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Flashcards in LA urology (Reuss) Deck (38):
1

History

  • Duration
  • relation to other events
    • exercise
    • parturition
  • number animals affected
  • Non specific signs
    • weight loss
    • colic
    • decreased performance
  • Diet
  • Medications
  • Water intake: 40-60 ml/kg/day
  • Urine output: 5-20 ml/kg/day
    • amount
    • pattern
    • character
    • groaning/grunting

2

Abnormal micturation

  • Stranguria
  • Dysuria
  • Pollakiuria
  • Polyuria
  • Oliguria
  • Anuria

  • Stranguria: straining to urinate
  • Dysuria: pain on urination
  • Pollakiuria: inc frequency urination
  • Polyuria: inc total volume urination
  • Oliguria: dec total volume of urination
  • Anuria: passing no urine

3

Oral exam

  • Excessive tartar
    • kidney dz
  • Ulcers
  • Bad breath

4

External genitalia

  • urethral fossa
    • squam
    • stones
  • Vulva
    • crystals
    • evidence of bleedings

5

Transrectal palpation

Horse

Cow

Small Ruminant

  • Horse
    • Left kidney
    • Bladder
    • Ureters -bad news
    • Urethra
  • Cattle
    • Left kidney
      • Lobulated
      • almost on midline
    • Ureters
    • Bladder
    • Urethra
  • Small ruminant
    • digital
    • transabdominal
    • perineal urethra (urethral pulse if stone)

6

Ruminant urine collection

  • Females: urethral diverticulum
    • stroke vulva
  • Males: NOT POSSIBLE to catheterize
    • sigmoid flexure
    • urethral diverticulum
    • stroke preputial hairs
  • small ruminants
    • suffocate them...lol

7

Lab evals we do

  • CBC
  • CHEM
  • UA

8

CBC

Anemia

  • Cause of renal disease
    • hemolysis => pigment nephropathy
    • acute blood loss => vasomotor nephropathy
  • Effect of renal disease
    • Anemia of chronic disease
    • Decreased erythropoietin production
    • Decreased life span of RBCs

9

Hematology

  • Chronic infection or inflammation
  • Glomerulonephritis

  • Chronic infection or inflammation
    • Neutrophilia
    • Hyperfibrinogemia
    • Inc globulins / total protein
  • Glomerulonephritis
    • hypoalbuminemia
    • panhypoproteinemia = almost always GI DZ

10

Serum biochem

Creatinine

  • waste product from muscle
  • Freely filtered
  • filtration rate = excretion rate
  • increases once 75% nephrons damaged

11

Serum biochem

BUN

  • LA patients can secrete in sweat
  • LA patients can recycle
  • Can use urea to inc medullary hyperotonicity
    • retain water

12

GFR measurements

  • Creatinine clearance
  • Iohexol Clearance
  • Nuclear scintigraphy

13

Serum electrolytes

Acute Kidney Injury

  • dec Na, Cl
  • inc K, Mg
  • dec Ca, inc P

14

Serum electrolytes

Chronic kidney dz

Horses

  • inc Ca, dec P

15

Urinalysis

  • Color
    • horses should have cloudy urine
    • ruminants should not be cloudy
  • Red urine:
    • blood, hemoglobin
  • Brown urine:
    • myoglobin

16

UA

Hematuria

Hemoglobinuria

Myoglobinuria

  • Hematuria
    • erythrocytes settle out
  • Hemoglobinuria
    • urine and serum discolored
  • Myoglobinuria
    • urine stays discolored
    • serum clear

*urine dipsticks can't tell the difference

17

urine pH

  • herbivores have alkaline urine
  • exceptions:
    • high protein diet
    • anorexia
    • neonate

18

USG

  • Estimates solute concentration
    • weight of solution relative to equal volume of distilled water
  • Use refractometer
    • dipstick not accurate (I think)
  • Can be falsly increased if lots of protein or glucose
    • use osmolality (# particles/kg water)

19

Hyposthenuria

Isosthenuria

Hypersthenuria

  • Hyposthenuria
    • USG < 1.008
    • normal in suckling foals
  • Isosthenuria
    • USG 1.008 - 1.014
    • tubule disease
    • high producing dairy cows N: 1.007 - 1.015
  • Hypersthenuria
    • USG > 1.014
    • N: 1.015-1.035
    • Dehydration: > 1.025

*Sedation will falsly lower USG

20

Fractional clearances

  • Reflection of tubular disease
    • Urine (electrolyte) % Plasma (x) * P (Cr) % U (Cr) * 100 = % FC
  • Na clearance most useful
    • should be less than 1
    • should be close to 0 in dehydrated horses
  • Altered by IV fluids, furosemide, exercise

21

Urine GGT

  • Biliary and pancreatic tubular GGT production not filtered by kidney
  • Proximal tubular brush border enzyme
    • early indicator of proximal tubule damage
    • increases quickly with aminoglycoside tox
    • only released during active destruction

22

Liver dz without tubular dz and GGT

no GGT in urine

23

Tubular dz without liver dz and GGT

tubular dz will mean GGT in urine, not liver dz

24

Urine GGT will go up before

Creatinine

25

Ratios used to get rid of

dilutional effect

26

Urine GGT/Creatinine Ratio

  • (UGGT)/(UCr) * 100
    • normal < 25 IU/g
    • 25-100 IU/g ???
    • > 100 IU/g are clinically relevant
    • Follow trends

27

Proteinuria

Normal kidney

Proteinuria

  • Normal kidney
    • glomerulus excludes albumin, globulin
    • proximal tubules reabsorb low-molecular weight proteins
  • Proteinuria
    • kidney
      • more pronounced with glomerular disease
    • Exudative processes in ureters, bladder, urethra
    • vulvar contamination

28

Proteinuria

False positives

  • False positives
    • alkaline pH causes trace protein on dipstick
      • overcomes citrate buffer
    • Hemoglobin
  • Sulfosalicylic acid precipitation (SSA)
  • Urine protein: creatinine = 1.0:1

29

Glucosuria

  • Reabsorbed in proximal tubule
  • Renal threshold = 150 mg/dl

 

 

30

Glucosuria + normoglycemia =

proximal tubular damage

31

Glucosuria + hyperglycemia =

systemic disease

32

Sediment

Casts

Crystals

  • Casts
    • dissolve quickly in alkaline urine (LOOK W/IN 1/2-1hr)
    • indicates tubular damage
  • Crystals (hard to interpret, all can be normal)
    • calcium carbonate, phosphate, oxalate
    • struvite

33

Sediment

WBC

RBC

  • WBC > 10/hpf = pyuria
    • infection, inflammation
    • +/- Bacteria
  • RBC > 5/hpf = hematuria
    • inflammation, infection, neoplasia, exercise

34

Ultrasound

Kidneys

  • Transabdominally
  • Transrectally
  • Assess size, density, structure
  • Cortex should be more echogenic than medulla
  • Pelvis echogenecity varies

35

Renal biopsy

  • complications
    • hemorrhage
    • bowel penetration
  • not done often
    • doesn't give etiology, just confirms end stage kidney dz

36

cystoscopy

  • ureteral openings
  • cystoliths

37

Abdominal Radiographs

  • Retrograde cystogram
  • Excretory pyelography

*suspect bladder rupture

38

Nuclear scintigraphy

assess renal perfusion