Renal Flashcards

Question

What percentage of PLN dogs are hypercoagulable?

Answer 1

* Hereditary nephropathy – Cocker Spaniels * Focal segmental glomerulosclerosis – Soft-Coated Wheaten Terriers * Tubulopathies: Cystinuria, Hyperoxaluria, Hyperuricosuria

Answer 2

% of a filtered solute that is excreted in urine

Answer 3

Indicates renal tubular dysfunction (proximal tubule)

Answer 4

Strongest indicators of tubular damage

Answer 5

Analyzing urinary proteins by molecular weight

Answer 6

Strong suspicion for glomerular pathology

Answer 7

* NGAL – tubular injury * KIM-1 – proximal tubular damage

Answer 8

Suggests non-renal cause of PU/PD

Answer 9

Varies; requires blood gas analysis for evaluation

Answer 10

Very large cells that appear only with severe damage ## Footnote Plasma cells are a type of white blood cell that produces antibodies.

Answer 11

Negative APP; routinely assessed ## Footnote Albumin helps maintain oncotic pressure in the blood.

Answer 12

Iron transport; HMW ## Footnote Transferrin is a glycoprotein that binds and transports iron.

Answer 13

Glomerular slit diaphragm protein ## Footnote Podocin is crucial for the filtration barrier in the kidneys.

Answer 14

Lipid metabolite; reflects intrarenal hemodynamics ## Footnote Thromboxane B2 is involved in vasoconstriction and platelet aggregation.

Answer 15

Capillary leakage marker ## Footnote Adiponectin is involved in regulating glucose levels and fatty acid breakdown.

Answer 16

Iron storage; appears in severe injury ## Footnote Ferritin is a protein that stores iron and releases it in a controlled fashion.

Answer 17

Tubular cell injury marker ## Footnote NAG is used to assess proximal tubular injury in the kidneys.

Answer 18

Used to monitor gentamicin nephrotoxicity ## Footnote GGT is an enzyme that, when elevated, indicates renal damage, especially from medications.

Answer 19

Non-specific nephron injury ## Footnote LDH is an enzyme found in many tissues and can indicate cellular damage.

Answer 20

Tubular injury marker ## Footnote AAP is found in the brush border of proximal tubules and indicates renal tubular injury.

Answer 21

Tubular cell lysosomal marker ## Footnote ALP can indicate biliary obstruction or bone disease but also reflects renal tubular injury.

Answer 22

Vitamin A transport; ↓ reabsorption = injury ## Footnote RBP levels decrease in cases of proximal tubular injury.

Answer 23

Indicates proximal tubular dysfunction ## Footnote β2-microglobulin is a component of MHC class I molecules and is elevated in kidney disease.

Answer 24

Reabsorption marker ## Footnote α1-microglobulin is a protein that can indicate tubular reabsorption capacity.

Answer 25

Marker released after direct tubular injury ## Footnote NGAL is also elevated in cases of urinary tract infections and inflammation.

Answer 26

↑ with ischemia or toxins ## Footnote KIM-1 is a membrane protein that is upregulated in kidney injury.

Answer 27

Renal-specific isoform may exist ## Footnote Clusterin levels can indicate renal tubular damage.

Answer 28

Protease inhibitor; ↑ in renal injury ## Footnote Cystatin B can indicate renal tubular dysfunction.

Answer 29

Disruption of the glomerular filtration barrier ## Footnote This can indicate conditions like nephrotic syndrome.

Answer 30

Glucosuria in euglycemia, aminoaciduria, phosphaturia ## Footnote These findings suggest proximal tubular injury.

Answer 31

Useful for detecting gentamicin-induced nephrotoxicity ## Footnote This ratio helps differentiate between causes of renal damage.

Answer 32

NGAL, KIM-1, Clusterin, Cystatin B show promise in early detection of AKI ## Footnote These markers are being researched for their role in monitoring kidney health.

Answer 33

AKI, Rise within hours of AKI ## Footnote These biomarkers can provide early detection of acute kidney injury.

Answer 34

Phosphaturic hormone; ↑ with CKD progression ## Footnote FGF-23 is involved in phosphate metabolism and is elevated in chronic kidney disease.

Answer 35

Indicates oxidative stress ## Footnote AGEs are formed through non-enzymatic glycation and are markers of metabolic dysfunction.

Answer 36

Measures resistance index (RI) of interlobar/arcuate arteries ## Footnote Increased RI can indicate ureteral obstruction or renal transplant rejection.

Answer 37

Approximately 3.0–4.5 cm ## Footnote Renal length may vary, and a size of 5.0 cm is generally not concerning.

Answer 38

Nonspecific; weakly correlates with histologic disease ## Footnote Increased echogenicity can be seen in conditions like chronic kidney disease.

