Flashcards in Nephrology and Urology Deck (302):
Abnormal increase in the concentration of non-protein nitrogenous wastes in blood
Causes of Pre-Renal Azotemia
Causes of Renal Azotemia
Causes of Post-Renal Azotemia
When the kidneys are no longer able to maintain regulatory function, excretory Function, and endocrine Function
When does Renal failure occur?
When greater than 75% of the nephron population is non-functional
Characteristics clinical findings associated with Uremia
What the indirect methods for measuring Glomerular function?
Serum urea levels
Serum creatinine levels
What are the accurate techniques for measuring Glomerular function?
Clearance of radioisotopes with renal scintigraphy
Iohexal/inulin/creatinine clearance tests
What percentage of nephrons have to be destroyed before GRF is decreased?
What is the gold standard for measuring Glomerular function?
What can cause an increase in urea?
high protein diets
What causes the production of Creatinine?
breakdown of creatine in muscle
When do you get a decrease in creatinine?
Reduced muscle mass
What are the limitations of Creatinine?
Does not discriminate between causes of azotemia, Acute vs. chronic renal failure, or Reversible or irreversible renal failure
small polypeptide protease inhibitor produced by all cells with a nucleus that is freely filtered by the glomeruli and does not undergo tubular secretion
methylated form of the amino acid arginine which is produced in every cell and released into the body's circulation during protein degradation and excreted exclusively by the kidneys
What is the best method for Urine collection?
What are the useful tests on the Urine dipstick?
What is the gold standard of urine concentration?
What test measures concentration of urine relative to plasma?
Urine Specific gravity
What is the range of urine specific gravity for hyposthenuria?
What is the range of urine specific gravity for Isosthenuria?
What is the range of urine specific gravity for Hypersthenuria?
Greater than 1.012
What is the range of urine specific gravity for minimally concentrated?
What is the range of urine specific gravity for Inadequately concentrated?
What is the range of urine specific gravity for adequately concentrated urine in dogs?
greater than 1.030
What is the range of urine specific gravity for adequately concentrated urine in cats?
greater than 1.035
What are the DDx for a urine specific gravity of 1.005?
What is a test you can perform for an animal with low concentrating urine?
Partial Water Deprivation Test
Fractional excretion of electrolytes
The fraction of electrolyte clearance relative to creatinine clearance
What crystals are found in Lhaasa Apsos?
What crystals are found in bull dogs?
What crystals are created due to Ethylene Glycol?
What crystals are seen in dalmations or with hepatic shunts?
What are common crystals seen in cats?
What causes a false positive on Urine protein creatinine ratio?
Lower Urinary Tract Disease
Urine protein creatinine ratio
comparison of protein to creatinine
What is the most common bacterial cause of UTI?
Gross macroscopic hematuria
Sufficient blood to be apparent to the naked eye
Urine is brownish to red
Occult microscopic hematuria
Hematuria not present to the naked eye
Red to brownish urine without intact red blood cells
What are the causes of pseudohematuria?
myoglobinuria or chemicals
What causes systemic hematuria?
What causes Renal Hematuria?
What causes Bladder, Ureter, and Urehral Hematuria?
Feline idiopathic cystitis
What causes Genital tract Hematuria?
What are the clinical manifestations of kidney disease?
Name some Renal Toxins
Straining to urinate
How much urine is produced per hour?
What are primary causes of enlarged kidneys due to neoplasia?
Why does Renal Carcinoma cause Polycythemia?
overproduction of erythropoietin by the tumor or due to renal hypoxia
What is the treatment for Renal carcinoma?
What is the prognosis for an animal with Renal Carcinoma?
16 months with treatment
What renal neoplasia is common in cats?
How do you treat Renal lymphoma?
Multi-agent chemotherapy (COP or CHOP)
What is the prognosis for Renal lymphoma?
60% have remission
What are non-neoplastic causes of renomegaly?
Polycystic kidney disease
Acute Kidney injury
Encompasses mild damage that does not cause azotemia to severe damage associated with complete anuria
Acute renal failure
Decreased GFR leading to retention of nitrogenous wastes
What is the criteria for Acute Kidney Injury?
