Urology/Nephrology Flashcards by Corinne Perra

What are the 3 substances/hormones produced by the kindey?

Erythropoietin
1,25-Dihydroxycholecalciferol
Renin

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What is azotemia?

Abnormal increase in the concentration of non-protein nitrogenous wastes (eg urea and creatinine)

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What is renal failure?

Clinical syndrome when the kidney is no longer able to maintain

Regulatory function
Excretory function
Endocrine function

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Renal failure occurs when >_____% of the nephrons are non functional

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T/F: you will always see azotemia in renal disease

False

Requires 75% nephron loss to have azotemia

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What is a uremia?

Clinical signs associated with critical loss of functional nephrons

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What are the extra-renal manifestations of renal failure, which is aka uremic syndrome

Azotemia
Hypoalbuminemia
Hypercholesterolemia
Metabolic acidosis

Hyperkalemia
Hypocalcemia
Increased PTH

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What are the methods of direct measurement of GFR?

Clearance of radioisotope with renal scintigraphy

Iohexal
Inulin
Creatinine clearance tests

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What are INDIRECT methods of measuring GFR?

Serum urea levels
Serum creatinine
Cystatin C
SDMA

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Serum levels of urea are affected by??

Species/age 
Liver function
Dietary protein content 
Endogenous protein catabolism 
Renal function

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Urea is synthesized in the __________ from???

Liver; ammonia and protein in GI tract/muscle breakdown

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Why is urea not a reliable estimate of GFR?

Passively reabsorbed in the tubules —> can be exacerbate by slower tubular flow rates (dehydration/hypovolemia)

False positives - GIT bleeding, intravascular hemolysis, and high protein diets

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Where is creatine synthesized?

Breakdown of creatine phosphate in muscles

> produced at a constant rate
> dependent on muscle mass
> influenced less by diet

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What are causes of increased serum concentrations of creatinine?

Reduced renal clearance

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What are causes of decreased serum concentrations of creatinine?

Reduced muscle mass

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Which is a better indication of GFR, creatinine or urea?

Creatinine

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T/F: severity of renal disease is proportional to the increased creatinine

False

Cannot prognosticate based on magnitude of azotemia

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What is cystatin C?

Small polypeptide protease inhibitor produced by all cells with nucleus

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T/F: cystatin C is freely filtered by glomeruli and is almost completely reabsorbed by proximal tubular cells

True

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Where is SDMA produced?

In every cell, released into circulation during protein degredation

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SDMA is increased when there is a _____% decline in GFR

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How can urine be collected?

Free flow
-> cannot be used for culture

Catheterization
-> difficult in females

Cystocentesis
BEST method
-sterile sample

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What are components of a urinalysis?

Colour/clarity 
Dipstick 
Concentration 
Sediment 
urine protein:creatinine ratio

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What are the useful tests in a dipstick analysis of urine?

Protein 
PH 
Blood 
Glucose 
Ketone

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How do we measure urine concentration

Refractometer -calibrated with distilled water-> should measure 0

What can cause a falsely increased USG?

Glucosuria | Proteinuria

What is the USG for hyposthenuria?

1.000 - 1.007

What is the USG for isosthenuria ?

1.008-1.012

Minimally concentrated urine has a USG of?

1.013-1.030

What is the USG for adequately concentrated urine in dogs and cats?

