Clin/lab assess SA (Cooke) Flashcards Preview

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Flashcards in Clin/lab assess SA (Cooke) Deck (36):
1

Normal kidney function

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

2

fluid balance effected when

2/3 of functional kidney mass is lost

3

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

3/4 of functional kidney mass lost

4

Azotemia

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

5

Uremia

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

6

Stranguria

  • straining
  • painful urination

 

7

Pollakiuria

  • increased frequency of urination
  • small volume of urination

8

Anuria

  • lack of urine production

9

Oliguria

  • decreased urine production

10

Urinary specific signs

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

11

Polydipsia

  • Drinking more than 100 ml/kg/day

12

polyuria

  • increased volume of urine

13

Non-specific CS of urinary dz

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

14

Physical exam cat

abdominal palpation

  • Bladder
  • left kidney
  • right kidney

*pain, crepitus, size/shape

15

Physical exam dog

abdominal palpation

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

*pain, crepitus, size/shape

16

Physical exam

Rectal exam dogs

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

17

Physical exam

Integument

  • wet, stained fur around vulva/prepuce

18

Physical exam

Systemic signs

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

19

Tests to eval urinary tract

  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)

20

Creatinine

  • 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)

21

Blood urea nitrogen (BUN)

  • 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)

22

Individual kidney GFR

  • nuclear scintigraphy

23

urinalysis eval

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

24

Specific gravity

concentration in dehydrated state

  • Dog: >/= 1.035
  • Cat: >/= 1.040

25

azotemic dog with USG 1.012

pre-renal problem

26

Azotemic dog with USG 1.048

renal component

27

Reagent strips

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

28

Interpreting protein

  • interpret with respect to 
    • specific gravity
    • urine sediment

29

Microalbuminuria

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

30

Glucose in urine

  • Without hyperglycemia: tubular damage
  • With hyperglycemia: diabetes

31

Urinalysis:

Blood

Hemoglobin

Myoglobin

  • 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

32

Urinalysis

Cells

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

33

Red/white cells

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

34

Casts

  • 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

35

Sediment

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

36

Cystoscopy

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