Urology and Nephrology (E1) Flashcards
How much CO do the kidneys take?
25%
What percentage of water is reabsorbed at the proximal tubules?
65%
Which hormones work at the distal tubules? Where is it produced? What is it’s function?
Aldosterone
- Adrenal cortex
- Reabsorb sodium, excretes potassium to increase blood pressure
ADH (vasopressin) [also works in collecting duct]
- Pituitary gland
- Opens aquaporins to bring water back into circulation, concentrating urine
What does the juxtaglomerular apparatus measure?
Blood pressure
Which hormones are produced in the kidney? What are their functions?
EPO
-RBC production (bone marrow)
1,25 Dihydroxycholecalciferol (Calcitriol)
-active form of vitamin D
Renin
-Converts Angiotensinogen to Angiotensin I (liver, RAAS)
What function does PTH have on the kidneys?
Signals kidneys to excrete phosphorous and reabsorb calcium to increase [calcium] in the body
What are the causes of pre-renal azotemia?
Dehydration Hypoadrenocorticism Cardiac disease Hypovolemia Shock
(Perfusion problems)
What are the causes of renal azotemia?
Parenchymal disease Infections Cysts Inflammation Neoplasia Toxins
What are the causes of post-renal azotemia?
Blockage - urethral/bladder or just urethral
Obstruction
T/F Azotemia occurs when renal disease is present.
False, it indicates renal FAILURE
What are the 4 things that occur in cases of uremia?
Azotemia
Hypoalbuminemia
Hypercholesterolemia
Metabolic acidosis
What are accurate techniques for determining GFR?
GOLD STANDARD- Renal scintigraphy (radioisotopes)
Iohexal/Inulin/ creatinine clearance tests
Why does GIT bleeding, intravascular hemolysis and high protein diets cause false positives when using urea to measure GFR?
Causes liver to produce more urea
T/F: Creatinine is a better indicator for GFR than urea.
True
What polypeptide protease inhibitor is produced by all nucleated cells is used to measure GFR?
Cystatin C
What combination of tests is usually used to assess the kidneys?
SDMA
Creatinine
Complete urinalysis
Protein, pH, ketones, blood and which other value is useful when analyzing a urine dipstick?
Glucose
What is the normal reference range for a dog’s urine specific gravity? A cat?
Dogs >1.030
Cats >1.035
What are the 2 first choice antibiotics to treat a UTI?
Cephalosporins
Amoxi-Clav
What disease must be ruled out before performing a partial water deprivation test? What is this test for?
Cushing’s
Diabetes insipitus vs psychogenic polydipsia
If the specific gravity of urine increases when you give desmopressin, which type of DI is present?
Central
What type of azotemia is present if the fractional Na excretion is <1%?
Pre-renal
Why is it better to perform a urinalysis in house?
Storage causes crystal growth and the disintegration of casts and cells.
Why would you get a false positive UPC when a UTI is present?
Bacteria contain protein
What test should be performed before a UPC?
Urine sediment
What is the unit used to quantify bacterial culture growth?
Colony forming units (cfu)
T/F: Kidney biopsy samples should include cortex and medulla.
False, only cortex (risk damaging vessels)
Which Acid/Base derangement is common with renal disease/failure?
Metabolic acidosis
What is the normal ml/kg/hr urine output in dogs?
1-2 ml/kg/hr
T/F Patients with chronic renal failure may not have a decreased USG.
False, acute may not have a decreased USG (due to testing stored urine)
Before starting fluid therapy you perform a urine sediment test and see active sediment with tubular casts. Where is the problem (pre-renal, renal, or post-renal)?
Renal
What is the most common renal tumor and which species is it more common in?
Renal Carcinoma
Dogs
What non-neoplastic cause of renomegaly are Shar Pei dogs predisposed to?
Amyloidosis
What modality is most useful for investigating renomegaly?
Ultrasound
Which 3 dog breeds are predisposed to PKD?
Bull terriers
Cairn terriers
Westies
T/F Acute kidney injury is reversible.
True
What does RIFLE stand for?
Risk Injury Failure Loss End-stage kidney disease
(for objectively defining acute kidney injury)
What urine output is considered oliguria?
<0.5 ml/kg/hr
What etiology of AKI occurs when you have insufficient blood flow to the kidneys? How is this characterized?
Pre-renal
Fractional excretion of sodium < 1
Which are the 3 most important nephrotoxins resulting in AKI?
Ethylene glycol
NSAIDs
Aminoglycosides
What are the 4 phases of ARF in order?
Initial
Extension
Maintenance
Recovery
What part of the kidney becomes damaged first when ischemic damage occurs?
Proximal convoluted tubules
What is the best way to monitor blood volume?
Central venous pressure (cm H2O)
Name 3 (or 4) types of renoprotective drugs/
Calcium channel blockers (e.g. Amlodipine)
Selective DA-2 receptor agonists (e.g. low level Dopamine)
Selective DA-1 receptor agonists (e.g. Fenoldopam- preferred to dopamine)
Erythropoeitin analogues
What are the renal tubular biomarkers used relative to creatine in a ratio, used to help localize the region of the tubular disease in AKI/ARF?
