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SAM 2 > Urology- Introduction > Flashcards

Urology- Introduction Flashcards

1
Q

What comprises the upper urinary tract?

A

Kidneys and ureters

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2
Q

What comprises the lower urinary tract?

A

Bladder and urethra

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3
Q

What is the purpose of the upper urinary tract?

A

Production and movement of urine

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4
Q

What is the purpose of the lower urinary tract?

A

Storage and elimination of urine

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5
Q

How much of the CO do the kidneys receive?

A

20-25%

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6
Q

What is the functional unit of the kidney?

A

Nephron

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7
Q

What are the functions of the kidneys? (5)

A
  1. Excrete waste
  2. Retrieve filtered particles
  3. Maintain acid/base balance
  4. Regulate blood pressure
  5. Stimulate erythrocyte production
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8
Q

Where is most of the water reabsorbed in the nephron?

A

Proximal tubule and descending loop of henle

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9
Q

Where is angiotensin 1 converted to angiotensin 2?

A

Lungs

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10
Q

What gland produces aldosterone?

A

Adrenal

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11
Q

What cells produce renin?

A

Juxtaglomerular cells

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12
Q

What does renin stimulate the production of and where?

A

Angiotensin 1 in the liver

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13
Q

T/F: The kidney is the site of production of active vit D.

A

True

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14
Q

What is azotemia?

A

Abnormal increased in concentration of BUN and/or creatinine in the blood

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15
Q

What can pre-renal azotemia be due to?

A
  • Dehydration
  • Hypoadrenocorticism
  • Cardiac disease
  • Shock
  • Hypovolemia
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16
Q

What is pre-renal azotemia a result of?

A

Poor renal perfusion

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17
Q

What can renal azotemia be due to?

A
  • Parenchymal disease
  • Infections
  • Cysts
  • Inflammation
  • Neoplasia
  • Toxins
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18
Q

What can post-renal azotemia be due to?

A

Blockage of the ureters, bladder, or urethra

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19
Q

T/F: Azotemia is synonymous with uremia.

A

False!

Although an azotemic patient may ALSO be uremic

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20
Q

Renal failure is defined by failure to perform what three functions?

A

Regulatory, excretory, and endocrine

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21
Q

What will renal failure result in?

A

Retention of nitrogenous solutes and derangement of fluid, electrolytes, and acid-base balance

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22
Q

Loss of what percent of nephrons will result in renal failure?

A

75%

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23
Q

T/F: An animal cannot survive with only one kidney.

A

False

Although the animal is then at higher risk for renal failure since it only has 50% of it’s total nephrons.

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24
Q

What is the definition of renal disease?

A

Presence of morphological or functional lesions in one or both kidneys.

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25
Q

What is uremia?

A

Collection of clinical signs and biochemical changes associated with the critical loss of functional nephrons.

(Primarily due to accumulation of toxic substances)

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26
Q

T/F: Uremia includes extra-renal manifestations of renal failure.

A

True

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27
Q

What does the glomerular filtration rate directly related to?

A

Renal functional mass

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28
Q

What are some accurate techniques to measure GFR? (2)

A
  • Clearance of radioisotopes with renal scintigraphy

- Iohexal/inulin/creatinine clearance tests

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29
Q

What are some indurect methods that indicate GFR?

A
  • Serurm urea levels
  • Serum creatinine levels
  • Cystatin C
  • SDMA
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30
Q

What is the gold standard test for GFR?

A

Renal scintigraphy

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31
Q

Where is urea synthesized?

A

Liver

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32
Q

Where is urea excreted?

A

Kidneys

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33
Q

What does urea do in the kidney?

A

Helps maintain the concentration gradient in the medulla. (Essential for proper kidney function)

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34
Q

Are all animals going to have the same “normal” levels of urea?

A

No, normal levels are effected by all the things.

