urology and nephrology Flashcards
1
Q
functional unit of the kidney
A
nephron
2
Q
abnormal increase in the concentration of non protein nitrogenous wastes in blood
A
azotemia
3
Q
causes of pre renal azotemia
A
dehydration hypoadrenocorticism cardiac disease shock hypovolemia
4
Q
causes of renal azotemia
A
parenchymal disease infections cysts inflammation neoplasias toxins
5
Q
post renal azotemia causes
A
blockage – bladder / urethral
6
Q
T/F
azotemia is uremia
A
false
7
Q
renal failure occurs when kidneys are no longer able to maintain
A
regulatory function
excretory function
endocrine function
8
Q
renal failure occurs at what percent damage
A
> 75%
9
Q
The constellation of clinical signs and biochemical abnormalities associated with critical loss of functional nephrons
A
uremia
10
Q
T/F
the glomerular fitration rate is diretly related to renal functional mass
A
true
11
Q
gold standard glomerular function test
A
scintigraphy
12
Q
where is urea synthesized
A
liver
13
Q
where is urea excreted
A
kidney
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
15
Q
creatinine is dependent on
A
muscle mass
16
Q
creatinine excretion
A
unchanged by the kidneys
17
Q
serum concentrations of creatinine increase with
A
reduced renal clearance
18
Q
serum creatinine concentrations decrease with
A
lower muscle mass
old patients with cachexia
19
Q
which is a better indicator of GFR:
urea
creatinine
A
creatinine
20
Q
azotemia does not develope until GFR has decreased to ___%
A
25%
21
Q
The constellation of clinical signs and biochemical abnormalities associated with critical loss of functional nephrons
A
cystatin C
22
Q
T/F
cystatin C is freely filtered by the glomerulus
A
true
23
Q
SDMA detected at what % decline in GFR
A
40%
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
25
SDMA sensitivity
100%
26
creatinine specificity
100%
27
creatinine sensitivity
17%
28
SDMA specificity
91%
29
best method for urine collections
cystocentesis
30
gold standard measurement of urine concentration
osmolality
31
falsely increases the concentration of urine
glucosuria
32
measures concentration of urine relative to plasma
urine specific gravity
33
urine SG
| 1.000 - 1.007
hyposthenuric
| <300mOsm
34
urine SG
| 1.008 - 1.012
isostenuric
| =300 osmo
35
urine SG
| 1.013 - 1.030
minimally concentrated urine
36
urine SG
| 1.013 < 1.022
inadequately concentrated urine
37
urine SG for an adequately concentrated dog
> 1.030
38
urine SG for an adequately concentrated cat
> 1.035
39
cats UPC proteinuric
> 0.4
40
dogs UPC proteinuric
> 0.5
41
most common urinary bact
e coli
42
blood in the urine
hematuria
43
red to brownish urine without intact RBC
pseudohematuria
44
T/F
| signs of dysuria are commonly associated with renal hematuria
FALSE -- unless concurrent with lower urinary tract disease, it uncommon
45
client complains that the dog has a history of pollakiuria or stranguria ... what is this a feature of
lower urinary tract disease
46
normal urine output per hour
1-2ml/kg/hr
47
T/F
| renal carcinoma is more common in dogs than cats
true
48
T/F
| renal lymphoma is usually unilateral
FALSE - bilateral
49
T/F
| renal lymphoma commonly causes renal azotemia
true -- also has a tendency to spread to the CNS
50
what percent of cats with renal lymphoma go into remission?