Answer 39

Round, anechoic, thin-walled, with distal acoustic enhancement ## Footnote Simple cysts are often incidental findings in imaging.

Answer 40

Often normal variant; may indicate leptospirosis ## Footnote The medullary rim sign is a hypoechoic line that can be seen on ultrasound.

Answer 41

Visible renal pelvic fluid; persistent dilation indicates possible obstruction ## Footnote Pyelectasia can be a normal finding during diuresis but may indicate disease if persistent.

Answer 42

Assess renal size, shape, contour, and presence of radio-opaque calculi ## Footnote However, plain films cannot evaluate internal renal architecture.

Answer 43

Ureter/pelvis/UVJ; now mostly replaced ## Footnote IV Urography was once a common diagnostic tool but has been largely supplanted by more advanced imaging techniques.

Answer 44

Internal architecture, masses, fluid, cysts, pelvic dilation ## Footnote Ultrasound is a non-invasive imaging technique that provides valuable insights into kidney health.

Answer 45

Ureteral obstruction, renal ectopia, intrarenal masses, detailed anatomy ## Footnote CT scans provide detailed cross-sectional images of the kidneys and surrounding structures.

Answer 46

Renal perfusion and vascular resistance estimation ## Footnote Doppler ultrasound is useful for assessing blood flow and vascular conditions in the kidneys.

Answer 47

Renal cortex thickness ## Footnote This indicates that changes in the cortex may reflect chronic kidney disease more accurately than overall kidney size.

Answer 48

Cats with CKD ## Footnote These pseudocysts are often a benign finding in cats suffering from chronic kidney disease.

Answer 49

* Induction Phase * Extension Phase * Maintenance Phase * Recovery Phase

Answer 50

Ischemic or nephrotoxic insult ## Footnote This phase ends when renal dysfunction becomes evident.

Answer 51

Critical damage has occurred with ↓GFR, azotemia, and uremic signs present ## Footnote Supportive care is critical as elimination of the insult won’t reverse damage.

Answer 52

Ischemic or toxic injury to nephron structures ## Footnote Includes acute tubular necrosis and glomerulonephritis.

Answer 53

* Serum creatinine * BUN * SDMA * Serum cystatin C

Answer 54

Persistent decrease in kidney function for >7 days but <3 months.

Answer 55

* Hypovolemia * Decreased Cardiac Output * Systemic Vasodilation * Renal Vasoconstriction

Answer 56

They inhibit vasodilatory prostaglandins, leading to ischemia.

Answer 57

Intrarenal vasoconstriction, tubular epithelial cell injury, intratubular obstruction.

Answer 58

* Ischemic injury * Nephrotoxic injury

Answer 59

* Sepsis * Leptospirosis * Babesiosis * Parvovirus * Hypoadrenocorticism * Pancreatitis * Heatstroke * CRGV

Answer 60

63% develop AKI, often with proteinuria.

Answer 61

They can detect structural injury before azotemia occurs.

Answer 62

Tubular injury.

Answer 63

* Diseases of Large Renal Vessels * Glomerular and Microvascular Injury * Acute Tubular Necrosis (ATN) * Tubulointerstitial Injury

Answer 64

Injury to the renal parenchyma with persistent biomarkers despite restoration of perfusion.

Answer 65

* Monitor volume status * Adjust drug dosing * Watch for nephrotoxicity

Answer 66

Persistent azotemia or proteinuria despite rehydration.

Answer 67

Very high mortality

Answer 68

Leptospirosis and CRGV

Answer 69

Signs of tubular injury

Answer 70

Vasoconstriction of afferent and efferent arterioles

Answer 71

↑ vasoconstrictors and ↓ vasodilators

Answer 72

AKI and renal fibrosis

Answer 73

Type III delayed hypersensitivity

Answer 74

Osmotic nephrosis

Answer 75

Unknown, possibly tartaric acid

Answer 76

53% of reported cases

Answer 77

* Vomiting * PU/PD * Ataxia * Facial/paw edema * Disorientation * Azotemia * Glucosuria * Proteinuria

Answer 78

Early GI decontamination + 48h IV diuresis

Answer 79

* Cats: 1.4 mL/kg * Dogs: 4.4 mL/kg

Answer 80

* Glycolic acid * Glyoxylic acid * Oxalic acid

Answer 81

* CNS depression * Latent phase * AKI phase

Answer 82

High anion gap metabolic acidosis

Answer 83

* Anorexia * Vomiting * Lethargy * PU/PD * AKI

Answer 84

Hypercalcemia leading to AKI due to nephrocalcinosis

Answer 85

Bisphosphonates (e.g., pamidronate)

Answer 86

Indicates decreased GFR (late marker)

Answer 87

* ↑ Creatinine * ↑ BUN * ↑ Phosphorus

Answer 88

Degenerated cellular casts

Answer 89

* Shock * Bruising * Abdominal distension

Answer 90

↑ (often >500 mOsm/kg) ## Footnote Higher osmolality indicates concentrated urine due to pre-renal causes.

