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Equine kidney disease Flashcards

(68 cards)

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1
Q

What pH is equine urine normally

A

Alkaline

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2
Q

What are the isothenuric, hypothenuric and hyperthenuric ranges

A

Hypo = <1.008
Iso = 1.008 - 1.014
Hyper = >1.014

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3
Q

What is GGT:creatinine ratio used for

A

Sensitive marker of tubular injury/dysfunction because GGT is high when there is leakage from tubular epithelium

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4
Q

What counts as polydipsia

A

> 100ml/kg/day

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5
Q

What is the most common cause of polydipsia in horses

A

Psychogenic

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6
Q

When do we see an increase in creatinine in blood

A

When 75% of kidney function is lost

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7
Q

What is SDMA

A

Endogenous arginine released into bloodstream during protein catabolism
-Not excreted in kidney failure
- Suggested to detect kidney injury earlier than creatinine but not clear

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8
Q

What electrolyte abnormalities are seen in AKI

A

Hyponatraemia and hypochloraemia are main ones

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9
Q

What electrolyte abnormalities are seen in CKD

A

Hyperkalaemia
hypercalcaemia
Hyponatraemia

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10
Q

Why do we see hypercalcaemia in CKD

A

Lack of excretion in CKD
BUT also should investigate possibility of paraneoplastic syndrome

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11
Q

What effect can hypoalbuminaemia have on calcium levels in CKD

A

Less protein bound calcium can lead to underestimation of biologically active calcium and mask hypercalcaemia

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12
Q

Signs of acute kidney injury

A

Vague; dull, inappetant
Oliguria more common than anuria

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13
Q

Difference between hypovolaemia and dehydration

A

Hypovolaemia = loss of water from the circulation
Dehydration = loss of body water

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14
Q

What can be a drug related cause of internal haemorrhage

A

Phenylephrine administration causnig rupture of great vessels of spleen in older horses

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15
Q

Blood results in haemorrhagic shock

A

High lactate due to poor tissue perfusion
Pre-renal azotaemia due to poor renal perfusion + just small volume urine

No evidence of blood loss immediately (takes ~24hrs for protein and RBCs to drop)

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16
Q

Why doesn’t PCV drop for 24hrs in acute blood loss

A

Due to splenic reserves and catecholamine induced contraction of spleen following tissue hypoxia

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17
Q

What nephrotoxins can cause acute kidney injury

A

NSAIDs
Aminoglycosides
Bisphosphonates
Pigment

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18
Q

When is NSAID toxicity most likely

A

In sick, dehydrated horses recieving IV NSAIDs

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19
Q

What type of antibiotics are aminoglycosides and how can we do the dosing to avoid tubular damage

A

= contration dependent
Small % of every dose goes to prox tubular epithelial cells

Key = using longer dosing intervals (>24hrs) to avoid accumulation and to allow some time where tubules are not exposed

Therapeutic drug monitoring is a good idea to check that drug concentration gets down to 0

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20
Q

What are bisphosphonates and how can we reduce risk of kidney damage

A

= used to reduce osteoclastic activity in bones

Do not use if impaired renal function
Do not use concurrently with NSAIDs
Give adequate access to water

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21
Q

How do pigments cause kidney damage

A

Oxidative damage

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22
Q

Two types of pigment nephropathy and how might we get them

A

Myoglobin: muscle injuriies, hypoglycin A, myopathies
Haemoglobin: haemolysis e.g from IMHA, neonatal isoerythrolysis