60%
51
very useful tool for investigating renomegaly
ultrasounds
52
main cat breed affected by polycystic kidney disease
persian
53
acute renal failure
Decreased GFR leading to the retention of nitrogenous wastes
54
T/F
| the term acute kidney injury implies it can be reversed
true
55
T/F
| acute renal failure can be caused by pre,renal,post
true
56
what is the RIFLE criteria of AKI
```
risk
injury
failure
loss
end stage kidney disease
```
**based on proportion of serum creatinine increases and urine output decreases
57
what iris grade:
| blood creatinine < 1.6mg/dl
grade 1
58
what iris grade:
| blood creatinine 1.7-2.5 mg/dl
grade 2
59
what iris grade:
| blood creatinine 2.6-5.0
grade 3
60
what iris grade:
| blood creatinine 5.1-10 mg/dl
grade 4
61
what iris grade:
| blood creatinine >10.0mg/dl
grade 5
62
what are some examples of etiologies of acute kidney injury
```
hypoxia
ischemia
dehydration
hypotension
hypoadrenocorticism
heat stroke
hypoperfusion
```
63
renal etiologies of AKI
```
hypoperfusion
>1 week long obstruction
vasoconstriction
thrombosis and DIC
infectious causes
immune mediated
neoplasia
secondary to systemic inf
```
64
list 3 nephrotoxins that will cause acute renal injury
ethylene glycol
NSAIDS
aminoglycosides
65
what can urine leakage lead to
uroabdomen
66
etiologies of post renal AKI
urine leakage or obstruction
67
what are the 4 phases of acute renal failure
initial
extension
maintenance
recovery
68
this phase of ARF does not present with clinical signs, it is definable by a decrease in urine output and an increase in creatinine
initial / onset phase
69
what usually triggers the onset of ARF
an ischemic event
70
T/F
| the initial/onset stage of ARF is early enough that intervention is not necessary
FALSE
71
phase of ARF defined by compromised Na:K pumps, loss of cellular brush boarders, and continued hypoxia
extension phase
72
this phase of ARF lasts 1-3 weeks and urine is an ultrafiltrate
maintenance
73
this phase of ARF is heralded by polyuria and extreme Na loss
recover - can take weeks to months to recover
74
what is a risk factor of intrinsic renal failure
anesthesia
75
what is abnormal urine output
< 0.5 ml/kg/hr
76
treatment of ARF
FLUIDS
maintain the fluid balance
correct shock and dehydration
77
fluid to correct shock in canine
60-90ml/kg over 60 minutes
78
fluid to correct shock in feline
45ml/kg over 60 minutes
79
dehydration correction calculation
%dehydrated x BW = liters over 6 to 12 hours
80
oliguria treatments
– Mannitol
– Furosemide
– Dopamine
– Calcium channel blockers
no EBM that these work -- give FLUIDS
81
osmotic diuretic that scavenges free radicals and decreases cellular swelling
mannitol
contraindications are anuria and dehydration
82
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
furosemide
83
when you give furosemide how long until urine output should increase
within 2-60 minutes
84
furosemide contraindications
dehydration
lethargy
tachycadia
ototoxicity
85
dopamine is not effective in this species
cas
86
Fenoldopam use
increases urine output
87
calcium channel blockers MOA
pre-glomerular vasodilation
88
standard of care in leptospirosis
calcium channel blockers
89
definitive treatment for ARF
Extracorporeal renal replacement therapy (ERRT)/ dialysis
or peritoneal dialysis
90
ethylene glycol specific tx
4-methylpyrazole/ fomepizole – Within 8 hours of ingestion
91
NSAIDS specific tx
misoprostal - PGE analogue
92
leptospirosis specific tx
penicillins and doxycyline
93
pyelonephritis tx
Culture, fluoroquinolones or TMS (4-6 weeks)
94
complications associated with hyperkalemia
bradycardia
sinus arrest
muscle weakness
ileus
95
normal blood bicarb in a dog
18-25 mEq/L or mmol/l
96
normal blood bicarb in a cat
17-22 mEq/L or mmol/l
97
tx hypocalceima
calcium gluconate 10%
98
what drugs should be avoided in ARF
ace inhibitors - they will inhibit arterial vasoconstriction
99
hypertensive BP
> 180 mmHg systolic