GGT
NAG
What is the shock IVF rate in dogs? Cats?
60-90 ml/kg/hr
45 ml/kg/hr
What is the insensible fluid loss for dogs (per day)?
22ml/kg
How do insensible fluid losses occur?
Breathing and sweating
How do you calculate the volume of dehydration?
% dehydration x BW [x1000 (for mL)]
Mannitol is a(n) ______ diuretic while Furosemide is a(n) ______ diuretic
Osmotic
Loop
What is the definitive treatment for oliguria?
Extracorporeal renal replacement therapy (ERRT)/ Dialysis
What are the indirect measures of GFR?
Serum urea or creatinine
Cystatin C
SDMA
Creatinine is dependent on __________ and is produced at a _____ rate.
Muscle mass
Constant
How does administering insulin treat hyperkalemia? What do you administer after the insulin?
It drives glucose into the cell, potassium follows the glucose.
Dextrose (can also be used alone to induce insulin release)
How is acidosis treated in a patient with failing kidneys?
IV Bicarbonate administration (1/4 bolus then remainder as a CRI over 2-6hrs)
Calculation: Base deficit x BW x 0.3
Other than diet, how can hyperphosphatemia be treated?
Phosphate binders:
Aluminum hydroxide/carbonate (Alutabs/Alucaps)
Calcium carbonate/acetate (Ipakitine)
Lanthanum carbonate (Renalzin)
Large kidneys indicate ____ kidney disease, small kidneys indicate _____ kidney disease.
Acute
Chronic
Azotemia does not develop until GFR has decreased to ____% of normal.
25
What is the specific gravity of plasma? If the USG is this value what is this called?
1.008-1.012
Isosthenuria
What does the MDB (minimum data base) include?
CBC/Chemistry (incl. PCV/TP)
Urinalysis
Fecal
What is the gold standard for measuring urine concentration? What does that mean?
Osmolality
Number of particles in solution
T/F: CKD is curable and there are various treatments available.
False, incurable.
Treatments exist to modify the disease progression.
Do cats or dogs live longer with CKD?
Cats
What does DAMNIT stand for? What is this acronym for?
Degenerative/Developmental
Auto-immune/Anomalous
Metabolic
Neoplastic/Nutritional
Inflammatory (Infectious, Iatrogenic, Idiopathic, Immune-mediated)
Trauma
Stands for causes of CKD
What is the specific treatment for ARF caused by ethylene glycol ingestion (assume treatment within 8hrs of ingestion)?
4-Methylpyrazole or Ethanol IV
What is rarely increased in stage I and II of CKD and usually increased in stage III and IV CKD?
Phosphate
What are the 2 therapies to treat proteinuria?
ACE inhibitor (Benazepril)
Angiotensin Receptor Blocker [ARB] (Telmisartan)
Which method of BP measurement is better for cats and small dogs? Which BP does it measure?
Doppler
SAP
Blood pressure cuffs should be____% of the circumference of the leg.
40
Pyelonephritis is more common in cats. Why are cultures important? How long do you treat? When do you repeat the culture?
In order to choose the appropriate antibiotics
4-6 weeks
1 week post treatment
Proton pump inhibitors such as ______ are more effective to control stomach acid than H2 blockers such as _____.
Omeprazole, Pantoprazole
Famotidine, Ranitidine, Cimetidine
Which 2 drugs are used for appetite stimulation in animals with CKD?
Mirtazapine (for dogs and cats)
Cyproheptadine/ Periactin (for cats)
T/F: Renal diets are beneficial to patients with CRD, changing to these diets increases mean survival time.
True
What stage of CKD are renal diets beneficial for dogs? Cats?
Dogs -III (3)
Cats -II (2)
Symptomatic animals with CKD with a PCV of ____ may benefit from EPO therapy. What are the 2 therapy options? What should be given concurrently?
<20%
rHuEPO
Darbopoietin-alpha (much better)
Iron
How do ACE inhibitors decrease blood pressure? What are some drugs in this class?
It causes vasodilation
Benazepril, Enalapril
How do loop diuretics decrease blood pressure? What drug represents this class? Is this a good long-term choice for the treatment of hypertension due to kidney disease?
Prevents sodium reabsorption and thus decreases blood volume
Furosemide
No, causes dehydration and is potentially nephrotoxic
What are independent prognostic factors for CRD?
Creatinine (higher level, shorter life-span)
UPC
WBC count
What are the 2 hallmarks of CRF?
Azotemia and inappropriately concentrated urine
What are physiological causes of proteinuria?
Strenuous exercise
Seizures
Fever
Stress
What is the gold standard for urine protein measurement? What method is used clinically?
24-hour urine protein measurement
Urine Protein: Creatinine ratio
Glomerular disease causes ____(more/less) protein loss than tubular disease. When UPC ratio > 8 then ______ should be considered.
More (>2)
Amyloidosis
What is the term used for the condition causing severe proteinuria due to primary glomerular disease?
Protein Losing Nephropathy (PLN)
Which breeds have familial glomerulonephritis?
Samoyeds
English Cocker Spaniels
(Shar-peis)
T/F: Glomerulonephritis can result in hypocoagulability and thus bleeding disorders.
False, causes HYPERcoagulability