Clin/lab assess SA (Cooke)

Question 1

Normal kidney function

Answer 1

1. fluid and electrolyte balance
   
   • conservation
   • excretion
2. Excretion of nitrogenous wastes
3. Erythropoietin
4. Renin
5. Vitamin D activation
   
   • calcium reg
   • phosphorus reg

Question 2

fluid balance effected when

Answer 2

2/3 of functional kidney mass is lost

Question 3

increased BUN and cr when (unable to excrete BUN and cr)

Answer 3

3/4 of functional kidney mass lost

Question 4

Azotemia

Answer 4

• increase in BUN and/or creatinine
• categories
  
  • pre-renal
  • renal
  • post-renal

Question 5

Uremia

Answer 5

• Clinical signs associated with renal failure
• these patients have to be azotemic

Question 6

Stranguria

Answer 6

• straining
• painful urination

Question 7

Pollakiuria

Answer 7

• increased frequency of urination
• small volume of urination

Question 8

Anuria

Answer 8

• lack of urine production

Question 9

Oliguria

Answer 9

• decreased urine production

Question 10

Urinary specific signs

Answer 10

1. Stranguria
2. Pollakiuria
3. Hematuria
4. Malodorous urine
5. Anuria
6. Oliguria

Question 11

Polydipsia

Answer 11

• Drinking more than 100 ml/kg/day

Question 12

polyuria

Answer 12

• increased volume of urine

Question 13

Non-specific CS of urinary dz

Answer 13

• Polydipsia
• Polyuria
• Systemic signs
  
  • vomiting
  • anorexa
  • weight loss
  • fever
  • pale mucous membranes

Question 14

Physical exam cat

abdominal palpation

Answer 14

• Bladder
• left kidney
• right kidney

*pain, crepitus, size/shape

Question 15

Physical exam dog

abdominal palpation

Answer 15

• bladder
• +/- left kidney
• +/- prostate

*pain, crepitus, size/shape

Question 16

Physical exam

Rectal exam dogs

Answer 16

• Prostate
• Urethra
• lymph nodes, hernias, anal sacs, masses

Question 17

Physical exam

Integument

Answer 17

• wet, stained fur around vulva/prepuce

Question 18

Physical exam

Systemic signs

Answer 18

• fever
• body condition
• oral ulcers
• pale mucus membranes

Question 19

Tests to eval urinary tract

Answer 19

1. Urinalysis
   
   • upper and lower tract
2. Serum chemistry
   
   • tubular function
   • GFR (upper tract)
3. Renal function tests (upper)
4. Imaging (upper and/or lower)

Question 20

Creatinine

Answer 20

• estimation of GFR
• produced by muscle
  
  • related to muscle mass and GFR
• excreted by filtration only (no secretion/reabsorption)
• IRIS staging
• not sensitive (75% loss of function)

Question 21

Blood urea nitrogen (BUN)

Answer 21

• estimation of GFR
• produced from liver in protein metabolism
• excreted by filtration
  
  • secreted and reabsorbed
• Related to
  
  • GFR
  • peritubular capillary blood flow
  • tubular fluid flow
  • dietary protein
  • hepatic function
• not sensitive (75% loss function)

Question 22

Individual kidney GFR

Answer 22

• nuclear scintigraphy

Question 23

urinalysis eval

Answer 23

• within 1 hour
• 4-6 hours if refridgerated
  
  • bring to room temperature

Question 24

Specific gravity

concentration in dehydrated state

Answer 24

• Dog: >/= 1.035
• Cat: >/= 1.040

Question 25

azotemic dog with USG 1.012

Answer 25

pre-renal problem

Question 26

Azotemic dog with USG 1.048

Answer 26

renal component

Question 27

Reagent strips

Answer 27

* accurately measure * pH * glucose * ketones * hemoglobin * protein * bilirubin * don't accurately measure * leukocytes * nitrites * urobilinogen * SG * affected by * moisture * alkaline urine * discolored urine

Question 28

Interpreting protein

Answer 28

* interpret with respect to * specific gravity * urine sediment

Question 29

Microalbuminuria

Answer 29

* Low levels of albuminuria * \> 1mg/dL * Clinical significance * other systemic abnormalities * Confirmatory test

Question 30

Glucose in urine

Answer 30

* Without hyperglycemia: tubular damage * With hyperglycemia: diabetes

Question 31

Urinalysis: Blood Hemoglobin Myoglobin

Answer 31

* Blood: spins down with urine on top * hemoglobin: pigment stays in urine =\> most common in SA * spun blood stays in plasma * myoglobin: pigment stays in urine * spun blood, doesn't stay in plasma

Question 32

Urinalysis Cells

Answer 32

* Squamous cells * usually normal * Transitional cells * traumatic cath * inflammation * neoplasia * Caudate cells * rare * from renal pelvis * Renal tubular cells * tubular inflammation (upper tract)

Question 33

Red/white cells

Answer 33

* Red blood cells * normally * rule out iatrogenic hemorrhage * White blood cells * normally * infection vs inflammation

Question 34

Casts

Answer 34

* Hyaline * 1-2/hpf normal * Cellular casts * suggests ongoing renal disease * may be first sign of renal damage animals on aminoglycoside abx * absence of casts not indicative of health \*can dissolve with in hours of urine sitting around

Question 35

Sediment

Answer 35

* Fat * Crystals * crystalluria not always pathologic * type may be dependant on pH * Sperm * Parasite eggs

Question 36

Cystoscopy

Answer 36

* eval of vaginal vault, urethra, bladder * +/- tx * stones, strictures, ectopic ureters * Anesthesia * technical skills * equiptment