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year 1/2 > Elimination & Detox 2: Equine Nephrology > Flashcards

Elimination & Detox 2: Equine Nephrology Flashcards

1
Q

the kidney’s job is to….

THEREFORE, in RENAL FAILURE, the kidney is unable to…

A

the kidney’s job is to…
–> REGULATE THE OSMOLARITY (how concentrated) OF THE BLOOD

THEREFORE, in RENAL FAILURE, the kidney is unable to ADJUST THE OSMOLARITY OF BLOOD & thus CANNOT CONCENTRATE or DILUTE BLOOD and thus URINE

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2
Q

osmolarity definition

A

the CONCENTRATION of a SOLUTION expressed as the TOTAL NUMBER OF SOLUTE PARTICLES per LITER

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3
Q

if you are in RENAL FAILURE, what is the LIKELY RANGE of USG VALUES you would have?

what is this condition called?

A

RENAL FAILURE –> ISOSTHENURIA!

1.008 –> 1.012

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4
Q

if you’re in RENAL FAILURE, what would your USG likely be at…

THE END OF A LONG HIKE ON A HOT DAY?

after DRINKING A BUNCH OF BEER?

A

LONG HIKE = 1.012 (as concentrated as you can get with isosthenuria)

AFTER BEER = 1.008 (as dilute as you can get with isosthenuria)

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5
Q

FRACTIONAL EXCRETION (Fex)…

if the TUBULES are DAMAGED, then _____ ____ DECREASES & ____ ____ gets HIGHER

NORMAL fractional excretion should be around ___% because…

A

DAMAGED TUBULES = ELECTROLYTE RESORPTION DECREASES, so FRACTIONAL EXCRETION IS HIGHER

NORMAL fractional excretion should be around 1% because KIDNEYS SHOULD RESORB MOST OF THE SODIUM & CREATININE

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6
Q

what 2 kinds of cells make GGT?

in both, WHAT stimulates this to be made?

A

2 kinds of cells?
1. HEPATIC BILIARY TUBULAR CELLS
2. RENAL TUBULAR CELLS

in both, made in TIMES OF STRESS

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7
Q

if a HORSE has…

HIGH URINE GGT = ????

HIGH BLOOD GGT = ????

A

HIGH URINE GGT = DEFINITELY RENAL DZ

HIGH BLOOD GGT = from LIVER, so NOT SURE WHAT’S GOING ON

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8
Q

3 common Ddxs for DEHYDRATION?

A
  1. DECREASED INTAKE (not drinking enough)
  2. INCREASED LOSS (GI/URINARY)
  3. THIRD SPACE picking up FLUID but PUTTING IT WHERE YOU CANNOT SEE IT
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9
Q

in PRE-RENAL AZOTEMIA, what should the SODIUM levels be?

A

SODIUM SHOULD BE NORMAL to HIGH because KIDNEY NORMALLY HELPS SAVE SODIUM

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10
Q

if ____ levels are NORMAL, then ______ AZOTEMIA is LESS LIKELY

A

POTASSIUM, POST-RENAL

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11
Q

PRE-RENAL AZOTEMIA (in horses)…

USG?

hydration status?

urine volume?

additional info? (3)

A

USG = >1.025

hydration status = DEHYDRATED

urine volume = DECREASED

additional info? = can also have DECREASED RENAL PERFUSION due to…
1. HEMORRHAGE
2. SHOCK
3. DECREASED CO

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12
Q

RENAL AZOTEMIA…

USG?

hydration? + 1 clinical sign

urine volume if ACUTE or CHRONIC renal failure? (2)

additional info? (2)

A

USG = 1.008 –> 1.012

hydration? = DEHYDRATED + POLYURIA (kidney can’t hold onto water)

urine volume?
1. CHRONIC RENAL FAILURE = INCREASED
2. ACUTE RENAL FAILURE = DECREASED

additional info?
1. look for ELECTROLYTE CHANGES
2. can have MILD ANEMIA if CHRONIC RENAL FAILURE

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13
Q

POST-RENAL AZOTEMIA…

USG?

hydration?

urine volume?

what chem finding should we find?

