Exam 2 Flashcards
Function of Kidneys
Excretion
• Urea
• Creatinine
• Uric acid
• Bilirubin
• Drugs
Regulation
• Water, electrolytes
• Arterial pressure
• Acid-base balance
• Secretion, metabolism, excretion of hormones
• Gluconeogenesis
Regulation of Arterial Pressure by Kidneys
Short-term
• decreased perfusion -> secretes renin -> angiotensinogen -> angiotensin I -> angiotensin II by angiotensin converting
• angiotensin II is a strong vasodilator & only lasts for a few minutes
long-term
• excrete varying amounts of Na & H2O
Acid Base Regulation by Kidneys
o Bicarb resorption
o H+ secretion (hydrogen, sulfuric/phosphoric acid)
Therapeutic Options For Proteinuria
o ACE inhibitors
o Angiotensin II Receptor Blockers
o Omega-3 fatty acids
o Clopidogrel (avoid thromboembolism)
o Amlodipine (for concurrent hypertension)
Ace Inhibitors, Omega-3 Fatty Acids
Ace Inibitor
• Decreases arterial resistance
• Preferential efferent arteriole dilation
• 1st line of defense proteinuria
Omega 3 Fatty Acids
• Anti-inflammatory
• Reduces platelet activity
Angiotensin II Receptor Blockers; drugs & function
Losartan
Telmisartan
• Theoretically treats angiotensin escape that may occur when ACE inhibitors fail
Things to Examine w/ UTI
o Hooded vulva?
o Dermatitis
o Vaginal stenosis
o Discharge
o Prostate enlargement
Localizing UTI
Lower (bladder, urethra, prostate)
• Stranguria, pollakiuria
• Hematuria, pyuria, proteinuria, bactiuria
Upper (ureter & kidney)
• PU/PD
• Signs of systemic infection
• +/- leukocytosis
• Hematuria, pyuria, proteinuria, bactiuria, granular casts
Urinalysis
o USG
o Dipstick
o Urine sediment
o Culture
Urine Culture
Qualitative
• Isolation/ID of bacteria
• Not recommended
Quantitative
• CFU per unit volume
• Allows determination of significance of bacteria
UTI Predisposing Factors
o Urine retention or leakage
o Uroliths, neoplasia, polyps
o Underlying systemic dz
o Excessive perivulvular skin or ectopic ureters
o Placement of urinary catheter
Complicated Vs Uncomplicated UTIs
Uncomplicated
• Sporadic
• Healthy individual
• Lack of comorbidities
• Fewer than 3 episodes per year
• Treat 7-14 days
• Monitor clinical signs
Complicated
• Anatomic abnormality
• Functional abnormality
• Co-morbidity
• Recurrent infection
• Treatment failure
Assessing UTI w/ Ultrasound
o Bladder wall thickness
o Radiolucent uroliths
o Neoplasia (bladder, renal or other intra-abdominal causing compression)
o Dilated renal pelvises
(pyelectasia = hallmark sign of pyelonephritis, but NOT pathognemonic)
o Renal cortical and medullary tissue architecture
o Prostate
o Adrenal gland size
Reinfection Vs Relapse Vs Refractory
Reinfection
• Recurrent UTI in 6 months post successful treatment
• isolation of different organism
Relapse
• Recurrent UTI in 6 months post successful treatment
• isolation of the same organism
Refractory
• Persistently (+) culture during treatment
Subclinical Bactiuria
o presence of bacteria in the urine as determined by positive bacterial culture, in the absence of clinical and cytological evidence of UTI
o Treatment may not be necessary
o presence of multidrug-resistant bacterium does not represent, by itself, an indication for treatment
Diseases associated w/ proteinuria
o Kidney disease
o Hyperadrenocorticism
o Neoplasia
o Immune-mediated diseases
o Infectious diseases
What’s wrong with having proteinuria?
o Bad for kidneys (chicken or the egg?)
o May cause thromboembolism
o Hypertension
o Part of nephotic syndrome (proteinuria, hypoalbumenia, hypercholesterolemia, edema)
Pre-renal Proteinuria
o low-level proteinuria
o overabundant filtered load of low molecular weight proteins that overwhelm the resorptive capacity of the proximal tubule
o hemoglobin, myoglobin, and immunoglobulin in the urine
Renal Proteinuria
o all forms of functional and pathologic proteinuria
o must be an alteration in renal physiology.
pathologic renal proteinuria
• defect in glomerular filtration barrier, tubular reabsorption, or interstitial damage
• most persistent cause of proteinuria
• highest levels of protein secondary to glomerular disease
Functional renal proteinuria
• transient, mild proteinuria
• caused by heat, stress, seizure, venous congestion, fever, and extreme exercise
Post-renal Proteinuria
• protein that is deposited in the urine from any part of the urinary tract distal to the kidney
• UTIs, inflammation, and hemorrhage
• Genital infections or inflammation (vaginitis, prostatitis)
• Extraurinary post-renal proteinuria can be minimized by performing cystocentesis.
• Post-renal proteinuria is never persistent once the underlying condition is removed
Looking at Persistence & Magnitude of Proteinuria
Persistance of Proteinuria
o Compare values day to day
o Repeat urine tests 3 times 2wks apart
o Collect from different micturition episodes & pool
Magnitude of Proteinuria
o Urine dipstick
o Affected by Alkiline urine, cells in sediment
o Strip sitting in urine too long
o If + on dipstic, do UPC
When to monitor Urine Protein/Creatinine Ratio
o Non-azotemic with persistent/steady microalbuminuria
o Non-azotemic with UPC less than 0.5
When to use Diagnostics to determine where protein is coming from
o Borderline proteinuria detected -> reevaluate in 2 to 4 months.
o If proteinuria (UPC > 0.4 in a cat and > 0.5 in a dog) is repeatable on 2 or more serial urine tests with benign sediments -> workup
o Work-up: rule out infectious disease, neoplasia, endocrine disease, checking blood pressure
Acute Kidney Injury; Basics, Symptoms, Clinical Presentation
• acute reduction in kidney function
• leads to change of GFR, urine production, tubular function
Symptoms
o Inability to maintain fluid
o Electrolyte imbalance
o Acid-base balance disturbances
o Azotemia
Clinical Presentation of AKI
o good body condition
o Vomit/diarrhea
o Lethargy
o Anorexia
o Painful
