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Internal medicine (equine) > Urinary medicine (Yr4) > Flashcards

Urinary medicine (Yr4) Flashcards

1
Q

what causes pre-renal acute renal failure?

A

haemodynamic cause…
hypovolaemia, volume redistribution (effusions), decreased cardiac output, altered vascular resistance (endotoxaemia)

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2
Q

what cause post-renal acute renal failure?

A

uncommon… only really seen with neonates that rupture there bladder as blockages are uncommon

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3
Q

what are the renal causes of acute renal failure?

A

ischaemia or nephrotoxin exposure (less commonly glomerulonephritis)

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4
Q

what are some nephrotoxic substances?

A

antibiotics - aminoglycosides, tetracyclines
endogenous substances - haemoglobin, myoglobin
NSAIDs, heavy metals…

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5
Q

what should be monitored in horses on nephrotoxic drugs?

A

serum creatinine

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6
Q

what is the most nephrotoxic aminoglycoside?

A

neomycin

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7
Q

where do aminoglycosides accumulate?

A

proximal tubular cells (they are freely filtered at the glomerulus then reabsorbed by proximal tubular cells)

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8
Q

why are aminoglycosides (such as gentamicin) only given once daily?

A

reabsorption in the kidneys is time rather than dose dependant, so less toxic to give one large dose

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9
Q

what can you pre-treat horses with before giving gentamicin (aminoglycosides) to reduce the nephrotoxicity?

A

calcium

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10
Q

what will be a significant finding on urinalysis if there is pre-renal azotaemia?

A

maximally concentrated urine (>1.035)

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11
Q

how is acute renal failure treated?

A

IV fluids (Hartmans)
diuretics (furosemide)
stop nephrotoxic drugs

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12
Q

what fluid rate would you put a horse with acute renal failure on?

A

twice maintenance (60ml/kg/hr)

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13
Q

what diuretics can be used for treating acute renal failure?

A

furosemide
dopamine

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14
Q

what are the main causes of chronic renal failure?

A

glomerular disease
interstitial nephritis (from tubular necrosis)
renal neoplasia
amyloidosis

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15
Q

what clinical signs can be seen with chronic renal failure?

A

chronic weight loss
lethargy, PUPD, poor coat, poor performance
halitosis, oral ulceration
(possible ventral oedema but this is inconsistent)

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16
Q

how is chronic renal failure diagnosed?

A

persistent isosthenuria (1.008-1.014)
mild anaemia and hypoalbuminaemia
electrolyte abnormalities (hypercalcaemia, hyponatraemia…)

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17
Q

how can chronic renal failure be treated?

A

one;y palliative…
ensure water and salt available
lower protein (manage BUN)
decrease calcium

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18
Q

what is a good prognostic indicator for chronic renal failure?

A

creatinine (higher creatinine indicates a shorter survival time)

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19
Q

what is polyuria defined as?

A

urine output exceeding 50ml/kg/day

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20
Q

what is polydipsia defined as?

A

fluid intake exceeding 100ml/kg.day

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21
Q

what is dysuria?

A

abnormal urination

22
Q

what are some possible causes of PUPD?

A

renal failure
PPID
psychogenic polydipsia
excessive salt consumption
diabetes
sepsis/endotoxaemia
iatrogenic

23
Q

what age horses does PPID effect?

A

older

24
Q

why does PPID cause PUPD?

A

PPID causes increased ACTH, cortisol antagonism of vasopressin on the collecting ducts meaning less reabsorption of water

25
Q

how common is psychogenic PUPD seen in horses?

A

one of the most common causes (boredom, change environment, diet….)

26
Q

why does diabetes insipidus cause PUPD?

A

there is a decreased volume of vasopressin, and also decreased sensitivity of the renal collecting ducts to vasopressin

27
Q

why does diabetes mellitus cause PUPD?

A

hyperglycaemia leads to glycosuria causing an osmotic polyuria (and hence polydipsia)

28
Q

what is the value for hyposthenuria in horses?

A

<1.007

29
Q

what are the top difference if a horse has PUPD with hyposthenuria but no azotaemia?

A

psychogenic polydipsia
diabetes insipidus

30
Q

what test can be done to distinguish between diets insipidus and psychogenic polydipsia?

A

water deprivation test

31
Q

how can the water deprivation test differentiate between diabetes insipidus and psychogenic polydipsia?

A

if USG increases to >1.025 in less than 24 hours it is psychogenic polydipsia
if it stays hyposehtnuric its diabetes insipidus

32
Q

how is a water deprivation test carried out?

A

empty bladder and get a baseline bodyweight
deprive horse of water access and measure USG, bodyweight and urea periodically
(stop if horse becomes azotaemic, dehydrated or loses 5% bodyweight)

33
Q

what is a modified version of the water deprivation test?

A

medullary washout

34
Q

how is the medullary washout done?

A

restrict water to 40ml/kg/day for 3-4 days
USG >1.025 at the end of this indicates psychogenic polydipsia

35
Q

what are the two types of diabetes insipidus?

A

neurologenic
nephrogenic

36
Q

how can you differentiate between neurogenic and nephrogenic?

A

neurogenic… USG increases >1.020 following ADH or vasopressin administration
nephrogenic… no change ion USG following ADH or vasopressin

37
Q

how can you differentiate between haematuria and haemoglobinuria?

A

centrifuge the samples, haematuria will separate haemoglobin/myoglobinuria won’t

38
Q

what is the pathogenesis of why myoglobinuria occurs?

A

muscle cells rupture releasing myoglobin (rhabdomyolysis)

39
Q

what can cause myoglobinuria?

A

sporadic/recurrent exertional rhabdomyolysis
polysaccharide storage myopathy
atypical myopathy
post-anaesthetic myositis

40
Q

how is myoglobinuria diagnosed?

A

clinical signs (urinalysis)
increased creatinine kinase

41
Q

what are some causes of haemoglobinuria?

A

immune mediated haemolytic anaemia
neonatal isoerythrolysis
infectious causes (babesia, EIA…)

42
Q

what can cause haematuria?

A

urinary tract infection
urolithiasis
neoplasia

43
Q

if there is haematuria throughout the entire urination, where can you localise the lesion to?

A

kidney
ureters
bladder

44
Q

if there is haematuria at the start of urination, where can you localise the lesion to?

A

distal urethra

45
Q

if there is haematuria at the end of urination, where can you localise the problem to?

A

proximal urethra and bladder neck

46
Q

what are some causes of haematuria?

A

urinary tract infections (pyelonephritis, cystitis)
urolithiasis

47
Q

what horses are predisposed to urolithiasis?

A

males (shorter urethra)
older horses

48
Q

what are some predisposing factors to urolithiasis?

A

urine retention, UTI, genetics
alkaline urine

49
Q

what is sabulous cystitis?

A

crystalloid sediment build up in the ventral bladder secondary to bladder paralysis or emptying problems

50
Q

what is the prognosis for sabulous cystitis?

A

poor (needs regular bladder emptying and secondary UTI control)

Internal medicine (equine) (22 decks)

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