R - Risk
I - Injury
F - Failure
L - Loss
E - End-stage kidney disease
Intenational renal interest society
Grade 1 AKI
Blood creatinine less than 1.6 mg/dl
Grade 2 AKI
Blood Creatinine 1.7-2.5mg/dl
Grade 3 AKI
Blood Creatinine 2.6-5.0mg/dl
Grade 4 AKI
Blood creatinine 5.1-10mg/dl
Grade 5 AKI
Blood creatinine greater than 10mg/dl
What are the pre-renal causes of AKI?
decreased effective circulatory volume
What are the renal causes of AKI?
Prolonged renal hypoperfusion
Immune mediated causes
Secondary to systemic disease
Post renal causes of AKI
Urine leakage or obstruction
What are the four phases of acute renal failure?
Initial phase of Acute renal failure
decrease in urine output or increase in creatinine without clinical signs
Extension phase of Acute Renal Failure
Continued hypoxia and inflammation
Proximal tubule and loop of henle susceptible to toxic and ischemic damage
Compromised Sodium:Potassium pump
Increased cytosolic calcium
Loss of brush border or apical and basal cell surfaces
Maintenance phase of Acute Renal Failure
1-3 weeks duration
Urine output is increased or decreased
Urine = ultrafiltrate
Recovery phase of Acute Renal Failure
Heralded by polyuria
Extreme Sodium loss
What are the risk factors for Renal tubular necrosis/injury?
Systemic inflammatory syndrome
How do you manage the risk factors for Renal tubular necrosis/injury?
Aggressively treat shock
Avoid nephrotoxic drugs
What are the Renoprotective drugs?
Calcium channel bloackers
Selective DA-2 receptor drugs
Selective DA-1 receptor agonists
What is normal urine production per hour?
What is abnormal urine production per hour?
less than 0.5ml/kg/hr
Diagnosis of AKI/ARF
Identify a predisposing cause
Reduced urine output
Casts - RTE cell casts
Renal tubular biomarkers:
Treatment of ARF
Maintaining fluid balance
What drugs are use in the treatment for ARF?
What is the correct shock dose for dogs?
What is the correct shock dose for cats?
What is the amount of insensible fluid loss?
What is the amount of Maintenance fluids for a dog?
What fluids would you use with for treatment of ARF?
0.45% NaCl + dextrose
What are the fluid requirements for ARF?
less than 0.5ml/kg/hr urine producton
How do you treat Oliguria?
Calcium Channel blockers
Osmotic diuretic that increases circulatory volume and decreases cell swelling
Loop diuretic the increases urine production without increasing GFR
What does Fenoldopam do?
increased urine output
What is the benefit of Dopamine?
a pressor when ARF is secondary to cardiac output failure or severe hypotensive
What drug is used in the standard of care for Leptospirosis?
Calcium Channel blockers
What do Calcium channel blockers do?
Prevent calcium moving intracellularly
What is the definitive treatment of ARF?
Extracorporeal renal replacement therapy/ dialysis
What are the indications for Dialysis?
FLuid overload with pulmonary edema
What is the complication of Peritoneal dialysis?
Dialysis disequilibrium syndrome
Blockage of the peritoneal drain by the omentum
What is the treatment for Ethylene glycol?
What is the treatment for NSAIDs?
What is the treatment for Leptospirosis?
Penicillin and doxycycline
What is the treatment for Pyelonephritis?
Fluoroquinolones or TMS
What is the treatment for Aminoglycoside toxicity?
What is the treatment for TMS toxicity?
What is the treatment for Hyperkalemia?
Correct metabolic acidosis
What is the treatment for Acidosis?
Sodium Bicarbonate IV
What is the treatment for Hypocalcemia?
What is the treatment for Hypercalcemia?
What is the treatment for Hyperphosphatemia?
What is the treatment for Hypertension?
Amlodipine and hydralazine
What is the treatment for Gastrointestinal problems associated with ARF?