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23
Q

If we see myoglobin pigment in urine what should we look for on the bloods

A

Evidence of myopathy; CK and AST

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24
Q

What is the most common cause of pigmenturia

A

Atypical myopathy

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25
What is acute glomerular nephritis and how do we diagnose
= nephrotic syndrome; biopsy shows immune complexes May see with other autoimmune diseases
26
What does biopsy of acute interstitial nephritis show
Interstitial oedema and infiltrate
27
Treatment for acute interstitial nephritis
Rare condition; rapid increase in urea and creatinine Give corticosteroids but poor prognosis
28
Treatment principles for AKI
Get rid of risk factors e.g NSAIDs, haemorrhage Replace and maintain fluids with IV therapy Can use furosemide to reduce metabolic demands on cell to save tubular cells (inhibits Na/K ATPase) + cause diuresis
29
Clinical signs of chronic kidney faliure
WEight loss, inappetance, PU/PD, oedema, lethargy, May have uraemic syndome Tend to look good UNTIL there is loss of protein
30
What are the signs and aetiology of glomerulonephritis
Immune mediated deposition of immune complexes on glomerulus BM see haematuria and proteinuria Poor prognosis
31
Differentiate chronic renal disease from acute
Urine is isothenuric (rather than concentrated) Azotaemia often very marked Mild anaemia Hypoalbuminaemia Electrolytes: high K+, low Na+/Cl-, high Ca2_
32
Treatment of chronic kidney disease
palatable diet highly caloric diet without starch/sugar Very poor prognosis once thin due to low albumin
33
What is idiopathic renal haemorrhage and how do we treat it
= spontaneous severe haemorrhage May respond to steroids Consider nephrectomy if unilateral
34
What is oliguria
Reduced urine output - Can be absolute or lack of expected urine output given fluid therapy
35
What is pollakiuria
Increased frequency of urination - Must differentiate infcreased frequency from increased VOLUME with polyuria causing higher freq
36
What other things could cause apparant strnguria
GI pain e.g from ulcers, meconium impaction
37
What does hyposthenuric urine show
Active water secretion since more dilute than plasma = indicative of CKD, psychogenic PD, diabetes insipidus
38
What drugs can cause urine to appear isosthenuric
Sedatives (may have been used during catheterisation)
39
What can intermittent haematuria e.g after strenuous exercise be a sign of
Calculus
40
How common are primary UTIs
rare Because normal flora is protective+ bladder has protective mucous
41
What things can predispose to secondary cystitis
Urethral damage e.g from breeding, parturtion, iatrogenic Abnormal anatomy Urolithiasis Bladder paralysis Bladder neoplasia Sterile inflammatory cystitis leading to opportunistic infection
42
What is a good first line antibiotics for UTIs
TMPS since this is concentrated in the urine
43
What counts as proof of infection in urine
Quantitive culture from catheter showing >10 leukocytes/hpf
44
Haematuria possible causes (renal, bladder, urethra)
* Renal: idiopathic haemorrhage, neoplasia, cystic structures * Bladder: stones, idiopathic haemorrhagic cystitis, bacterial cystitis, neoplasia * Urethra: neoplasia, colliculus seminalis inflammation in geldings + haemolysis; not true haematuria
45
If blood coming from both kidneys rather than one on endoscopy what does this suggest
Due to haemolytic condition
46
If haematuria coming from just one ureter what are the likely causes
neoplasia, kidney stone, idiopathic renal haemorrhage, cystic change
47
Where are uroliths found in horses
Bladder (very rare to be urethral or ureteral) 3X more likely in geldings
48
Are uroliths related to UTIs
Doesn't seem likely since geldings most predisposed to stones but mares get more UTIs
49
Are uroliths diet induced
NO - all have forage and excrete clacium via kidneys
50
What clinical signs might a horse with nephroliths show
[normally asymptomatic] Can show pain when ridden, biting signs May try blocking kidney to see if it removes the pain before removing kidney
51
When would we consider nephrectomy for neprholith
If causing signs and animal NOT azotaemia
52
Clinical signs of cystoliths
Haematuria after exercise Concurrent UTI signs Stranguria/dysuria
53
Treatment of cystoliths in horses
Need surgery = perineal urethrotomy and cystoscopy guided stone removal
54
What infectious cause of urinary incontinence must we consider/rule out
EHV-1 myeloencephalopathy
55
What are the common causes of incontinence
Related to neurological dysfunction or idiopathic
56
POssible causes of urinary incontinence
- Sabulous cystitis - Sacrococcygeal injury; trauma - Bladder calculi - EHV myeloencephalitis/opathy - Polyneuritis equi - Sacral abscessation - Sacral neoplasia
57
What do we tend to find with incontinence due to sacral trauma
Issue is LMN supply to bladder; feel atonic distended bladder with incomplete emptying and overflow dribbling
58
What do we look for when trying to work out if urinary incontinence could be EHV-1 myeloencephalopathy
Ask about vaccination, travel etc Look for cauda equina signs and ataxia e.g weak anal tone, poor perineal sensation, pelvic limb ataxia, gluteal atrophy
59
What is equine sabulous cystitis
When calcium crystals accumulate as seidment in the ventral spect of bladder Can become so heavy it pulls the bladder over the pelvic brim See thick yellow sludge of protein, bacteria, ammonia WBCs, RBCs, mucus, chalk
60
Diagnosis and treatment of equine sabulous cystitis
Diagnosis = cystoscopy Treatment = repeated bladder lavage, treat inflammation and secondary infections NB: poor prognosis
61
At what urine concentration is it worth investigating suspected PU/PD further
<1.012
62
What medical diseases can we check for that may be causing PU/PD and how
Liver via GGT PPID via ACTH test Diabetes mellitus via fasted glucose test Chronic kidney failure via urea/creantinine
63
When do we want to avoid water deprivation test
If chance horse may be in chronic kidney failure
64
If horse is able to concentrate urine during water deprivation test what does it have
Psychogenic polydipsia
65
If horse cannot concentrate urine during water deprivation test and becomes dehydrated what does it have
Diabetes insipidus
66
What tumours of the penis are common
Squamous cell carcinoma; starts as papilloma then neoplastic transformtaino Melanoma = pigmented solid mass
67
Treatment for equine genital squamous cell carcinoma
Early resection, remove lots of penis and do perineal urethrostomy Can try local chemo?....
68

Equine (26 decks)

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