Dog > 1.030 | Cat> 1.035

``` Case History of trauma Dog with PU/PD UA -USG 1.005 -dipstick normal ``` What are possible DDX ?

Hyposthenuria - diabetes insipidus (central or nephrogenic) - cushings - psychogenic

For a hyposthenuric dog, your top DDX are.. Diabetes insipidus, psychogenic polypidpisa, and hyperadrenocortisim. What do you do next?

Rule out.. hyperadrenocortisim with a urine cortisol:creatine ratio Partial water deprivation test

When doing a partial water deprivation test, when do you see maximal ADH release?

After 5% loss of body weight in water

Failure to concentrate with partial water deprivation test rules out?

Rules out psychogenic polydipsia Left with diabetes insipidus

How can you differentiate between central and nephrogenic DI?

Give desmopressin - > concentrate urine = central - > non concentrated = nephrogenic

When doing a urine sediment, what are you looking for?

Cells Bacteria Crystal Casts

What can cause a false positive UPC?

Cloudy urine

How can you determine is a proteinuria is due to renal disease or not?

Urine protein:creatinine ratio >0.5 tubular/glomerular disease

What are non-renal causes of proteinuria?

Hemorrhage UTI/cystitis Intravascular hemolysis (hemoglobinuria)

What test can you use to find a transitional cell carcinoma?

Bladder tumors antigen test | 88% specificity

What is the most common bacteria found in UTI?

E. coli Gram negative aerobic Also common bacteria in contaminated samples

When doing a kidney biopsy, what part of the kidney should you take your sample from?

Cortex

What is hematuria ?

Presence of blood in ruine

What can cause a pseudohamturia?

Hemoglobinuria, myoglobinuria, or chemicals

Where can heamaturia originate from?

Systemic disorder Renal Bladder, ureter, urethra Genital tract

What disease of the kidney can cause hematuria?

Neoplasia, calculus, trauma, infarction, cyst, glomerulonephritis, and infection

What can cause a hematuria arising from he bladder/ureter/urethra?

``` Bacterial infection Calculi Trauma Neoplasia Polyps Cyclophosphamide Feline idiopathic cystitis ```

What genital tract conditions can cause a hematuria?

Prostatic disease, oestrus, infection, neoplasia, and trauma

What diagnostics can you do in a case of hematuria?

``` Hematology/blood smear Biochem UA and cluture Imaging (US) Cystoscopy Vaginoscopy Prostatic wash ```

What are clinical signs of kidney disease?

``` PU/PD Anorexia/ GI signs/ weight loss Pale mucous membranes Lethargy Blindness Distended abdomen ```

What are signs of lower urinary tract disease?

Inappropriate urinating Pollakiuria, dysuria, stranguria Hematuria

You have a patient with a disorder of micturition, what should your clinical exam include?

Vitals, body score, and hydration status Palpate kidney ``` Oral - uremic stomatitis Rectal -prostate Bladder palpitation Neuro exam Ophthalmic exam ``` Young animals -fibrous osteodystrophy Perineum -odor, urine scald, folds Vaginal exam-discharge/masses

T/F: you always have a low USG with acute kidney disease

False

What are causes of renomegaly?

Primary - renal adenocarcinoma - renal lymphoma - renal sarcoma - nephroblastoma Metastatic (rare)

T/F: renal carcinoma is more common in dogs than cats

True

Clinical signs associated with renal carcinoma?

Hematuria and weight loss Unilateral renomegaly Rarely azotemia Polycythemia as a paraneoplasic syndrome —> EPO production Hypertrophic osteopathy as paraneoplastic syndrome

How can you diagnose renal carcinoma?

Renal ultrasound | FNA

What is the treatment for renal carcinoma?

Ensure sufficient rxn in contralateral kidney Nephrectomy Prognosis is about 16months

T/F: renal lymphoma is more common in cats than dogs

True

T/F: renal lymphoma usually only affects one kidney

False | Both

What is the presentation of renal lymphoma?

Renomegaly Weight loss Inappetance PU/PD Azotemia Systemic CNS spread

What is the treatment for renal lymphoma?

Chemotherapy 60% of cats go into remission

What are the non-neoplasic causes of renomegaly?

``` Inflammation -nephrosis -pyelonephritis -FIP -lepto Amyloidosis Hydronephrosis Polycystic kidney dz Portosystemic shunt ``` Acute urethral obstruction (cats)

What breed is polycystic kidney disease prevalent in?

Persian cats Autosomal dominant gene - mutant PKD1 Also in... bull terriers Carin terriers WHW terriers