Koster Test 2 Flashcards
(156 cards)
1
Q
At what % GFR does azotemia develop?
A
25%
2
Q
What are the causes of pre-renal proteinuria?
A
Fever
CHF
Cushing’s
Sled dog that ran a marathon
3
Q
What is the most common route of infection for LUTD?
A
Ascending infection
Hematogenous uncommon
4
Q
What urinary signs are seen within 18 hours of Tiger Lily poisoning?
A
Casts and glucose
5
Q
T/F: Dogs have a higher risk for prostatic neoplasia if they are castrated
A
True
6
Q
What is it important to do when investigating an animal for female genital disease?
A
Vaginal speculum exam
Cytology if intact
7
Q
Tx for cystine calculi?
A
Alkalinize urine
Low protein diet
8
Q
What is the goal of therapy for stage 1 CKD?
A
Identify primary disease and start specific therapy to eliminate disease if possible
9
Q
If you see the following on CBC, what do they mean?
Erythron
Leukon
Platelets
A
Erythron = CKD
Leukon = pyelonephritis
Platelets = HUS
10
Q
What is the specific tx for pyelonephritis (G-)?
A
Floroquinolones or TMS (4-6 weeks)
11
Q
What drugs are used to treat an uncomplicated UTI?
A
TMS, amoxycillin, cephalosporins
10-14 days
HDSD enrofloxacin for 3 days (dogs only)
12
Q
What drugs can be used to relax the ureters?
A
Prazosin
Amiptryptalline
13
Q
What is urge incontinence or detrusor instability?
A
Detrusor contraction during storage of urine or low compliance of the detrusor muscle, which may be confirmed by cystometrography
14
Q
What is the goal of treatment for stage 4 CKD?
A
Symptomatic therapy
15
Q
Tx for detrusor instability?
A
Anticholinergic (oxybutynin, imipramine, dicyclomine)
16
Q
T/F: Dopamine is extremely effective in cats with oliguria
A
False
Not effective
17
Q
Ammonium urate and xanthine uroliths are associated with what conditions?
A
Hepatic disease
Genetic tubular defects
18
Q
When treating a UTI, why do you reculture at 2-3 weeks into the tx?
A
Test for resistance
19
Q
What factors can cause a falsely high urea?
A
GIT bleeding
Intravascular hemolysis
High protein diet
20
Q
What breeds are associated with ammonium urate and xanthine uroliths and what is the cause in each breed?
A
Dalmatians - hepatic disease, genetic tubular defect
Black Russian - genetic tubular defect
21
Q
Do you want to increase or decrease the pH when treating urate uroliths?
A
Increase
22
Q
When is immunosuppressive tx for glomerular disease contraindicated?
A
Pancreatitis
Bone marrow suppression
DM
23
Q
Common example: Cat with repeated episodes of previous LUTD that develops acute obstruction.
Name the condition
A
ARF
24
Q
What pathogen causes an encrusting cystitis?
A
Corynebacterium
25
What are the accurate techniques (direct methods) of measuring glomerular function?
Clearance of radioisotopes with renal scintigraphy
Iohexol/creatinine clearance
26
What is the gold standard for measuring urine concentration?
Osmolality (Uosm)
27
What is the first drug choice for immunosuppressive tx of glomerular disease?
Mycophenolate
28
Which nerve is responsible for bladder voiding? What type of innervation?
Pelvic nerve
Parasympathetic
29
What is the average value for insensible fluid loss?
22ml/kg/d
30
What is the specific tx for TMS toxicity?
Urinary alkalinization
31
What can cause a false negative proteinuria on dipstick?
Acidic urine
Bence jones proteinuria
32
USG in cats and dogs associated with CRF?
Cats = 1.008-1.030
Dogs = 1.008-1.022
33
What is the DOC to treat hypertension in dogs and cats with CRF?
Dogs = benazepril
Cats = amlodipine
34
What drugs are most important when treating LUTD in cats?
Analgesics - opioids
35
What environmental factors are important when treating feline LUTD?
Reduce stress
Litter boxes
Water sources
Activity/playing
36
When you hear reduced fractional excretion of sodium, what do you think of?
Pre-renal disease
37
What drug can you use to treat urate uroliths in dalmatians only?