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35
Q

T/F: Urea is a reliable estimate of GFR

A

False

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36
Q

Why is urea an unreliable estimate of GFR?

A

Subject to passive re-absorption in the tubules which can be exacerbated by slow rates of flow or tubular damage

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37
Q

What can lead to a falsely high urea level? (3)

A

GIT bleeds, intravascular hemolysis, high protein diets

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38
Q

What is creatinine synthesized from?

A

From the breakdown of creatine in muscle

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39
Q

T/F: Creatinine is produced at varying rates depending on muscle activity.

A

False, produced at a constant rate

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40
Q

T/F: Creatinine levels are dependent on muscle mass.

A

True, heavier muscled animals will have higher levels or creatinine

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41
Q

Is creatinine influenced by the diet?

A

Not significantly

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42
Q

Where is creatinine excreted?

A

Kidneys, unchanged

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43
Q

What will increase serum creatinine levels?

A

Reduced renal clearance/GFR

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44
Q

What will decrease serum creatinine levels?

A

Reduced muscle mass (may be significant in old or cachexic patients)

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45
Q

At what percent reduction of GFR will azotemia develop?

A

75% reduction (aka 25% of normal)

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46
Q

Is the relationship between creatinine excretion and GFR linear?

A

No, but still better indication than urea

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47
Q

Does creatinine give you an exact reason for the decreased GFR?

A

No

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48
Q

Will creatinine levels differ dependent on the cause of the azotemia?

A

No

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49
Q

Will creatinine levels differ dependent on an acute versus a chronic process?

A

No

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50
Q

Will creatinine levels differ dependent on reversible or irreversible failure?

A

No

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51
Q

T/F: Severity of clinical signs of azotemia are directly proportional to the magnitude of the increase.

A

False, there is massive individual variation

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52
Q

Is the severity of the azotemia a good prognostic indicator?

A

No, just gives you an indication that there IS a problem

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53
Q

What is cystatin C?

A

Small polypeptide protease inhibitor produced by all nucleated cells

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54
Q

Why is cystatin C a good indicator for GFR?

A

Freely filtered by the glomeruli and does not undergo tubular secretion

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55
Q

T/F: Cystatin C is completely reabsorbed by the proximal tubular cells and catabolized into amino acids

A

True

56
Q

What is SDMA?

A

Symmetic dimethlarginine- methlyated form of arginine which is produced by all cells and released into the blood during protein degradation

57
Q

What is the advantage of SDMA over creatinine as an indication of GFR?

A

Increases earlier than creatinine and can be detected at 40% decline in GFR

58
Q

Is SDMA impacted by extra-renal factors or lean body mass?

A

No, kidney function specific

59
Q

What is an important test for determining kidney function?

A

Urinalysis

60
Q

What is the best method for urine collection for analysis?

A

Cystocentesis

61
Q

What is a disadvantage of cystocentesis?

A

May give a false positive for blood

62
Q

What kind of animal is urinary catheterization most used it?

A

Male dogs

63
Q

What are the only useful tests on dipsticks?

A

Protein, pH, blood, glucose, ketone

Dipsticks are designed for humans, not animals

64
Q

What are the two ways in which we can measure urine concentration?

A

Gold standard: osmolality

Used in practice: specific gravity

65
Q

How are refractometers calibrated?

A

Distilled water set to 1.000

66
Q

What solute can result in a falsely increased specific gravity?

A

Glucose

67
Q

What range of SG is hyposthenuria?

A

1.000 - 1.007 or

68
Q

What range of SG is is isosthenuria?

A

1.008 - 1.012 or ~300mOm

69
Q

What range of SG is hypersthenuria?

A

> 1.012 or >300mOm

70
Q

What range of SG is minimally concentrated urine?

A

1.013 - 1.030

71
Q

What range of SG is is inadequately concentrated urine?

A
72
Q

What range of SG is adequately concentrated urine?

A

Dogs >1.030

Cats >1.035

73
Q

What do we look for in sediment exams?