Answer 91

94% ## Footnote High sensitivity makes this modality valuable in diagnosing ureteral obstruction.

Answer 92

Diagnostic for uroabdomen ## Footnote This criterion helps differentiate between normal and abnormal fluid collections.

Answer 93

When the cause of AKI is unclear or glomerulonephritis is suspected ## Footnote Renal biopsy is not first-line and follows non-invasive diagnostics.

Answer 94

↑ in dogs with AKI and arrhythmias, not associated with outcome ## Footnote This biomarker can indicate cardiac stress but does not predict prognosis.

Answer 95

Restore and maintain intravascular volume, renal perfusion, and correct acid-base and electrolyte disturbances ## Footnote Fluid therapy is crucial for managing AKI and preventing complications.

Answer 96

* 0.9% NaCl * Synthetic colloids (e.g., HES) ## Footnote These fluids are linked to higher risk of AKI or complications.

Answer 97

1–2 mL/kg/hr ## Footnote Understanding urine output is essential for assessing renal function.

Answer 98

* Calcium gluconate * Insulin + dextrose * Beta-agonists (e.g., albuterol) * Bicarbonate * Dialysis ## Footnote These agents help stabilize cardiac function and lower serum potassium.

Answer 99

Attempting to convert oliguria/anuria to polyuria ## Footnote Mannitol may help reduce tubular swelling but is not recommended if the patient is dehydrated.

Answer 100

It promotes renal potassium excretion in non-oliguric patients ## Footnote Furosemide is effective for fluid overload but not for anuric patients.

Answer 101

* Peritonitis * Catheter occlusion * Excessive protein loss * Pleural effusion * Dialysis disequilibrium syndrome (DDS) ## Footnote These complications highlight the need for careful monitoring during PD.

Answer 102

42% ## Footnote Hemodialysis offers improved outcomes for severe AKI but varies by individual case.

Answer 103

* Nausea * Vomiting * Anorexia * Ileus ## Footnote These complications necessitate the use of antiemetics in treatment.

Answer 104

Affects absorption, metabolism, and excretion of medications ## Footnote Adjustments are necessary to avoid toxicity and ensure efficacy.

Answer 105

<1 mL/kg/hr ## Footnote Absolute oliguria indicates severe renal impairment and is associated with higher mortality.

Answer 106

Hemodialysis (HD) and Continuous Renal Replacement Therapy (CRRT) ## Footnote These techniques utilize a semipermeable membrane and a large-bore dual-lumen catheter.

Answer 107

42% ## Footnote The 30-day survival rate for cats is 48%.

Answer 108

38% ## Footnote The 1-year survival rate for dogs is 33%.

Answer 109

Etiology and presence of oliguria or anuria ## Footnote Anuria is a significant negative prognostic factor.

Answer 110

~50% ## Footnote This rate has remained unchanged over decades despite dialysis availability.

Answer 111

45% ## Footnote The pooled mortality rate for cats is 53%.

Answer 112

They tend to fare better ## Footnote Infectious causes include conditions like leptospirosis.

Answer 113

20-fold ## Footnote This statistic highlights the severity of anuria as a prognostic factor.

Answer 114

19% ## Footnote Normalization occurs within 13 days in 75% of these cases.

Answer 115

55% ## Footnote In cats, only 25% normalize creatinine, and half of all survivors remain azotemic.

Answer 116

20–25% ## Footnote Even without full recovery, patients can have prolonged survival and good quality of life.

Answer 117

Presence of structural and/or functional abnormalities in one or both kidneys that persist for ≥3 months. ## Footnote CKD is typically irreversible and progressive, even with appropriate therapy.

Answer 118

* Pyelonephritis * Ureteral obstruction * Dehydration ## Footnote A thorough diagnostic workup is crucial to identify and treat these reversible contributors.

Answer 119

Ranges from 0.5% to 3.74% in primary care settings.

Answer 120

15–30% of cats ≥15 years old have CKD.

Answer 121

* Juvenile nephropathy/renal dysplasia * Tubulointerstitial nephritis * Glomerular disease ## Footnote Glomerular disease may be underdiagnosed due to limited biopsy use.

Answer 122

Tubulointerstitial inflammation, atrophy, and fibrosis with secondary glomerulosclerosis.

