Exam 2

Question 1

How do renal insufficiency and renal failure differ in regard to amount of nephrons lost?

Answer 1

insufficiency–66% (2/3) are lost

failure–75% (3/4) are lost (azotemic)

Question 2

What amount would be considered polyuric in small animals?

Answer 2

> 50ml/kg/day

Question 3

If azotemia is present, you would expect the USG to be at least ______ to call it pre-renal

*Give value for both dog and cat

Answer 3

dog: >1.030

Cat: >1.035

Question 4

What are the 4 phases of renal failure

Answer 4

induction
extension
maintenance
recovery

Question 5

4 most likely causes of death during initial management of acute renal failure in small animals

Answer 5

1) hyperkalemia
2) metabolic acidosis
3) severe azotemia
3) overhydration/pulmonary edema

Question 6

When selecting fluid therapy for acute renal failure, what two things influence your choice?

Answer 6

1) acid/base status of patient

2) electrolyte status of patient

Question 7

concerning fluid composition, which fluid:

1) has highest Na concentration? lowest?
2) has highest pH? lowest?

Answer 7

1) highest= 0.9% NaCl;
lowest= LRS

2) highest= plasma (7.4)
lowest= 0.9% NaCl (5.6)

Question 8

What 3 components of fluid therapy do you add together to determine amount needed

Answer 8

rehydration volume
maintenance volume
estimated ongoing losses

Question 9

Concerning fluid calculations:

1) how do you calculate fluids needed for dehydration?
2) what is the maintenance rate for dogs? Cats?

Answer 9

1) bodyweight(kg) x (%dehydration)= total deficit in L (convert!!!! x1000 to ml)

2) dogs= 60ml/kg/day
cats= 40ml/kg/day

Question 10

Which treatment for hyperkalemia does NOT alter serum K levels? What does it do instead?

Answer 10

10% Ca gluconate

cardioprotective–protects heart from effects of hyperkalemia

Question 11

When managing oliguric renal failure, how does your fluid calculation change?

Answer 11

Instead of calculating dehydration deficit and replacing it, you measure the urine output and add that to maintenance and ongoing losses

Delivered over 4hr

Question 12

When monitoring CVP for overhydration, you don’t want it to be greater than?

Answer 12

8cm H2O

Question 13

Fanconi syndrome primarily affects which breed? It’s due to a defect in ______ ________

Answer 13

Basenji

proximal tubule

Question 14

Staging of CKD is based on? What do we look at to determine substage?

Answer 14

based on creatinine levels

substage: is there presence of hypertension or proteinuria

Question 15

cervical ventroflexion in cats is commonly due to which electrolyte abnormality?

Answer 15

Hypokalemia

Question 16

What dietary factors in cats are risk factors for hypokalemia (3)

Answer 16

1) acidifying ingredients
2) low Mg
3) high protein

Question 17

CKD diets should be low in (3 things) and high in (2 things)?

Answer 17

LOW:
–protein, phosphorous, Na

High:
–B vitamins, caloric density

Question 18

Calcitriol would be contraindicated in CKD patients with which electrolyte abnormality?

Answer 18

Hyperphosphatemia

**remember, Vit D increases absorption of both Ca AND PO4 from gut…

Question 19

Which medication commonly used to manage hypertension in CKD patients may potentiate hypokalemia

Answer 19

Amlodipine

Question 20

Describe the how ACE inhibitors can be used to treat PLN. Name 2.

Answer 20

Two drugs: Benazepril, enalapril

they block formation of angiotensin II so there is no constriction of efferent arteriole–> decreased glomerular pressure

Question 21

The 3 main categories of diseases assoc. with acute intrinsic renal failure (i.e. not pre or post-renal)

Answer 21

Acute glomerlonephritis

Acute interstitial nephritis

Acute tubular necrosis (majority*)

Question 22

Concerning polycystic kidney disease (PKD):

1) what are the two forms of inheritance
2) which spp/breeds are predisposed to each form
3) what is the age (young or old) of those who get the different forms

Answer 22

1) Autosomal dominant and autosomal recessive
2) Dominant= bull terriers & persian cats

Recessive= west highland whites, Cairn terrier, perendale sheep

3) dominant= adults
recessive= young

Question 23

What are the 3 components of the selective filtration system in the glomerulus

Answer 23

1) fenestrated endothelium
2) basement membrane
3) podocytes

Question 24

What is the hallmark of glomerular disease?

Answer 24

proteinuria in the absence of urinary tract inflammation

Question 25

Which disease of the glomerulus involves sticky of the basement membrane to bowman’s capsule?

Answer 25

Focal segmental glomerulosclerosis

Question 26

Where are the immune complexes deposited with:

1) membranoproliferative GN
2) membranous GN

Answer 26

1) subendothelial & mesangial (hypercellularity)

2) subepithelial (spikes with JMS stain)

Question 27

Which form of amyloidosis is most common in animals?

Answer 27

Secondary (AA amyloidosis)

Question 28

Two important metabolites of ethylene glycol

Answer 28

Glycoaldehyde

Glyoxylate

Question 29

Pyelonephritis implies involvement of which two areas of the kidney

Answer 29

renal pelvis and renal parenchyma

Question 30

How do embolic nephritis and pyelonephritis differ in their primary cause?

Answer 30

Embolic= secondary to bacteremia

Pyelonephritis= ASCENDING infection from cystitis

Question 31

How does the appearance of an infarct vary based on the affected artery?

Answer 31

renal artery–entire kidney necroses

arcuate artery–wedge-shaped area in cortex and medulla (most common)

interlobular–necrosis of cortex only

Question 32

What type of lesion/necrosis is seen in the kidney with NSAIDs

Answer 32

renal medullary/papillary necrosis

**blocked PGE2 production

Question 33

For horses:

1) normal water intake
2) normal urine production

Answer 33

1) 40-60ml/kg/day (less if grazing, more if hot/lactating/working)
2) 15-30ml/kg/day

Question 34

Normal USG for:

1) adult horses
2) foals

Answer 34

1) 1.020-1.050

2) 1.001-1.027

Question 35

Most common cause of tubular necrosis in horses?

Answer 35

Aminoglycoside antimicrobials

Question 36

If you are trying to improve renal perfusion and urine production in a horse secondary to aminoglycoside toxicity, which medication should you avoid?

Answer 36

Furosemide–exacerbates aminoglycoside toxicity

Question 37

What are the 3 hallmarks of chronic interstitial disease in horses

Answer 37

azotemia
hypercalcemia
USG 1.008-1.014

Question 38

What are the 2 forms of renal tubular acidosis in horses and how do they differ?

Answer 38

RTA I–can’t excrete hydrogen

RTA II–can’t reabsorb bicarb

Question 39

What is considered a low USG in food animals?

Answer 39

<1.020