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Internal Medicine
Renal
79
Veterinary Medicine
Graduate
12/05/2011

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Cards

Term
What are the major causes of proteinuria?
Definition
Urinary tract inflammation (UTI MOST COMMON)
Glomerular injury (ie. amyloidosis)
Term
When trying to differentiate the significance of a proteinuria, what should you do?
Definition
FIRST = look at Urine specific gravity
then - try urine protein-creatinine ratio
Term
Bilirubinuria is more significant in which species? Why?
Definition
Cats, because they have a higher renal threshold, so if it is elevated then the serum concentration is also elevated.
*most likely cause = primary hepatic disease*
Term
What are some considerations when preforming a renal biopsy?
Definition
- very vascular, both capsule and parenchyma, so it may bleed
- run biopsy needle parallel to the renal cortex to get to where most of the nephrons are
- rarely preformed
Term
What are some indications for preforming a renal biopsy?
Definition
- young dog that is unable to concentrate urine
- glomerular injury and need to find etiology
Term
What are the most common types of renal neoplasias in a dog?
Definition
Carcinoma, adenocarcinoma
- very aggressive, but also decent prognosis (check for metastisis)
Term
If a dog is presented with unexplained azotemia and icterus, what should be on your differentials?
Definition
LEPTO
titer is easy to run and rule out
Term
Which is more common: Pre-renal, renal, or post-renal azotemia?
Definition
PRE-renal
sometihng causing decreased perfusion to the kidneys
(hypovolemia, shock, decreased cardiac output, dehydration, hypoproteinemia)
Term
What are the common causes of pre-renal azotemia?
Definition
decreased perfusion to the kidneys:
-hypovolemia
-shock
-diuretic use
-anesthesetic event
- cardiac disease (decreased CO)
- dehydration
- hypoproteinemia
Term
How would you diagnose pre-renal azotemia?
Definition
HISTORY and EXAM
-look @ hydration status
-cardiac signs of illness
-tachycardia
-abnormalities in non renal systems
Fully concentrated urine (USG = Normal)
urinalysis = Normal
polycythemia (increased PCV)
biochem may show non renal disease process
Term
What is the prognosis with pre-renal azotemia? What are some long term effects?
Definition
Prognosis is generally good
- if ischemia of kidney persists, it can damage nephrons and cause primary azotemia
Term
What is the mechanism of disease in obstructive post-renal azotemia?
Definition
Obstruction (involving BOTH kidneys) prevents excretion of urine.
Urine backs up the urinary tract.
Backs up to kidneys.
Increased Tubular pressure opposes GFR
Term
Animals with a ruptured bladder and uroperitoneum are unable to pass urine.
True or False?
Definition
FALSE
they may be able to pass small amounts of urine, so it may appear normal to owners
Term
When performing a abdominal paracentesis, which is a better indicator of a ruptured bladder: BUN or Creatinine?
Definition
CREATININE
-takes longer to equilibriate, where BUN is much quicker
Term
What is the functional definition of primary renal azotemia?
Definition
Solute retention associated with a loss of 75% of functional nephrons
Term
Profound dehydration can cause tachycardia.
True or False?
Definition
TRUE
Term
What are some clinical signs of dehydration?
Definition
Increased skin tenting
dry mucous membrnaes
prolonged capillary refill time
enophthalmia
weakened femoral pulses
tachycardia
Term
What are the three components of 24 hour fluid replacement therapy?
Definition
Replacement therapy (to get animal back to normal)
Maintenance therapy (maintain normal hydration)
On-going losses (lost in vomit/diarrhea)
Term
What are some causes of acute renal failure?
Definition
Nephrotoxins
-Acetominophen in cats
-ethylene glycol poisoning
Obstructions
Ischemia
-thromboembolisms
Term
What is the most common electrolyte imbalance seen in acute renal failure?
Definition
HYPERKALEMIA
because the potassium is not excreted properly in the urine
Term
What is most often seen in acute renal failure:
A) metbolic alkalosis
B) metabolic acidosis
C) respiratory alkalosis
D) respiratory acidosis
Definition
B) metabolic acidosis
Term
What are the common nephrotoxins that cause acute primary renal failure?
Definition
Antibiotics
Ethylene glycol
chemotherapy agents
NSAIDS
ACE inhibitors
acetominophine
Term
How do nephrotoxins cause acute renal failure? (mechanism of pathogenesis)
Definition
cause renal hypoperfusion
- disturb proximal tubular cellular metabolism
Term
What are some physical exam findings of acute renal failure?
Definition
Uremic breath, oral ulcers
congested mucous membrnaes
dehydration, fever with nephritis
renal pain on palpation
normal-enlarged kidneys
Term
Which is not associated with Acute Renal Failure:
A) PU/PD
B) mucous membrane congestion
C) Kidney pain on palpation
D) Small bladder
E) dehydration
Definition
Answer: A)
with acute renal failure there is not enough time to make the animal pu/pd !!
the rest can all be seen though
Term
Why would you preform serological assays in diagnostic workups of acute renal failure?