Prokinetics: Ondansetron, Metoclopramide
Antiemetics: Metoclopramide, maropitant
Omeprazole, pantoprazole, famotidine, ranitidine
What is chronic kidney disease?
Loss of functional renal tissue due to prolonged process
Usually progressive and irreversible
What are the degenerative causes of CKD?
Chronic interstitial nephritis
What are the developmental causes of CKD?
Familial renal dysplasia
What is a metabolic cause of CKD?
What is the neoplastic cause of CKD?
What is an infectious cause of CKD?
What is an iatrogenic cause of CKD?
Vitamin D supplementation
What is an immune mediated cause of CKD?
Immune-complex mediated glomerulonephritis
What are the effects of Hyperphosphatemia?
Drives renal secondary hyperparathyroidism
Causes progression of disease
What causes Hypokalemia in CKD?
Increased renal potassium loss
What causes anemia in association with CKD?
Decreased life span of RBC
Effect of PTH on bone marrow and RBCs
What causes renal injury in CKD?
What is the treatment for Proteinuria associated with CKD?
What are the aims of Treatment and Management of CKD?
Treat underlying cause
Improve clinical signs/quality of life
Slow the progression
What causes Vomiting and nausea associated with CKD?
Stimulation of the CTZ by uremic toxin
What are the appetite stimulants used for the treatment of CKD?
Cyproheptadine in cats
Mirtazapine in dogs and cats
How do you treat Hyperphosphatemia associated with CKD?
Dietary phosphate restriction
Intestinal phosphate binders
When would you begin a cat on a Renal Diet?
IRIS stage 2
When would you begin a dog on a Renal Diet?
IRIS stage 3
How would you treat Hypokalemia associated with CKD?
Oral potassium supplements
How would you treat non-regenerative anemia associated with CKD?
rHuEPO or Darbopoietin
What is the Hypertension therapy for cats?
What is the Hypertension therapy for dogs?
How do ACE inhibitors work?
inhibit conversion of angiotensin I to angiotensin II
Reduce glomerular capillary pressure and glomerular size
Angiotensin receptor blocker
Management of acute on chronic disease
identify and treat underlying cause
What is considered a non-proteinuric UP/C value in dogs?
less than 0.2
What is considered a non-proteinuric UP/C value in cats?
less than 0.2
What is considered a borderline proteinuric UP/C value in dogs?
0.2 to 0.5
What is considered a borderline proteinuric UP/C value in cats?
0.2 to 0.4
What is considered a proteinuric UP/C value in dogs?
greater than 0.5
What is considered a proteinuric UP/C value in cats?
greater than 0.4
What is a physiologic cause of proteinuria?
What is the pre-renal cause of proteinuria?
Abnormal concentrations of protein been presented to the kidneys
What is the renal cause of proteinuria?
Defective renal function or inflammation of renal tissue
What is the post-renal cause of proteinuria?
Inflammation in the ureter, bladder, urethra or prostate
What causes a false positive of Proteinuria on the urine dipstick?
What causes a false negative of proteinuria on the urine dipstick?
What causes proteinuria in association with glomerular disease?
Defective renal function: Glomerular pathology or tubular pathology
Inflammation of renal parenchyma: Pyelonephritis or acute tubular necrosis
What is a renal cause of Proteinuria?
Increased Glomerular permeability
decreased tubular protein reabsorption
Protein losing nephropathy
condition causing severe proteinuria due to primary glomerular disease
condition where immune-complexes are deposited in the glomeruli
What is the cause of glomerulonephritis?
Familial nephropathy basement membrane: X-linked hereditary PLN of Samoyeds or Alport syndrome of English Cocker Spaniels
Non immune complex GN
Amyloid deposits in glomeruli
What are the infectious causes of Glomerulonephritis?
What is the cause of Hypercoagulability of Glomerulonephritis?
Increased platelet adhesion and aggregation
Loss of antithrombin
Increase in large clotting factors
How do you measure hypercoagulability?
How do you indirectly measure hypercoagulability?
Increased/decreased number of platelets
Kidney disease characterized by edema and loss of protein from the plasma into the urine due to increased glomerular permeability
How do you diagnose Glomerulonephritis?
