Nephrourology Flashcards
(41 cards)
What is nephrology?
Focused on the study of kidneys by themselves, its function, and management of kidney disease.
What are the functions of the kidney?
- “A WET BED”:
A = acid-base balance
W = water balance
E = electrolyte balance (sodium, potassium, chloride, calcium)
T = toxin removal
B = blood pressure control
E = erythropoietin production (hormone that stimulates production of red blood cells at the level of the bone marrow)
D = D-Vitamin metabolism (regulates calcium and phosphorous and thyroid hormone)
How do we know what’s a “normal” kidney?
1) We base most of our analysis on creatine/BUN measurements.
2) Also look at morphological analysis with x-rays, ultrasounds, etc.
3) Do an estimation of glomerular filtration rate (GFR) only in steady-state conditions
4) Biomarkers
What’s the most common marker used to assess renal function?
Creatinine measurements!
- it is the main clinical functional marker of renal function
- will increase once >75% of renal function is lost
- delayed recognition and therapy
- produced from skeletal muscle cells, cachexia (not having enough muscle) may cause falsely low results
What should you NOT forget to do….
Urinalysis!!
What’s the urine concentration ability in cats? Dogs?
Cats = < 1.040 (density of urine)
Dogs = < 1.035
**Isosthenuria (1.008-1.012) may indicate dysfunction
What are the different types of imaging for nephrology?
1) Abdominal Radiographs
- Assesses renal shape and size
- Radiopaque uroliths (stones < 2 mm may not be detected)
2) Ultrasonography
- Most sensitive modality (77%)
- Pyelectasia (>13 mm-pathognemonic)
- Detection of small ureteroliths
- Neoplastic disease
- Effusion
What are the clinical signs of kidney dysfunction?
1) Polypdipsia (increased water consumption)
2) Polyuria (increased urine volume)
3) Decreased appetite
4) Vomiting
5) Diarrhea
6) Weight loss/cachexia
7) Anemia (lack of hormone regulation)
Anything that affects the ________ can affect the kidneys as well.
Heart
Regarding etiology (cause), what are the three phases of acute kidney injury (AKI)?
- Pre-renal (before the kidney)
- Renal
- only phase that has something affecting the kidney directly. includes glomerular disease (GN, Thrombosis), Tubular injury (ischemia, toxins), interstitial nephritis, and vascular disease (vasculitis, thrombosis)
- Post-renal (after the kidney)
What’s the normal amount of creatinine in cats?
< 1.6 mg/dL
What are some recognitions that tell you that there is a problem with the kidneys?
- Increase in serum creatinine by ≥ 0.3 mg/dL within 48 hours
OR - Increase in serum creatinine ≥ 1.5 times baseline
OR - Urine production < 0.5 ml/kg/hr (6 hours)
Tell me more about renal etiology.
- Toxins involved ethylene glycol (antifreeze), lilies
- Nephrotoxic drugs: antibiotics, synthetic colloids, radiocontrast agents
- Metabolic disease: hypercalcemia
- Endogenous substances: myoglobin, hemoglobin
What is Interstitial nephritis? Give me examples.
- It is an infection of the kidneys.
- EX: Pyelonephritis (E. coli), Leptospirosis (dogs mostly), granulomatous disease, Neoplasia (i.e. lymphoma)
In microbiology, urine aerobic culture, in cases where the cause of renal dysfunction, is ______________.
Unknown
In microbiology, what does a positive culture mean? What about a negative culture?
- A positive culture raises the concern for pyelonephritis or UTI’s (infection)
- A negative culture does not rule out infection
What is post-renal etiology?
Any type of obstruction that affects urine flow to cats
Regarding post-renal etiology, what are some obstructive diseases?
- Urolithiasis (ex: ureteroliths in cats)
- Strictures
- Congenital defects
Tell me general knowledge about unilateral obstructive disease.
- non-specific clinical signs
- no azotemia (unless pre-existing CKD in the contralateral kidney)
- no signs of uremia
- unilateral renomegaly
- +/- sub-lumbar pain
What are the different types of obstructive disease?
Unilateral and bilateral
Tell me general knowledge about bilateral obstructive disease.
- GI signs (anorexia, vomiting, lethargy)
- abdominal pain/discomfort
- severe azotemia
- hyperkalemia
- metabolic acidosis
In regards to ureterolithiasis, what are most ureteroliths composed of? Can they be dissolved?
- Most ureteroliths are composed of calcium oxalate.
Cats - (>98%, Dogs - (>30% to 60%) - These stones cannot be dissolved medically, so we either have it pass spontaneously, let it remain in place, or have it surgically removed.
What’s the phrase for renal damage?
“Big Kidney-Little Kidney”
In the prevalence of CKD, how old are cats? Species?
- Age = 7 years or older
- Species = maine coon, abbysian, siamese, russian blue, and burmese
