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RUSVM SAM 2 > Urology/Nephrology > Flashcards

Urology/Nephrology Flashcards

1
Q

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

A

Erythropoietin
1,25-Dihydroxycholecalciferol
Renin

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2
Q

What is azotemia?

A

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

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3
Q

What is renal failure?

A

Clinical syndrome when the kidney is no longer able to maintain

Regulatory function
Excretory function
Endocrine function

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4
Q

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

A

75

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5
Q

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

A

False

Requires 75% nephron loss to have azotemia

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6
Q

What is a uremia?

A

Clinical signs associated with critical loss of functional nephrons

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7
Q

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

A

Azotemia
Hypoalbuminemia
Hypercholesterolemia
Metabolic acidosis

Hyperkalemia
Hypocalcemia
Increased PTH

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8
Q

What are the methods of direct measurement of GFR?

A

Clearance of radioisotope with renal scintigraphy

Iohexal
Inulin
Creatinine clearance tests

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9
Q

What are INDIRECT methods of measuring GFR?

A

Serum urea levels
Serum creatinine
Cystatin C
SDMA

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10
Q

Serum levels of urea are affected by??

A 
Species/age 
Liver function
Dietary protein content 
Endogenous protein catabolism 
Renal function
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11
Q

Urea is synthesized in the __________ from???

A

Liver; ammonia and protein in GI tract/muscle breakdown

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12
Q

Why is urea not a reliable estimate of GFR?

A

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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13
Q

Where is creatine synthesized?

A

Breakdown of creatine phosphate in muscles

  • > produced at a constant rate
  • > dependent on muscle mass
  • > influenced less by diet
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14
Q

What are causes of increased serum concentrations of creatinine?

A

Reduced renal clearance

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15
Q

What are causes of decreased serum concentrations of creatinine?

A

Reduced muscle mass

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16
Q

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

A

Creatinine

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17
Q

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

A

False

Cannot prognosticate based on magnitude of azotemia

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18
Q

What is cystatin C?

A

Small polypeptide protease inhibitor produced by all cells with nucleus

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19
Q

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

A

True

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20
Q

Where is SDMA produced?

A

In every cell, released into circulation during protein degredation

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21
Q

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

A

40

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22
Q

How can urine be collected?

A

Free flow
-> cannot be used for culture

Catheterization
-> difficult in females

Cystocentesis
BEST method
-sterile sample

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23
Q

What are components of a urinalysis?

A 
Colour/clarity 
Dipstick 
Concentration 
Sediment 
urine protein:creatinine ratio
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24
Q

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

A 
Protein 
PH 
Blood 
Glucose 
Ketone
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25
Q

How do we measure urine concentration

A

Refractometer

-calibrated with distilled water-> should measure 0

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26
Q

What can cause a falsely increased USG?

A

Glucosuria

Proteinuria

27
Q

What is the USG for hyposthenuria?

A

1.000 - 1.007

28
Q

What is the USG for isosthenuria ?

A

1.008-1.012

29
Q

Minimally concentrated urine has a USG of?

A

1.013-1.030

30
Q

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

A

Dog > 1.030

Cat> 1.035

31
Q 
Case 
History of trauma
Dog with PU/PD
UA 
-USG 1.005
-dipstick normal

What are possible DDX ?

A

Hyposthenuria

  • diabetes insipidus (central or nephrogenic)
  • cushings
  • psychogenic
32
Q

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

A

Rule out..
hyperadrenocortisim with a urine cortisol:creatine ratio

Partial water deprivation test

33
Q

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

A

After 5% loss of body weight in water

34
Q

Failure to concentrate with partial water deprivation test rules out?

A

Rules out psychogenic polydipsia

Left with diabetes insipidus

35
Q

How can you differentiate between central and nephrogenic DI?

A

Give desmopressin

  • > concentrate urine = central
  • > non concentrated = nephrogenic
36
Q

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

A

Cells
Bacteria
Crystal
Casts

37
Q

What can cause a false positive UPC?

A

Cloudy urine

38
Q

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

A

Urine protein:creatinine ratio

> 0.5 tubular/glomerular disease

39
Q

What are non-renal causes of proteinuria?

A

Hemorrhage
UTI/cystitis
Intravascular hemolysis (hemoglobinuria)

40
Q

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

A

Bladder tumors antigen test

88% specificity

41
Q

What is the most common bacteria found in UTI?

A

E. coli
Gram negative aerobic

Also common bacteria in contaminated samples

42
Q

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

A

Cortex

43
Q

What is hematuria ?

A

Presence of blood in ruine

44
Q

What can cause a pseudohamturia?

A

Hemoglobinuria, myoglobinuria, or chemicals

45
Q

Where can heamaturia originate from?

A

Systemic disorder
Renal
Bladder, ureter, urethra
Genital tract

46
Q

What disease of the kidney can cause hematuria?

A

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

47
Q

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

A 
Bacterial infection 
Calculi
Trauma
Neoplasia
Polyps
Cyclophosphamide 
Feline idiopathic cystitis
48
Q

What genital tract conditions can cause a hematuria?

A

Prostatic disease, oestrus, infection, neoplasia, and trauma

49
Q

What diagnostics can you do in a case of hematuria?

A 
Hematology/blood smear 
Biochem 
UA and cluture 
Imaging (US)
Cystoscopy
Vaginoscopy
Prostatic wash
50
Q

What are clinical signs of kidney disease?

A 
PU/PD
Anorexia/ GI signs/ weight loss
Pale mucous membranes 
Lethargy 
Blindness
Distended abdomen
51
Q

What are signs of lower urinary tract disease?

A

Inappropriate urinating
Pollakiuria, dysuria, stranguria
Hematuria

52
Q

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

A

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

53
Q

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

A

False

54
Q

What are causes of renomegaly?

A

Primary

  • renal adenocarcinoma
  • renal lymphoma
  • renal sarcoma
  • nephroblastoma

Metastatic (rare)

55
Q

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

A

True

56
Q

Clinical signs associated with renal carcinoma?

A

Hematuria and weight loss
Unilateral renomegaly

Rarely azotemia

Polycythemia as a paraneoplasic syndrome —> EPO production

Hypertrophic osteopathy as paraneoplastic syndrome

57
Q

How can you diagnose renal carcinoma?

A

Renal ultrasound

FNA

58
Q

What is the treatment for renal carcinoma?

A

Ensure sufficient rxn in contralateral kidney
Nephrectomy

Prognosis is about 16months

59
Q

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

A

True

60
Q

T/F: renal lymphoma usually only affects one kidney

A

False

Both

61
Q

What is the presentation of renal lymphoma?

A

Renomegaly
Weight loss
Inappetance
PU/PD

Azotemia
Systemic
CNS spread

62
Q

What is the treatment for renal lymphoma?

A

Chemotherapy

60% of cats go into remission

63
Q

What are the non-neoplasic causes of renomegaly?

A 
Inflammation 
-nephrosis
-pyelonephritis
-FIP
-lepto 
Amyloidosis 
Hydronephrosis 
Polycystic kidney dz 
Portosystemic shunt

Acute urethral obstruction (cats)

64
Q

What breed is polycystic kidney disease prevalent in?

A

Persian cats

Autosomal dominant gene - mutant PKD1

Also in…
bull terriers
Carin terriers
WHW terriers

RUSVM SAM 2 (44 decks)

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