Xanthine oxidase inhibitors
38
With what form of prostatitis is the patient sick?
Acute
39
What stages of CKD does phosphate levels increase?
3 and 4
40
What is the gold standard for quantifying proteinuria?
24 hour urine protein measurement
41
What is a side effect of using piroxicam for TCC?
50% of patients develop gastric ulcers so give H2 blockers
42
Tx for struvite uroliths?
Diet to acidify urine (3 months)
Abx during calculolytic diets for infection
43
Common example: Geriatric dog on chronic NSAID that receives a general anesthetic without fluid support.
Name the condition
ARF
44
What is the preferred imaging modality to diagnose ureteral obstruction?
Computed tomography
45
What can you give to manage anorexia with CRF?
Cyproheptidine
Mirtazapine
46
What is the most common organism found on urine culture?
E. coli
47
What is the goal of therapy for stage 2 and 3 CKD?
Renoprotetive therapy to try to slow progression
48
What is an advantage of nuclear scintigraphy regarding GFR?
You can get a GFR for each kidney individually
49
Supportive care for GI?
Control anorexia, nausea, and vomiting
Uremic gastropathy - famotidine, ranitidine, omeprazole
Prokinetics - ondansetron, metoclopramide
Anti-emetics - metoclopramide, maropitant
50
Tx for prostatitis?
Anitmicrobials
Sx
51
Partial water deprivation test cannot be performed on patients with this condition
Cushings
52
What is the specific tx for aminoglycoside toxicity?
Ticarcillin binds with gentamycin
53
What tier: Glomerular proteinuria w/ azotemia and hypertension but no hypoalbuminemia
Tier 3B
54
Define the initial phase of ARF
Decrease in urine output or increase in [creatinine]
55
If there are clinical signs in a dog with chronic prostatitis, what are they?
Recurrent UTIs or preputial discharge
56
What causes/symptoms of ARF have a poor outcome?
Decreased urine production
Hypothermia
**Hyperkalemia**
Toxic (EG)
57
Describe a reinfection/superinfection UTI
New/different organism
Reinfection - C&S positive \>7 days after last treatment course
Superinfection - C&S positive at day 7 after starting abx
58
Tx for BPH?
Surgical (orchidectomy) - decrease size by 50%
Chemical castrations - GnRH, gestagens
DHT inhibitors - finasteride maintain fertility (same response as surgery)
59
T/F: There is no EBM to support that any therapy will improve outcome of oliguria
True
60
Is renal carcinoma more common in dogs or cats?
Dogs
61
What findings make up nephrotic syndrome?
Proteinuria
Hypoalbuminemia
Ascites/edema
Hypercholesterolemia
62
How much earlier does SDMA increase than creatinine than dogs and cats when there was a 40% decrease in GFR?
Dogs = 9 months
Cats = 17 months
63
Is renal lymphoma more common in dogs or cats?
Cats
64
Since mycophenolate is expensive, what other drugs can you use to treat glomerular disease?
Cyclosporin
Chlorambucil
Azathioprine
Cyclophosphamide
65
What secondary processes further enhance CKD?
Systemic and glomerular hypertension
Mineral imbalance
Proteinuria
Renal fibrosis
66
What drug is used to tx LMN bladder?
Bethanecol
Express bladder 3-4/day
67
T/F: Prostatic neoplasia is not related to neuter status
True
68
Which is more common, acute or chronic prostatitis?
Chronic
69
DDx for glucosuria?
DM
Renal tubular disease
Stress hyperglycemia
Effect of glucocorticoid tx
70
What tier: Glomerular proteinuria w/o hypoalbuminemia or azotemia
Tier 1
71
Tx for TCC in the bladder?
Piroxicam
Sx
Chemo - mitoxantrone
72
Supportive care for hypertension?
Keep systolic BP \< 180
Avoid ACEi in ARF
Amlodapine and hydralazine
73
How long does the maintenance phase of ARF last?
1-3 weeks
74
What drugs are the standard of care when treating lepto?
Calcium channel blockers
75
What is reflex dyssynergia and what are two examples of animals that it occurs in?