100
what are these
| Metoclopramide, maropitant
antiemetics
101
what are these
| Ondansetron, metoclopramide
prokinetics
102
Geriatric dog on chronic NSAID that receive a general anesthesia without fluid support
ARF
103
Dog with pancreatitis and hypotension from SIRS
ARF
104
Cats with repeated episodes of previous LUTD that develop
| acute obstruction
ARF
105
time frame that defines chronic renal disease
>2 months
106
prevalence of CKD in cats
1-3%
107
prevalence of CKD in dogs
.5-1.5%
108
T/F
| polycystic kidney disease is a degenerative cause of CKD
FALSE -- developmental
109
what metabolic disturbance can cause chronic kidney disease
hypercalcemia
110
what percent of kidney failing leads to renal insufficiency and concentrating urine impairment
>66%
111
azotemia develops at this percentage nephron failure
75%
112
how does CKD cause anemia
failure to synthesize erythropoetin
113
how does CKD cause uremic gastritis
failure to catabolize peptide hormone gastin
114
this species may suddenly become blind due to CKD
cats -- hypertensive retinopathies
115
primary route of phosphate excretion
kidneys -- so with renal impairment there is hyperphosphatemia
116
what stages of CKD will show increased phosphate
stages 3 and 4 -- compensatory mechanisms have failed
117
effects of hyperphosphatemia
secondary renal hyperparathyroidism
118
what is not an independent risk factor in cats with chronic renal disease
plasma phosphate levels -- only rises when creatinine rises
119
what is telmisarten
an angiorensin receptor blocker --
120
2 drugs you can give in proteinuria
acei - benazepril
| ARB - telmisarten
121
percent of patients with CKD that are hypertensive
20%
122
treat pyelonephritis
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
anti emetic that is a serotonin antagonist
ondansetron
124
anti emetic that is a dopamine antagonist
metoclopramide
125
NK antagonist anti emeti
maropitant
126
proton pump inhibitors that can treat vomiting and nausea
omeprazole and pantoprazole
127
H2 blockers for vomiting
famotidine, ranitidine, cimetidine
128
what is sucralfate
a gastric mucosal protectant
129
appetite stimulate for cats
Cyproheptadine (periactin)
mirtazapine - cats and dogs
130
what iris stage is renal diet likely beneficial in
stage 2,3,4
2 and higher cats
3 and higher dogs
131
non-regenerative anemia symptomatic erythropoeitin therapy in animals with a PCV lower than?
<20%
132
T/F
| anabolic steroids are treatment of choice for renal failure
FALSE -- no evidence
133
hypertensive BP
160-179
134
normotensive BP
< 150
135
hypertensive drug for cats
calcium channel blocker amlodipine
136
hypertensive drug for dogs
acei - enalepril
| benazepril
137
inhibit conversion of angiotensin I to angiotensin II
ace inhibitors
138
Limit pro-fibrotic effects angiotensin II on the kidneys
ace inhibitors
139
Shown to reduce proteinuria (cats and dogs)
ace inhibitors - benazepril
140
T/F
| ace inhibitors will prolong the survival time in renal failure
false - no proven improvement
141
iris stage 4 survival time in dogs and cats
dogs - 30 days
| cats - 35 days
142
in a dog with >20 PCV do not need ____
darbopoeitin
143
physiological causes of proteinuria
strenuous exercise
seizures
fever
stress
144
pre-renal causes of proteinuria
Abnormal concentrations of proteins been presented to the
| kidneys (MM)
145
renal causes of proteinuria
defective renal function or inflammation of renal tissue
146
post renal causes of proteinuria
inflammation in the ureter, bladder, urethra, or prostate
147
proteinuria is first detected by
dipstick
148
what can cause false negatives of proteinuria
acidic urine and bence jones proteinurise
149
gold standard to quantify proteinuria
24 hour measurement
150
which will lose more proteins in proteinuria:
| glomerular pathology or tubular pathology
glomerular
UPC > 2
most significant proteinuria -- protein losing nephropathy
151
if UPC is > 8 consider...