A

Bacteria, cells, casts, crystals

74
Q

What are some causes of hyposthenuria?

A
  • Psychogenic polydipsia
  • Diabetes insipidus
  • Hyperadronocorticism
75
Q

What does a partial water deprivation test differentiate between?

A

Psychogenic polydipisa and diabetes insipidus

76
Q

What would a failure to concentrate durin a partial water deprivation test indicate?

A

Nephrogenic DI or medullary washout

77
Q

What is the fractional excretion of electrolytes used to assess?

A

Renal tubular dysfunction

78
Q

What is the most common fractional excretion used?

A

Na- fractional excretion

79
Q

What are the electrolytes compared to in a fractional excretion value?

A

Creatinine

80
Q

What percentage Na-fractional excretion would indicate prerenal disease?

A
81
Q

What precentage Na-fractional excretion would indicate renal disease?

A

> 1%

82
Q

Which breed of dog is predisposed to calcium dihydrate crystals?

A

Bischons

83
Q

Which breed of dog is predisposed to cystiene crystals?

A

Bulldogs

84
Q

Which breed of dog is predisposed to ammonium biurate crystals?

A

Dalmatians

85
Q

Which animal is predisposed to struvite crystals?

A

Cats

86
Q

What toxin will result in calcium monohydrate crystals?

A

Ethylene glycol

87
Q

What is the urine protein creatinine ratio used to correlate?

A

Protein excretion during a 24hr period

88
Q

What are the urine protein creatinine ratio values for a cat?

A

> 0.4 = proteinuric

0.2-0.4 = borderline, recheck in 2mo

89
Q

What are the urine protein creatinine ratio values for a dog?

A

> 0.5 = proteinuric

0.2-0.5 = borderline, recheck in 2mo

90
Q

Should urine protein creatinine ratio be interpreted by itself?

A

No, only after sedimentation and culture

91
Q

Are bladder tumor anitgen tests super useful?

A

No, very poor specificity/sensitivity which gets worse with concurrent urinary tract disease

92
Q

What are the most common types of bacteria found in the urinary tract?

A

Gram negative aerobic bacteria

E. coli most common

93
Q

What is a common source of bacteria in urine?

A

Environmental contamination- false positive

94
Q

T/F: Presence of bacteria in any quantity is enough to diagnose a UTI.

A

False- must be a certain number of CFU’s per mL

95
Q

What are the storage time limits for a urine sample to culture?

A

Fresh- within 30 min
Refrigerated- up to 6 hours
Chemical preservatives and regrigeration- up to 72 hours

96
Q

What part of the kidney should be biopsied with ultrasound or endoscope?

A

Cortex

Blind sampling of the medulla risks hitting a interlobar artery

97
Q

Can full thickness/wedge biopsies be obtained from a kidney?

A

Yes, requires general anesthesia and abdominal surgery

98
Q

What is hematuria?

A

Presence of blood or red blood cells in the urine

99
Q

What is gross hematuria?

A

Sufficient blood present to be apparent to the naked eye

100
Q

What is occult hematuria

A

Blood present in insufficient quantities to be visible to the naked eye

101
Q

What is pseudohematuria?

A

Red to brownish urine without intact red blood cells

102
Q

What can pseudohematuria be due to the presence of?

A

Hemoglobin, myoglobin, or chemicals

103
Q

What is a systemic cause of hematuria?

A

Hemostatic disorders

104
Q

What are renal causes of hematuria

A

Neoplasia, calculi, trauma, infarction, cysts, glomerulonephritis, infection

105
Q

What are lower urinary tract causes of hematuria?

A

Bacterial infection, calculi, trauma, neoplasia, polyps, cyclophosphamide therapy, feline idiopathic cystitis

106
Q

What are genital tract causes of hematuria?

A

Prostatic disease, oestrus, infection, neoplasia, trauma

107
Q

Can hematuria lead to hemoglobinuria?