Definition
- leptospirosis
- ethylene glycol metabolites
Term
What are some considerations when administering antibiotics to an animal with acute renal failure?
Definition
- *culture and sensitivity*
may need specific abx for lepto, etc
- may need to reduce dose, or increase dosing interval because many abx are eliminated in the urine (compensate for decreased GFR)
Term
What is the drug of choice for treating Leptospirosis?
Definition
- Ampicillin
(we were taught Doxycycline Previously, but he says ampicillin then doxy if needed)
Term
What are the most common bacterial infections associated with acute renal failure?
Definition
E. coli
Staph
Strep
Term
What measurements are indicative of metabolic acidosis (in acute renal failure) ?
Definition
Blood pH below 7.2
bicarb of 12 or less
**start on bicarb therapy**
Term
Why might a dopamine infusion be used to treat acute renal failure? What are some precautions?
Definition
- dopaminergic receptors on the heart and kidneys
- kidney receptors cause vasodilation
- cats have no renal receptors (increased perfusion from cardiac effects)
net effect = increase renal blood flow to increase GFR
* long term use can have cardiac effects
Term
What are the treatment strategies for treating hypovlemia of acute renal failure? What happens if your first choice still doesn't increase urine output?
Definition
1) Fluids (LRS)
2) Mannitol to draw fluid into vasculature
if not increase for 2 hours...
3) add diuretic (furosemide), but needs to be well hydrated to work
4) finally Dopamine - to increase renal perfusion from cardiac and renal vasodilating receptors
Term
What are the indicators for bicarb therapy?
Definition
blood pH of 7.2 or less
bicarb levels of 12 or less
(he said this at least three times, so Im assuming its important...)
Term
What is the best prognostic factor when treating Acute Renal Failure?
Definition
Urine production
Term
What would be seen with the kidneys on necropsy of a dog with ethylene glycol poisoning?
Definition
Severe tubular necorsis
calcium crystals
Term
What is the more common cause of renal failure in dogs?
Definition
Leptosporosis
Term
What effects do renal failure have on RBCs?
Definition
decreased erythropoeitin released from the kidneys - so there is less ability to synthesis and release RBCs into periphery
- life span of circulating RBCs are REDUCED
=non regenerative anemia
(bone marrow also replaced to fibrous connective tissue)
Term
What are some radiographic findings of renal failure?
Definition
Reduced Renal size
irregular renal contours
renal mineralization
Term
What might cause enlarged kidneys?
Definition
infectious: FIP
obstructions (trigone neoplsia, etc)
Neoplasia
inflammation
Term
What are the differences between Chronic renal failure and Acute renal failure?
Definition
Acute - increased renal size, NO pu/pd, no anemia, hyperkalemia (not excreting), metabolic acidosis
Chronic - hypokalemia, no metabolic acidosis, DECREASED kidney size, osteoporosis (bone loss), pu/pd, non regenerative anemia
Term
Why should management of chronic renal failure include low protein diets?
Definition
Because minimizing the protein will decrease the azotemia, damage to the kidneys, and amount of solutes that the glomeruli should filter.
Term
Why should management of chronic renal failure include decreased sodium diet?
Definition
Because it can increase the risk of hypervolemia and hypertension - which would have substantial systemic effects
Term
Animals with chronic renal failure often are hypocalcemic, which causes bone resorption.
True or False?
Definition
FALSE
the problem is the PHOSPHORUS is increased causing a disturbance in the Ca:P ratio. The body reads this as a decrease in calcium, causing a release of PTH and resorption of bone.
Term
A dog presents with leukocytosis and pu/pd, T: 102.1, HR: 154, lethargy and weight loss. Should you start giving antibiotics?
Definition
NO
there is no fever
and he hates antibiotics
LOL
Term
When you encounter proteinuria, how do you differentiate its significance?
Definition
Preform a urine specific gravity reading.
If there is proteinuria in the presence of adequate concentration, this is normal. If the urine is isosthenuric, then it is a significant finding.
Term
What is the most common cause of glomerulus specific injury?
Definition
IMMUNE mediated
(which is triggered by antigen trapped in the glomerulus)
Term
What mediated immune injury to the glomerulus?
Definition
ANTIGEN
Term
Antigen is the trigger for gomerular injury in both cats and dogs.
True or False?
Definition
TRUE
Term
What is the special stain that can be used to look at the golmerulus?
Definition
Silver stain
Term
Amyloidosis is an inflammatory lesion.
True or False?
Definition
FALSE
Amyloid just crowds out the glomerulus
Term
Clinically significant proteinuria is common in cats.
True or False?
Definition
FALSE
Term
Which breed has a familial predisposition for amyloid causing glomerular disease?
Definition
Chinese Shar peis (dog)
Abysinnian cats
Term
What are the systemic consequences of progressive proteinuria?