amyloidosis
152
Group of conditions where immune-complexes are deposited in the glomeruli
glomerulonephritis
**more common in dogs
153
glomerulonephritis cause in these breeds:
| Shar-pei, Beagle, Abyssinian and Siamese
amyloidosis
154
first step investigating glomerulonephritis
infectious disease screening -- rule out borrelia, heart worm, ehrilichia, leishmania
155
when taking BP how many readings on average
5
156
lost through the glomerulus in glomerulonephritis and leads to hypercoag state
anti-thrombin -- similar size to ALB
157
how is hypercoag measured
thromoelastogrpahy
158
what stage is kidney biopsy contraindicated for
stage 4 -- too far gone
also contraindicated for coagulopathies
159
nephrotic syndrome includes these 4 findings:
– Proteinuria
– Hypoalbuminemia
– Ascites/ edema
– Hypercholesterolemia
160
Recommended as the first choice treatment for glomerulonephritis, rapid onset of action, low rate
of adverse drug reactions, but may cause vomiting
Mycophenolate mofetil
**immunosuppressive therapy
161
benazepril excretion
100% liver
162
enalapril excretion
50% liver
| 50% kidney
163
Treating hypercoagulability
aspirin low dose
clopidogrel
and manage uremia
**DO NOT give diuretics unless they cant breathe
164
most significant cause of renal disease and acute uremia of cats
Ureteral obstruction from calcium oxalate ureteroliths or non-mineralised debri
165
ureteral obstruction is common in cats older than
7
166
percentage false negatives on radiographs for ureteral obstructions
20-30%
calcium oxalate stones are most radiodense
167
what 2 crystals are not seen on radiographs
urate and cysteine
168
how sensitive is ultrasound to ureteral obstruction
70-80% -- only seen 4-7 days following complete obstruction
169
priciples ultrasound features of ureteral obstruction
hydronephrosis and dilatation of the proximal ureter
170
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
antegrade pyelonephography
171
preferred imaging modality at specialist hospitals to confirm mineralisation and non-mineralised uroliths and the differential patency of the ureters
CT
172
ureteral obstruction relaxant drugs
Prazosin and amitryptilline
173
___% ureteral obstructions resolve alone in 3-4 days
20-30
174
treating ureteral obstruction in a oliguric patient
mannitol, 0.5-1g/kg/day for 3 days
175
T/F
| Lithotripsy is good for dogs and cats
only dogs -- cats are resistant to fragmentation becuase the particles are still too large to pass
176
standard of care in ureteral obstructions
ureteral stents
soft polyurethane type catheters, they have double pigtail
design with multiple fenestrations along their length of the stent
177
how are ureteral stents placed in dogs
cystoscopy - retrograde
178
how are ureteral stents placed in cats
surgically - antegrade
179
T/F
| obstructed cat emergency - unblock the cat asap
false -- stabilize the cat first, unblocking could kill them
give fluids for hyperkalemia
180
anti stress pheromone for cats who get obstructed
feliway
181
list the components of the lower urinary tract
bladder
urethra
prostate
182
functions of the lower urinary tract
store and expel uring
183
causes of Dysuria/Stranguria/Pollakiuria
irritation of the bladder
neoplasia
neuro disease
184
dark yellow or orange urine
biliruinuria
185
red/port wine urine
hematuria or pigmenturia
186
pyuria
> 5 WBC/HPF, cysto urine
187
most common microbial isolate in lutd
e.coli
gram positive cocci second most common
188
T/F
| most LUTD infections are single species microbial infections
TRUE (75%)
189
most common route in infection in LUTD
ascending
190
how to treat uncomplicated LUTD
amoxicillin and cephalosporins
10-14 days or HDSD enrofloxacin in dogs only
191
what does crystalluria mean
urine has been saturated
192
Magnesium ammonium phosphate hexahydrate
struvite
193
treating struvites is the dog is able to urinate
with diet -- target pH as acidic
could take 2-3 months
hills s/d
194
calcium oxalate monohydrate associated with...