Urethral sphincter spasms with initiation of detrusor contraction
Idiopathic in male GSD
Cats with LUTD
76
What is the gold standard for diagnosing feline iterstitial cystitis?
Cystoscopy
77
How long after administration of furosemide shoud urine output increase?
2-60 minutes
78
What are some causes of acute on chronic renal disease?
Another disease
UTI
Drugs
Ureteral obstruction
Blood loss
79
T/F: There is no inflammatory leukogram or fever associated with LUTD
True
80
Supportive care for hyperkalemia?
Dextrose infusion
Insulin followed by dextrose infusion (BG monitoring)
Calcium gluconate
Correct met acidosis with bicarb over 15min
81
What are some non-neoplastic causes of renomegaly?
Renal inflammation
Amyloidosis
Hydronephrosis
Polycystic kidney disease
Portosystemic shunts
82
What is the average urinary loss?
44ml/kg/day
83
What drug do you use to tx UMN bladder?
Baclofen (smooth muscle relaxnt)
84
What is considered normal urine output?
1-2ml/kg/hr
85
What breed is associated with neoplasia in the bladder or urethra?
Scotties
86
Describe a relapse UTI
Same organism/strain 7 days after last treatment course
87
What is the most common cause of chronic renal disease?
Chronic interstitial nephritis (70%)
88
What USG is considered inadequately concentrated urine?
\<1.022
89
Why is it better to do sediment in house?
Crystals grow in storage
Casts and cells disintegrate in storage
90
What breeds are associated with cystine calculi?
Dachshunds
Newfoundland
Bulldogs
91
T/F: UTIs are more common in cats than dogs
False
92
Supportive care for hyperphosphatemia?
No specific therapies
Reduce in diet
Binders
Aluminum carbonate/hydroxide in food
93
What is the gold standard for measuring glomerular function?
Nuclear scintigraphy
94
What is the most common etiology for urinary incontinence?
Urinary Sphincter Mechanism Incompetence (SMI)
95
What can cause a false positive proteinuria on dipstick?
Alkaline urine
Contaminatino
96
Detrusor atony is associated with what condition?
Addison's
97
What test is done to confirm urinary incontinence?
Urethral profilometry
98
What is the USG range for isosthenuria?
1.008-1.012
99
What is the best method for urine collection?
Cystocentesis
100
What is the specific therapy for ethylene glycol toxicity?
4-methylpyrazole within 8hr of ingestion
101
T/F: All intact male dogs with UTI have prostatitis
True
102
What urine protein value in cats and dogs is consistent with CKD?
Dogs = \>0.5
Cats = \>0.4
103
What abx would you give to tx prostatitis and how long?
Baytril BID for 4-6 weeks
104
Should you feed wet or dry food when treating LUTD in cats?
Wet
105
What are the two most common infectious causes of LUTD?
E. coli
Gram+ cocci
106
What endocrine diseases can cause LUTD?
DM
Cushing's
107
What infectious diseases can cause glomerular disease?
Lyme
Heartworm
Ehrlichia
Leishmania
108
What is the standard of care for an obstructive stone or stricture?
Ureteral stent or SUB
109
What tier: Glomerular proteinuria w/ hypoalbuminemia, but no azotemia or hypertension
Tier 2A
110
What kind of diet is useful in treating urate uroliths?
Low protein (U/D)
111
What does a UA show in a dog with acute prostatitis?
UTI
112
What is the urine production rate in an animal with oliguria?
\<0.5ml/kg/hr
113
What is the normal USG value for dogs and cats?
Dogs = \>1.030
Cats = \>1.035
114
What is the specific treatment for NSAID toxicity?
Misoprostol (PGE analogue)
115
What Na-fractional excretion value differentiates pre-renal from post renal?
Pre-renal = \<1%
Renal = \>1%
116
What is the water intake for a normal patient and one with PD?
Normal = 60ml/kg/day
PD = 100ml/kg/day
117
Prevention for CaOx stones?
Diet
Thiazide diuretics (predispose to UTI)
Potassium citrate
Vitamins
118
What tier: Glomerular proteinuria w/ azotemia but no hypertension or hypoalbuminemia
Tier 3A
119
What is the first sign to appear with Tiger Lily poisoning?