Transmission electron microscopy
Immunofluorescent antibody assessment
What are the findings associated with Nephrotic Syndrome?
What is the treatment for Glomerulonephritis?
What drug should not be used alone for the treatment of Glomerulonephritis?
What is the first choice of treatment for Glomerulonephritis?
If Mycophenolate does not work for Glomerulonephritis then what do you add?
How do you treat Protein Losing Nephropathy?
treat proteinuria with ACE inhibitors, ARB, and Renal diets
treat hypercoagulability with aspirin or clopidogrel
What is the most significant cause of renal disease and acute uremia?
Ureteral obstruction from calcium oxalate
What is the clinical sign that cats with Acute unilateral ureteral obstruction present with?
Acute Abdominal pain
What is the clinical signs for Acute bilateral ureteral obstruction in cats?
bilaterally enlarged and painful kidneys
"Big Kidney Little Kidney" Syndrome
cats with past unilateral ureteral obstruction that causes the kidney to progress to fibrotic end stage. the contralateral hypertrophied kidney becomes acutely obstructed by a ureterolith causing further enlargement
Bilateral Chronic Kidney Disease with Concomitant Ureteral Obstruction
Chronic kidney disease secondary to fibrotic changes from previous obstruction predisposes to intrinsic kidney disease and a sudden obstruction causes decompensation of the tenuous residual kidney function
What do you see on ultrasound with ureteral obstruction?
hydronephrosis and dilation of the proximal ureter
What is the advanced imaging used for diagnosis of ureteral obstruction?
guided pyelocentesis and antegrade injection of positive contract media into the renal pelvis and ureter to delineate the size and patency of the ureter
What is the medical management for ureteral obstruction?
Ureteral relaxants - Prazosin and amitryptilline
What is an excellent choice of management for ureteral obstruction in dogs?
What is the standard of car for ureteral obstruction?
Ureteral stents through cystoscopy or Surgically
Subcutaneous ureteral bypass system
indwelling bypass using a combination locking loop nephrotomy/cystotomy tube
How do you stabilize a cat with ureteral obstruction?
What is treatment for hyperkalemia in an obstructed cat?
How do you relieve the obstruction of a cat?
Penile massage/rectal massage of urethra
Anesthesia and positioning
What is the ongoing management for a blocked cat?
Indwelling U-cath placement
Monitor urine production/urine sediment
What is the treatment for a blocked cat with an owner that cannot afford treatment?
Repeated cystocentesis and anti spasmotics
Pheromones for stress
What is a clinical finding associated with Urethral rupture?
What is a consequence of Uretheral rupture?
What is the cause of Uroabdomen?
How do you treat Uroabdomen?
Medical management and urinary catheterisation
Surgery once stable
What are non-obstructed lower urinary tract diseases?
Urinary tract infections
Feline lower urinary tract disease
What are the clinical signs of urinary tract disease?
What causes Dysuria/Stranguria/Pollakiuria?
Irritation of the bladder: bacterial, uroliths, or interstitial cystitis
Secondary lower urinary tract disease
How do you diagnose Lower Urinary Tract disease?
Collect urine on free flow and cystocentesis
Excretory contrast studies
Is Bilirubinemia normal in a dog?
Is Bilirubinemia normal in a cat?
What are the causes of Hematuria?
Lower Urinary Tract
Systemic disease: Bleeding disorder, Hypertension, or Hyperviscosity
What is the number one cause for UTIs?
What is the most common route of UTI?
What are the drugs of choice for an uncomplicated UTI?
the first time it presents with bacteria in the urine without stones in the bladder
What is classified as a Complicated UTI?
C and S positive greater than 7 days after last treatment course
C and S positive at day 7 after starting antibiotics
Same organism/strain, 7 days after last treatment course
What causes a Relapse?
Inappropriate drug choice
What causes Lower Urinary Tract Disease?
Anatomic urinary tract abnormalities
Upper urinary infection
cord from the bladder to the mother does ot disappear
cord from the bladder to the mother has an opening to the skin
What is the treatment for Recurrent UTI?