4 possible pathologies?

A

USG = VARIABLE

hydration? = NORMAL to DEHYDRATED

urine volume = DECREASED

chem finding = INCREASED POTASSIUM

4 possible pathologies?
1. STRANGURIA
2. DYSURIA
3. RUPTURED BLADDER
4. UROPERITONEUM

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14
Q

TRUE/FALSE

ISOSTHENURIA IS ALWAYS ABNORMAL.

defend it

A

FALSE, could just have DRANK A TON OF WATER

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15
Q

when is ISOSTHENURIA ABNORMAL?

A

when the patient is DEHYDRATED and wants to CONCENTRATE URINE & HOLD ONTO MORE WATER

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16
Q

if we see CASTS in URINE SEIDMENT, can suggest…

A

ACUTE RENAL FAILURE

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17
Q

TRUE/FALSE

SOME BACTERIA & CRYSTALS can be NORMAL IN URINE

A

TRUE

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18
Q

4 possible findings for ACUTE RENAL FAILURE in horses?

A
  1. LARGE, SWOLLEN kidneys
  2. CASTS in URINE SEDIMENT
  3. ENZYMURIA (GGT in urine)
  4. often GOOD RESPONSE TO TREATMENT
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19
Q

what medication can PREDISPOSE a horse to CHRONIC RENAL FAILURE?

A

LONG-TERM NSAIDs

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20
Q

3 possible findings for CHRONIC RENAL FAILURE in horses?

A
  1. SMALL, IRREGULAR KIDNEYS
  2. HYPERCALCEMIA
  3. POOR RESPONSE TO TREATMENT
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21
Q

what is a KEY diagnostic in determining if a HORSE is in ACUTE or CHRONIC renal failure?

A

THEIR RESPONSE TO TREATMENT

IF GOOD = LIKELY ACUTE

IF POOR = LIKELY CHRONIC

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22
Q

what 4 things can cause ACUTE RENAL FAILURE?

A
  1. AMINOGLYCOSIDES
  2. NSAIDs
  3. EXERTIONAL RHABDOMYOLYSIS can produce PIGMENT & STOP UP TUBULES & KILL THEM
  4. VASOMOTOR NEPHROPATHY
    –> depending on TONE of AFFERENT & EFFERENT ARTERIOLES to facilitate AUTOREGULATION
    –> if this DOESN’T WORK, can cause RENAL HYPOPERFUSION –> AKI
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23
Q

MYOGLOBINURIA can indicate WHAT DZ?

A

ACUTE EXERTIONAL RHABDOMYOLYSIS

24
Q

3 examples of AMINOGLYCOSIDES?

3 examples of NSAIDs in HORSES?

both of these can cause…

A

AMINOGLYCOSIDES
1. GENTAMYCIN
2. AMIKACIN
3. OXYTETRACYCLINE

NSAIDs
1. PHENYLBUTAZONE
2. FLUNIXIN
3. KETOPROFEN

both can cause ACUTE RENAL FAILURE

25
Q

what is the most COMMON PATHOLOGIC FINDING/CAUSE of ACUTE RENAL INJURY?

what other 3 clinical findings can we have in ACUTE RENAL INJURY?