GI signs
vomiting (may subside by 12 hours)
anorexia
depression
120
PE findings of a dog with prostatic neoplasia?
Painful gait with pain in sacrum
Prostate palpable in neutered dog
Possible asymmetry
Submandiobular LN may be palpable
121
What is the specific tx for lepto?
Penicillins and doxy
122
Supportive care for hypercalcemia?
Diuresis
Furosemide
Glucocorticoids
Calcitonin
Bisphosphonates
123
What risk is associated with using diet to dissolve struvite stones?
Causing CaOx calculi to form
124
Which urolith is more radiodense, struvite or CaOx?
CaOx
125
How are ureteral stents placed in dogs and cats?
Dogs = retrograde via cystoscopy
Cats = antegrade via surgery
126
What neoplasias can bee found with female genital disease?
Leiomyoma/leiomyosarcoma
TVT
127
What tier: Glomerular proteinuria w/ azotemia, hypertension, and hypoalbuminemia
Tier 3C
128
What tier: Glomerular proteinuria w/ hypoalbuminemia and hypertension but no azotemia
Tier 2B
129
Tx for PLN?
ACE inhibitor or amlodipine for hypertension
ACE inhibitor or ARB and renal diet for proteinuria
Asprin or clopidogral for hypercoagulability
130
Where does prostatic neoplasia metastasize to?
LN
Vertebrae
Lungs
131
Tx for prostatic neoplasia?
Sx - post-op incontinence
Chemo - mitoxantrone
COX-2 inhibitors
132
What are the causes of dysuria/stranguria/pollakiuria?
Irritation of the baldder
Neurological disease
Secondary LUTD
133
What are the only useful tests on a dipstick analysis?
Protein
pH
Blood
Glucose
Ketones
Ignore leukocytes, SG, and urobilinogen
134
What nerve is responsible for retaining urine in the bladder? What type of innervation?
Hypogastric nerve
Sympathetic
135
Common example: Dog with pancreatitis and hypotension from SIRS.
Name the condition
ARF
136
Signalment for dogs with struvite uroliths?
Intact, toy breed, female
137
138
When is biopsy contraindicated for glomerular disease?
Stage 4 IRIS or coagulopathy
139
What urolith is commonly related to UTIs in dogs?
Struvite
140
What are the indirect methods for measuring glomerular function?
Serum urea
Creatinine
Cystatic C
141
T/F: CaOx stones are more common in females
False
Males
142
If you have increased glucose in your urine, how would this affect your specific gravity?
Increased
143
When do you run cultures for recurrent UTIs?
Pre therapy
During therapy (2-3 weeks)
Post therapy (7 days)
144
What are some renoprotective drugs?
Calcium channel blockers (diltiazem)
Selective DA-2 receptor agonists (vasodilation) (dopamine)
Erythropoietin analogues
145
What creatinine concentration identifies a dog and cat as IRIS stage 2?
Dog = 125-180
Cat = 140-250
146
What drugs are used in dogs and cats for pain management of ureteral obstrustions?
Dogs = fentenyl
Cats = buprenorphine
147
What are the only conditions that dopamine is useful for when treating oliguria?
When ARF is secondary to cardiac output failure or severe hypotension
148
What is the prophylactic therapy for recurrent UTIs?
Give 30-50% original dose at bed time (nitrofurantoin)
Run microbiology q4w
Discontinue meds if negative for 6 months
Monitor C&S q1m for 3m then q3m for 1y
149
Supportive care for acidosis?
Bicarb IV
base deficit x BW x 0.3
Give 1/4 IV and remainder CRI (2-6hrs)
150
What is dysautanomia?
UMN bladder associated with toxicity
Autonomic system damaged
151
What drug is used to tx reflex dyssynergia?
Phenoxybenzamine
152
What is the treatment of choice for extopic ureter?
Cystoscopic laser ablation
153
Supportive care for hypocalcemia?
Calcium gluconate 10%
154
Which is more sensitive between creatinine and SDMA? Specific?
SDMA more sensitive (100% vs 17%)
Creatinine more specific (100% vs 91%)
155
What % of incontinence is due to SMI?
85%
156
Contraindications for mannitol therapy when treating oliguria?
**Anuria**
Dehydration