One daily bedtime administration 30-50% of original dose of Nitrofurantoin that is an urinary disinfectant
What are the alternative techniques for Recurrent UTI therapy?
Therapy for Urolithiasis?
Cystotomy with baskets
Hydropulsion of uroliths into the bladder
Big Smooth Radiodense Magnesium Ammonium phosphate due to Urease producing bacteria when the urine pH is high
In cats it is diet related
What breeds of dog get Struvites?
What is the treatment for Struvites?
Hills S/D diet that dilutes the acidic urine
Spiny radio-opaque small stones that are common in male dogs due to acidifying diets, obesity or Hypercalcemia
What kind of stone is associated with Ethylene glycol toxicity?
What is the treatment for calcium oxalate crystals?
Therapy for hypercalcemia
How do you prevent Calcium Oxalate formation?
Avoid Vitamins C and D
What is the crystal that looks like a "hairy apple"?
What causes Ammonium Urate and Xatnthine formation?
Hepatic disease (PSS, cirrhosis)
Genetic tubular defect
Breeds: Dalmations, Black Russian Terrier)
Decreased uptake of uric acid from hepatocytes to form allantoin
Radiolucent crystal associated with lower urinary pH
What is the treatment for Ammonium Urate formation?
Diet - low protein and increased pH
Xanthine oxidase inhibitors: Allopurinol
Supportive care for hepatic dysfunction
What breeds are associated with Cystine Calculi?
Australian cattle dogs
Tubular carrier proteins fail to reabsorb cystine
How do you treat Cystine crystals?
Low protein diet
Calcium phosphate uroliths
usually secondary to primary hyperparathyroidism
Associated with plant sources, poor diets rich in rice and soybean husks, cheap diets devoid of proper protein
What are the potential causes of Feline Lower Urinary Tract Disease?
Feline interstitial cystitis
What is the gold standard of diagnosis for Feline Interstitial cystitis?
What are the clinical signs of Feline Idiopathic Cystitis?
Palpate a large firm bladder
Inability to urinate
How do you diagnose Feline Idiopathic Cystitis?
somatic nerves to the external urethral sphincter causing the sphincter to be tight
parasympathetic nerve to the detrusor muscle that allows the animal to pee through contraction and received pain stimulations from the bladder
Sympathetic nerve allows the detrusor muscle relax and the urethral sphincter to contract and store urine
What is the treatment for Feline Lower Urinary Tract Disease?
Multiple Litter boxes
Plenty of Water sources
What is the preferred method of dislodging an obstruction in Feline Lower Urinary Tract Disease?
What is the treatment of Feline Lower Urinary Tract Disease?
Wet food not dry
Pheromones for stress
Analgesics - opioids
What are some Vaginal Diseases?
What is the main cause of Feline Lower Urinary Tract Disease?
Concurrent disease with stress
Persistent sheet of tissue in the vagina
seen in young females that will resolve in 6 weeks
What is the predisposing factor for vaginitis?
Hyperplasia of the vaginal wall that prolapses when the female comes into heat and will resolve after the dog goes out of heat
What are the neoplasias of the Female Genital tract?
Transmissible Venereal Tumors
What are the prostatic diseases?
Benign Prostatic Hyperplasia
What are the clinical signs of Prostatic Disease?
What are the clinical signs of Acute Prostatitis?
the dog is very sick
What are the clinical signs of Chronic Prostatitis?
symmetrically enlarged prostate
Hoe do you diagnose Chronic Prostatitis?
UA for UTI
What is the therapy for Benign Prostatic Hyperplasia?
Medical chemical castration
What is the therapy for Prostatic Cysts?
What is the therapy for Prostatitis?
Surgery - Orchidectomy
What is Finasteride used for?
converts testosteron to dihydrotestosterone to avoid castration
What antibiotics penetrate the Prostate well?
What antibiotics do not penetrate the prostate?
What are the clinical signs of Prostatic Neoplasia?
Painful gait with pain in sacrum
Palpable sublumbar LNs
Where would metastasis be located with Prostatic Neoplasia?