ethylene glycol tox
195
small envelope shaped crystal makes urine acidic and is more common in males
calcium oxalate dihydrate
196
T/F
| calcium oxalates can be treated with diets to dilute and dissolve
FALSE -- need surgery to remove/lithotripsy . they are spiny
197
crystal commonly seen in dalmatians, black russian terriers, and english bulldogs
ammonium urate and xanthine
198
T/F
| ammonium urate and xanthine are radiolucent
true
199
crystals seen in hepatic diseases such as PSS and cirrhosis
ammonium urate and xanthine
200
what breed is the only one that can be given xanthine oxidase inhibitors
dalmatians -
allopurinol decreases uric acid production
201
what should a diet do to the pH to treat ammonium urate and xanthine crystals
need to increase the pH (more basic) urea is acidic
202
6 sided crystal
cystine
203
uroliths Usually secondary to primary hyperparathyroidism
calcium phosphate uroliths
204
what is the sensory neurotransmitter that is altered in feline idiopathic cystitis
substance P
205
activates C-fibre vanilloid receptors
capsaicin
206
what is a speculum exam
vagina
207
signs of vaginitis appear when
6 weeks and 12 months old
208
signalment for prostatic disease in dogs
males -- intact except for neoplasia
209
T/F
| only intact males can get prostatic neoplasia
false -- independent of neuter status
210
disrupts DNA synthesis and repair
Topoisomerase inhibitor
211
common neoplasia in the bladder/urethra
transistional cell carcinoma
212
causes the bladder to contract/urinate
parasympathetics - Ach
| pelvic nerve
213
causes bladder to relax and fill up
sympathetics - Noradrenaline
| hypogastric nerve
214
where does the hypogastric nerve innervation come from
L1-4
215
where does the pelvic nerve innervation come from
S1-S3
216
diagnose:
| dog with a large distended bladder that is difficult to express, and has a lesion above the sacral segment
detrusor areflexia with sphincter hyperreflexia
small volumes of urine
tx: baclofen
217
dog with a large bladder, easily expressed, constantly leaks, and has a pelvic segment lesion
detrusor areflexia, and sphincter areflexia
rx: bethanecol and express bladder 3-4 times a day
218
how doe detrusor atony occur
from overfill/obstruction
large flaccid bladder
normal neuro exam
219
how will the neuro exam appear on the detrusor atony
normal
220
the involuntary escape of urine during the storage phase of the urinary cycle
incontinence
221
the most common etiology of urinary incontinence
urinary sphincter mechanism incompetence
222
urinary sphincter mechanism incompetence (SMI) is responsible for what percentage of incontinence
85%
especially in the spayed females because it is due to lack of estrogen
223
T/F
| SMI is more prevalent in small breed female dogs
FALSE -- large breeds
224
what drug has similar effects to PPA but also has CVS side effects
ephedrine
225
3 things seen on clinical exam with ectopic ureter
wet coat
inflamed perineum
excoriations
226
treatment of choice for ectopic ureter
cystoscopic laser ablation
227
what is seen on radiology with ectopic ureters
hydronephrosis
| hydoureter
228
a dog with proteinuria due to glomerular disease has what problem
renal disease
229
A dog has isosthenuric urine (USG 1.008-1.012) without azotemia. What percentage of kidney is damaged?
66%
230
```
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
```
C - linear foreign body
231
In cardiac disease we employ angiotensin converting enzyme inhibitors (ACE inhibitors). What effect will this have on the kidney?
efferent vasodilator
232
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
C - this is indirect
233
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
C
234
```
Which of the following hormones is NOT produced in the kidney?
A) Renin
B) Aldosterone
C) Erythropoietin
D) Calcitriol
```
B
235
```
Which one of the following is the least helpful indirect measure of GFR?
A) Creatinine
B) Cystatin C
C) Urea
D) Urine output
```
C - urea
236
```
Potential causes of hospital acquired AKI include all of the following except?
A) Radiocontrast agent
B) NSAIDs
C) Gentamycin
D) Leptospirosis
E) Septic Shock
```
D- lepto
237
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
B
238
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
E
239
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
240
```
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
```
C
241
```
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
```
B
242
```
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
243
```
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
```
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
```
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
```
C
245
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
B
246
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
B
247
```
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
```
B
248
```
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
```
C
249
```
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
250
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
D
251
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
C
252
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
D
253
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
B
254
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
D
255
```
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
```
C
256
```
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
```
C
257
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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
```
C
258
```
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
```
B
259
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
260
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
C
261
```
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
262
```
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
```
C
263
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
C
264
```
The complications of a glomerulonephritis syndrome include all of the following except?
A) Hypertension
B) Azotemia
C) Hypoalbuminemia
D) Hypocoagulable state
```
D
265
```
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
```
B
266
```
What immunosuppressive protocol is least desirable for ICGN?
A) Prednisolone
B) Mycophenolate mofetil
C) Mycophenolate + prednisolone
D) Mycophenolate + azathioprine
E) Mycophenolate + chlorambucil
```
A
267
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
268
```
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
```
C
269
```
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
```
C
270
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
B
271
```
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
```
B
272
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
273
```
A female S crossbreed, Sunshine, has urine C&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
274
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
C
275
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
C
276
```
Minnie, 8y MN min schnauzer presents with stranguria. Based on rads, what is Dx?
A) Cysteine
B) CaOx
C) Magn Ammonium phosphate
D) Urate
```
B
277
```
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
```
E
278
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
C