A

ACUTE TUBULAR NECROSIS

other 3?
1. CASTS on URINE SEDIMENT
2. ENZYMURIA = high URINE GGT
3. MICRO-HEMATURIA = urine LOOKS NORMAL but POSITIVE FOR BLOOD ON DIPSTICK & UA

26
Q

PAPILLARY NECROSIS…

= definition

commonly occurs after…., especially when…

causes what 2 things?

can PRE-DISPOSE horses to…

A

= necrosis of RENAL PYRAMIDS

commonly occurs after NSAID ADMINISTRATION (BUTORPHANOL) especially when DEPRIVED OF WATER

causes…
1. MICROHEMATURIA
2. ACUTE RENAL INJURY

can PRE-DISPOSE horses to NEPHROLITHS

27
Q

a NORMAL kidney should be ~____cm ACROSS on US

if a KIDNEY is LARGER THAN THIS VALUE on US, then likely…

A

17

if kidney is LARGER, then AKI

28
Q

ID what RED CIRCLE INDICATES

A

PALE AREAS IN CORTEX = ACUTE TUBULAR NECROSIS

29
Q

ID what RED CIRCLE INDICATES

A

PAPILLARY NECROSIS = necrosis of RENAL PYRAMIDS, they become SLUDGE in this image

30
Q

describe HISTOLOGIC finding here

A

CHRONIC NECROSIS & INFLAMMATION in kidney causes LOST NUCLEI

31
Q

how do we FIX ACUTE RENAL FAILURE? (trick question)

A

WE CANNOT! RENAL TUBULAR CELLS have to REGENERATE on their OWN

32
Q

2 goals for TREATING ACUTE RENAL FAILURE?

A
  1. STOP the patient from GETTING WORSE while RENAL TUBULAR CELLS HEAL/REGENERATE
  2. MAKE PATIENT FEEL BETTER while RENAL TUBULAR CELLS HEAL/REGENERATE
33
Q

3 treatments for ACUTE RENAL FAILURE?

A
  1. maintain EUVOLEMIA
    –> prevent FURTHER CELL DAMAGE by MAINTAINING RENAL PERFUSION/prevent renal hypo perfusion
  2. DIURESIS via EXTRA FLUIDS only if UREMIA needs to be corrected
  3. maintain ELECTROLYTE & ACID-BASE BALANCE
34
Q

PROGNOSIS for ACUTE RENAL FAILURE in HORSES

A

HIGHLY VARIABLE

35
Q

if a horse is ISOSTHENURIC, why will we see WEIGHT GAIN?

A

if ISOSTEHNURIC, then likely RENAL FAILURE & CANNOT DIURESE EXTRA FLUID, so likely EDEMA CAUSED WEIGHT GAIN

36
Q

ID pathology on US of KIDNEY

A

NEPHROLITH

37
Q

ID arrows & the TWO BOTTOM (both are the same)

A

ARROWS = NEPHROLITHS

BOTTOM = ACOUSTIC SHADOWING from minerals

38
Q

ID pathology

A

HYDRONEPHROSIS

39
Q

ID in kidney

A

URETER

40
Q

ID big ANECHOIC structure in KIDNEY

A

HYDROURETER

41
Q

ID pathology

A

NEPHROLITHS in BOTH KIDNEYS

42
Q

ID pathology

A

URETEROLITH

43
Q

definition of POLYURIA in horses?

definition of POLYDIPSIA in horses?

A

POLYURIA in horses = > 50 mL/kg/day URINATED

POLYDIPSIA in horses = > 100 mL/kg/day DRANK

44
Q

4 common DDxs for PU/PD in horses? how to rule in/out?

A
  1. RENAL = RENAL FAILURE
    –> CBC/chem, UA
  2. ENDOCRINE = CUSHING’S/PPID, DIABETES INSIPIDUS (not responding to ADH)
    –> PPID = ENDOGENOUS ACTH, TRH stim
    –> DI = water deprivation test or ADH response test
  3. PSYCHOGENIC = horse is bored & drinks often
    –> water deprivation test
  4. others = RARE
45
Q

do horses get DIABETES MELLITUS?

A

EXTREMELY RARE TO NO

46
Q

WATER DEPRIVATION TEST..

usually used to test for WHAT disease & based on WHAT clinical sign? what ALTERNATIVE test could you run for this disease?

what OTHER disease could this test for?

when should this test NOT be run?

