right kidney is small and shrunken. PB is azotemic. You can’t find a ureterolith. What is best diagnostic test?
A)	Plain abdominal CT
B)	Intravenous pyelogram with rads
C)	US guided antegrade pyelography
D)	Retrograde cystogram
A

C

270
Q

Kintaro 4y M(N) DSH presented with Hx of unproductive straining in litter tray overnight. You palpate a large firm painful bladder. Owner wants to do everything she can for her cat. What is next appropriate thing to do??
A) Sedate and attempt to “unblock” urethra
B) Collect blood (Creat/BUN, electrolytes, acid/base) measurement and start IVF
C) Start with a Ca-gluconate infusion while ECG monitoring as its cardioprotective
D) Warm kintaro as hypothermia associated with mortality

A

B

271
Q 
Sebastian has been diagnosed with an acute ureteral obstruction in the left ureter. He has acute abdominal pain, erratic behaviour and mild hematuria. His blood shows no evidence of azotemia. What Tx would you consider? Owner doesn’t want to place stent.
A)	Meloxicam and butorphanol
B)	Buprenorphine and prazosin
C)	Ketoprofen and morphine
D)	Morphine and Diazepam
A

B

272
Q

Jelly bean, a FS 3y Mini Schnauzer. Primary complaint: stranguria, pollakiuria. Cystocentesis confirms a UTI (bacteria and leukocytes with RBC). Abdominal US found mildly thickened bladder wall with sludge in bladder. What do you recommend?

A) Start with cephalexin while waiting for C&S
B) Cystoscopy to get biopsies from bladder wall
C) Potassium citrate because min schnauzer
D) Prescription diet to prevent supersaturation and increase thirst due to high sodium content

A

A

273
Q 
A female S crossbreed, Sunshine, has urine C&amp;S, 7 days post 6 weeks of Abx for a complicated UTI. Bacteria is E. coli again with same spectrum of sensitivity. What is diagnosis?
A)	Superinfection
B)	Relapse
C)	Reinfection
D)	Uncomplicated
A

A

274
Q

What do you recommend to Sunshine’s owners (relapse UTI)?

A) Repeat a 6 week course of Abx
B) Rx for 6m with urinary disinfectants
C) Recommend MDB, rads and US of bladder
D) Cranberry juice extract

A

C

275
Q

Investigate Sunshine (relapse UTI) and find she has a LMN disease causing urinary retention. What protocol do you recommend to control relapse UTI?
A) Tx with full course Abx for 1 year
B) Tx with 30-50% daily in morning for 6 m
C) Tx with 30-50% total dose in evening for 6 m
D) Tx with 60% dose for 3 m

A

C

276
Q 
Minnie, 8y MN min schnauzer presents with stranguria. Based on rads, what is Dx?
A)	Cysteine
B)	CaOx
C)	Magn Ammonium phosphate
D)	Urate
A

B

277
Q 
Minnie requires Tx for CaOx uroliths, what would you recommend? Avg size is 25mm.
A)	Dietary dissolution with Abx
B)	Observation
C)	Basket retrieval
D)	Urohydropulsion
E)	Mini-laparotomy cystotomy
A

E

278
Q

Which is not a potential Rx option for Minnie after Sx, considering high recurrence rate for CaOx?

A) Thiazide diuretics
B) potassium citrate
C) Acidifying diet

A

C

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