A

Yes, if the red cells lyse

108
Q

Are animals with hematuria usually dysuric?

A

No, not unless there is concurrent lower urinary tract disease/obstrution

109
Q

What are the clinical manifestations of kidney disease?

A
  • PU/PD
  • Anorexia/GI issues/ wt. loss
  • Pale MM
  • Lethargy
  • Blindness
  • Distended abdomen
110
Q

Why will renal disease/failure patients have pale MM?

A

Anemia due to decreased EPO production

111
Q

Why will renal disease/failure patients be blind?

A

Hypertension due to increased angiotensin 2

112
Q

What is pollakiuria?

A

Frequent, small volumes of urine

113
Q

What is dysuria?

A

Trying to urinate with little no to production

NOT straining

114
Q

What is stranguria?

A

Straining to urinate

May be painful

115
Q

What are some clinical findings of an animal with LUTD?

A
  • Dehydration
  • Enlarged bladder (may be profound)
  • Difficult/impossible urinary catheterization
  • Localized SQ fluid around perineum or ventral abdomen (post-renal)
  • Free peritoneal fluid
  • Urine retention/incontinence
  • Straining or abnormal posture
116
Q

What is a normal urine output?

A

1-2 mL/kg/hr

117
Q

Should specific gravity be measured prior to any fluid therapy?

A

Yes- fluid therapy can falsely decrease SG

118
Q

What are some things that can be used to differentiate between acute and chronic renal failure?

A
  • Weight loss
  • PU/PD history
  • PCV
  • USG
  • Size of parathyroid glands
  • Carbamylated Hb
119
Q

Is renal neoplasia common in small animals?

A

No

120
Q

What are the primary renal neoplasms?

A

Adenocarcinoma
Lymphoma
Sarcoma
Nephroblastoma

121
Q

Is the kidney a possible site of metastasis?

A

Yes

122
Q

Are renal carcinomas more common in dogs or cats?

A

Dogs

123
Q

Do renal carcinomas typically cause clinical signs in early stages?

A

No

124
Q

What are some features of renal carcinomas?

A
  • Hematuria and wt loss
  • Typically unilateral causing renomegaly
  • Rarely causes azotemia
  • Can cause polycythemia and hypertrophic osteopathy
125
Q

What percentage of animals will have metastasis from renal carcinomas at time of diagnosis?

A

50%

126
Q

How do you treat renal carcinomas?

A

Nephrectomy (make sure other kidney is okay first!)

127
Q

What is the prognosis for renal carcinomas?

A

Most dogs survive about 16mo without treatment

128
Q

Are renal lymphomas more common in dogs or cats?

A

Cats

129
Q

What are some features of renal lymphomas?

A
  • Usually bilateral and enlarging
  • Weight loss, inappetance
  • PU/PD
  • Commonly azotemic
  • Often systemic
  • Tendency to spread to CNS
  • Fair association with FeLV
130
Q

How do you treat renal lymphomas

A
  • Multi-agent chemotherapy
131
Q

What is the prognosis for renal lymphoma?

A

About 60% go into remission

Most cats survive 91 days with treatment

132
Q

What are some non-neoplastic causes of renomegaly?

A
  • Renal inflammation
  • Amyloidosis
  • Hydronephrosis
  • PKD
  • PSS
133
Q

Which breed is predisposed to PKD?

A

Persian cats- mutation in PKD-1 gene

134
Q

Is PKD generally symptomatic?

A

Depends on severity of cyst infiltration

135
Q

Why is renal pain difficult to assess?

A

Typically referred or interpreted as spinal pain

136
Q

What are some causes of renal pain?

A
  • Pyelonephritis
  • Renal Calculi
  • Acute nephrosis
  • Early hydronephrosis
  • Renal trauma
  • Abscess
  • Neoplasia (rare)

SAM 2 (21 decks)

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