A

usually used to test for DIABETES INSIPIDUS, PU/PD

can alternatively do an ADH-RESPONSE test

could possibly test for PSYCHOGENIC causes of PU/PD

this test SHOULD NOT BE RUN IF PATIENT IS ALREADY AZOTEMIC

47
Q

if we see PROTEINURIA, what PART of the kidney is likely diseased?

A

the GLOMERULUS

48
Q

what 2 bloodwork findings are nearly DEFINITIVE for RENAL DZ in horses?

A
  1. AZOTEMIA
  2. ISOSTHENURIA
49
Q

would you expect to see AZOTEMIA in PSYCHOGENIC causes of PU/PD?

A

NO, DRINKING A LOT WOULD NOT LEAD TO AZOTEMIA

50
Q

if urine has a “PORT WINE” color, what is the TOP DIFFERENTIAL?

what is another term for color in urine?

on urine dipstick, will come up positive for ____, so ____URIA; therefore this horse also has ____ _____

A

TOP DDX = EXERTIONAL RHABDOMYOLYSIS

another term = PIGMENTURIA

on urine dipstick, will come up positive for HEME so HEMOGLOBINURIA; therefore this horse also has INTRAVASCULAR HEMOLYSIS

51
Q

what is the MOST COMMON cause of INCONTINENCE in horses?

what are the 2 sub-categories?

A

MOST COMMON CAUSE OF INCONTINENCE = NEUROGENIC

can be UPPER MOTOR NEURON or LOWER MOTOR NEURONS affected

52
Q

POLYNEURITIS EQUI..

etiology?

= what occurs in this disease?

can SOMETIMES also affect…

what do we see on PE & why? (3)

how is it DIAGNOSED? (2)

treatment/prognosis?

A

etiology = IDIOPATHIC

what occurs? = INFLAMMATION of NERVES especially the DISTAL SPINAL CORD

can SOMETIMES also affect CRANIAL NERVES

on PE…
1. animals CONSTANTLY DRIBBLING URINE because CRYSTALS THERE
2. BLADDER feels like a DINNER PLATE on palpation
3. PARAESTHESIA/HYPALGESIA (very painful) around the TAILHEAD

diagnosis?
1. BIOPSY of SACROCAUDALIS DORSALIS LATERALIS (tailhead muscle)
2. SAND-FILLED bladder on US

NO DEFINITIVE TREATMENT & POOR PROGNOSIS

53
Q

SABULOUS CYSTITIS

etiology?

this is the MOST COMMON CAUSE OF…

= definition

what does “sabulous” mean?

treatment/prognosis?

A

IDIOPATHIC

MOST COMMON CAUSE OF NEUROGENIC INCONTINENCE in HORSES

= IDIOPATHIC BLADDER PARALYSIS but has NO OTHER NEURO SIGNS

sabulous = SAND

NO DEFINITIVE Tx & POOR prognosis

54
Q

6 DDXs under 4 categories for NEUROGENIC INCONTINENCE? (just list the names)

first 2 have 2, last 2 have 1 each

A
  1. IDIOPATHIC
    –> POLYNEURITIS EQUI
    –> SABULOUS CYSTITIS
  2. INFECTIOUS
    –> EHV-1
    –> BACTERIAL CYSTITIS
  3. ACQUIRED
    –> TRAUMA from DYSTOCIA or PELVIC FRACTURE
  4. CONGENITAL
    –> ECTOPIC URETER
55
Q

EQUINE HERPES VIRUS-1…

etiology?

can cause WHAT MAIN clinical sign? + give 3 others

contagion?

repeatability?

A

etiology = INFECTIOUS

can cause NEUROGENIC INCONTINENCE/URT Dz, among also…
1. FEVER
2. ATAXIA
3. ABORTION STORM

VERY CONTAGIOUS

REPORTABLE

year 1/2 (139 decks)

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