Definition
- sodium retention causes ASCITES
- Potential for THROMBOEMBOLISM (esp in the lungs)
- SYSTEMIC HYPERTENSION
Term
Why does persistent glomerular injury cause hypertension?
Definition
Multiple reasons.
Activation of Renin Angiotensin-aldosterone system
- catecholamine induced vasoconstriction
- modulation by uremic toxins such as PTH
Term
Why may edema be a sequalae to persistent proteinturia?
Definition
Because the animal is losing protein in teh urine - causing hypoproteinemia which causes a decrease in oncotic pressure. This is what causes edema
Term
Why may edema be a sequalae to persistent proteinturia?
Definition
Because the animal is losing protein in teh urine - causing hypoproteinemia which causes a decrease in oncotic pressure. This is what causes edema
Term
How would you diagnose glomerular injury ?
Definition
History of chronic disease (lepto, FIP, etc)
animals are NOT azotemic
will NOT be in renal failure
signs of uremia present
- marked proteinuria w/isosthenuria
- may have casts w/ benign sediment
- hypercholesterolemia
**urine protein:creatinine ratio** to determine loss of protein
Term
How would you differentiate Glomerulonephritis and renal amyloidosis?
Definition
Renal bioopsy
Term
What is the treatment for renal amyloidosis?
Definition
NO specific therapy available
DMSO and Colchicine - used in isolated instances
Term
How do you treat glomerulonephritis?
Definition
**ID AND REMOVE ANTIGEN**
manage chronic renal failure
aspirin for anti-platelet
ACE inhibitors to decrease glomerular hypertension (enalapril)
low salt diets/diuretics for effusions
Omega 3 supplements
Term
How do Omega 3 fatty acid supplements help with renal failure?
Definition
Change arachoadonic acids to less inflammatory ones.
inflammation is a significant part of the problem
Term
What is the consequence of renal glucosuria?
Definition
the glucose provides a substrate for bacteria so it predisposes the animal for Urinary tract infections.
A small amount of glucose in the urine is normal in Elk hounds
Term
What defines the abnormal boundaries of pyuria?
Definition
Term
Most urinary tract infections are monomicrobic or polymicrobic?
Definition
MONOmicrobic
this is the case of over 75% of the cases
Term
What are the most common microbial isolates of urinary tract infection?
Definition
**Ascending infection of normal flora**
E.COLI
gram +
(then proteus, klebsiella, pasteurella, pseudomonas)
Term
Urinary tract infection in the cat is an uncommon finding.
True or False?
Definition
TRUE
It is very uncommon
Term
Urinary tract infections are commonly caused by normal flora. These infections are typically Ascending or Descending?
Definition
ASCENDING
Term
When evaluating for a urinary tract infection what is the only accurate collecting method?
Definition
Cystocentesis
Term
What is the gold standard of diagnosing a UTI?
Definition
Urine CULTURE
also preform susceptibility to identify proper antibiotics to use
Term
What are predisposing factors to UTIs?
Definition
-exposure to organisms
- residual urine volumes
-anatomical abnormalities
-urinary calculi (take XRAY)
-impairment of systemic immune function (diabetes mellitus and Cushings disease) & steroid use
-glucose in the urine
-catherization of the urinary tract
Term
What is an uncomplicated UTI?
Definition
No underlying structural, neurological or functional abnormality
- clinical signs often resolve after 48 hours of treatment onset
**dont use fluoroquinolone (try clavamox **
Term
Cats should always be considered as Complicated UTI cases.
True or False?
Definition
TRUE
Term
What is the benefit of preforming a Culture and sensitivity when evaluating UTIs?
Definition
So that you can give the appropriate antibiotics and prevent a multi-drug resistant infection.
It costs a lot to do these cultures, but the antibiotics that you would have to end up using will ALSO be expensive.
Term
What is the difference between feline interstitial cystitis and feline lower urinary tract disease?
Definition
Nothing
Term
Obstructive FLUTD occurs primary in males or females?
What is the most common cause?
Definition
MALES
cause = urethral plugs
Term
FLUTD is often infectious.
True or False?
Definition
FALSE
often triggered by predisposing factors like stress
Term
Which of the following is NOT a predisposing factor for FLUTD?
a) Ad lib feeding of wet food
b) recent move
C) sleeping inside
D) Use of a litter box only for elimination
E) 21 hrs/day + indoor confinement
Definition
Answer: A)
wet food decreases the risk of flutd, and ad lib feeding of dry food is a predisposing factor
Term
PU can mean two very important things in renal disease. What are these two things??
Definition
PU = Polyuria
PU = Perineal Urethrostomy (common surgical treatment of male FLUTD cats)
Term
What are the treatment strategies for non obstructive FLUTD?
Definition
MANAGEMENT:
Dilute the urine (decrease urine specific gravity)
-wet food
-increase water
Also
litter box management
clean soiled areas
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