What is the treatment for Prostatic Neoplasia?
Chemo - Mitoxantrone
Topoisomerase inhibitors disrupt DNS synthesis and repair
What are the Neoplasias in the Bladder or urethra?
Transitional Cell Carcinoma
Squamous cell carcinoma
How do you diagnose Bladder or Urethra Neoplasia?
Catheter suction samples for cytology
What is the treatment for TCC of the bladder?
Chemotherapy - Mitoxantrone
Urine diversion - catheter
What causes Detrusor Atony?
caused by trauma or over distension causing disruption of the nerves
Where do you find the parasympathetic innervation to the bladder?
Where do you find the sympathetic innervation to the bladder?
L1-4 in dogs
L2-5 in cats
Where do you find the somatic innervation to the bladder?
What overrides the Pudendal nerve to increase urethral sphincter tone?
What are the UMN bladder signs?
Detrusor areflexia with sphincter hyperreflexia
Small bladder to large distended bladder
Small volumes of urine
Difficult to express
Where is the lesion located when there are UMN bladder signs?
Aboove sacral segment
What is the treatment for UMN bladder signs?
Antispasmodic causing muscle relaxant
What are the LMN bladder signs?
Detruspr areflexia and sphincter areflexia
Where is the location of the lesion when LMN bladder signs are seen?
Sacral spinal segment or pelvic segment
What is the treatment for LMN bladder signs?
Express bladder 3-4x/day
parasympathomimetic causing contraction of the bladder
Detrusor-sphincter reflex dyssynergia
with initiation of detrusor contraction the urethral sphincter spasms
What is the treatment for Detrusor-sphincter reflex dyssynergia?
Alpha-adrenergic blockers (Phenoxybenzamine)
In what species do you see Dysautoanomia?
What causes Detrusor Atony?
Overfill due to obstruction
How do you treat Detrusor Atony?
Manually express the bladder and keep the bladder small and hope the nerves grow back
Detrusor instability/detrusor hyperreflexia (Urge Incontinence)
Detrusor contraction during storage of urine or low compliance of the detrusor muscle which may be confirmed by cystometrography
What is the treatment for Detrusor instability/detrusor hyperreflexia (Urge Incontinence) ?
Anticholinergic - Oxybutynin imipramine or dicyclomine
the involuntary escape of urine during the storage phase of the urinary cycle
Intermittent or continuous dribbling of urine with a normal voiding episode
Loss of voluntary control of urination and consequent leakage of urine
What is the cause of Urinary Incontinence?
Urinary Sphincter Mechanism Incompetence
What are the clinical signs of Urinary Sphincter Mechanism Incompetence?
Soiled perineal coat
How do you diagnose Urinary Sphincter Mechanism Incompetence
Urethral pressure profile
What is the pathophysiology of Urinary Sphincter Mechanism Incompetence?
Lack of estrogen decreases sensitivity of the smooth muscle receptors to sympathetic stimulation
Spaying reduced urinary sphincter pressure
What is the Pressure transmission theory for Urinary Sphincter Mechanism Incompetence?
when urethral neck is not in the abdominal cavity it is not subjected to the same pressures as the intra-abdominal bladder, the bladder pressure exceed urethral pressure and the urine leaks
What is the Hammock theory for Urinary Sphincter Mechanism Incompetence?
the anatomic structures maintaining the position of the bladder and urethra are abnormal
What are the indications to perform a Urethral pressure profile?
Urinary Sphincter Mechanism Incompetence
What is the medical management for Urinary Sphincter Mechanism Incompetence
Estriol therapy + PPA
What are the side effects of Estriol?
increased mammary tumors
What are the surgical treatment for Urinary Sphincter Mechanism Incompetence?
Bovine Cross-Linked Collagen Implantation
Transobturator Vaginal Tape inside out
Static Hydraulic Urethral sphincter
What are the clinical signs of Ectopic Ureter?
What is the treatment of choice for Ectopic Ureter?
Cystoscopic laser ablation
What are the most accurate diagnosis of Ectopic Ureter?
Excretory urogram CT