Answer 123

* Serum creatinine * Proteinuria * Systemic arterial blood pressure ## Footnote These parameters guide treatment planning and prognostication.

Answer 124

Serum creatinine: <1.4 mg/dL; SDMA: <18 μg/dL.

Answer 125

Clinical signs may be absent or mild.

Answer 126

2.9–5.0 mg/dL.

Answer 127

It is a negative prognostic indicator and correlates with faster CKD progression.

Answer 128

* Disordered excretion of electrolytes and water * Reduced excretion of organic solutes (uremic toxins) * Impaired renal hormone synthesis (e.g., erythropoietin, calcitriol)

Answer 129

Medical management aiming to minimize metabolic complications, slow progression, and enhance quality of life.

Answer 130

A condition affecting bone and soft tissues due to dysregulation of phosphorus, calcium, magnesium, PTH, FGF23, and calcitriol.

Answer 131

FGF23 clearance declines, leading to FGF23 resistance.

Answer 132

Hypocalcemia.

Answer 133

Elevated FGF-23 is associated with increased risk of CKD progression and mortality.

Answer 134

Phosphorus retention

Answer 135

>72 mg²/dL²

Answer 136

Regulatory role in vascular calcification inhibition and fibrocytokine release

Answer 137

Fibrous osteodystrophy of the mandible and maxilla

Answer 138

Calcium oxalate

Answer 139

Potential dislodgement into the ureter leading to obstruction

Answer 140

Restricted phosphorus and moderate high-quality protein

Answer 141

Bind dietary phosphorus in the GI tract

Answer 142

Increased colonic protein fermentation and uremic toxin production

Answer 143

2.5 – 5.0 mg/dL

Answer 144

To avoid hypocalcemia

Answer 145

Indoxyl sulfate and p-cresyl sulfate ## Footnote These toxins are significant in the pathophysiology of chronic kidney disease.

Answer 146

Gut dysbiosis ## Footnote Modulation of the microbiome is a theoretical therapeutic target.

Answer 147

Dysrexia, nausea, vomiting, weight loss, and muscle wasting (cachexia).

Answer 148

43% ## Footnote Of those, 77% had to coax their cats to eat more than 50% of the time.

Answer 149

* Inadequate caloric intake due to anorexia or dysrexia * Uremic toxins and gastrointestinal effects * Hormonal/metabolic derangements (e.g., acidosis) * Increased basal metabolic rate associated with CKD * Poor body condition score (BCS)

Answer 150

Hypergastrinemia occurs as GFR declines in CKD.

Answer 151

Gastric fibrosis and mineralization.

Answer 152

No, it is not recommended.

Answer 153

NK1 receptor antagonist that blocks emetic signaling in CTZ and GI tract.

Answer 154

Orexigenic hormones (e.g., ghrelin). Usually decreased in CKD

Answer 155

Persistent weight loss, failure to meet caloric goals, progressive muscle wasting.

Answer 156

* Dehydration * Hypokalemia * Phosphate binders * Osteoarthritis * Anorexia and inadequate fiber intake

Answer 157

Osmotic agent that draws water into the colon.

Answer 158

20–30% of cases.

Answer 159

* Myopathy * Cervical ventroflexion * Plantigrade stance

Answer 160

Potassium gluconate.

Answer 161

Maintain serum K⁺ >4.0 mEq/L.

Answer 162

13–20 mEq/L ## Footnote This is the typical range for maintaining potassium levels in IV fluids.

Answer 163

≤0.5 mEq/kg/hr ## Footnote This limit is crucial to prevent complications during potassium administration.

Answer 164

Primary hyperaldosteronism (cats) ## Footnote This condition can lead to excessive potassium loss.

Answer 165

Dogs ## Footnote Particularly in those with advanced CKD or on certain medications.

Answer 166

* Reduce dietary K⁺ * Sodium polystyrene sulfonate * Zirconium cyclosilicate ## Footnote Sodium polystyrene sulfonate has risks including GI necrosis.

Answer 167

Up to 17% ## Footnote This is significant during the disease course.

Answer 168

* RAAS activation * Impaired sodium excretion * Endothelial dysfunction * Increased sympathetic tone ## Footnote These factors complicate the management of CKD.

Answer 169

* Kidneys: Accelerated CKD progression * Eyes: Retinal hemorrhage, detachment, blindness * Heart: Left ventricular hypertrophy * CNS: Encephalopathy, seizures, stroke, death ## Footnote These complications highlight the importance of controlling hypertension.

Answer 170

* BP ≥160 mmHg consistently * BP >200 mmHg once * Evidence of target organ damage present ## Footnote Fundic exams are critical for detecting retinal changes.

Answer 171

Target SBP <150 mmHg ## Footnote Aggressive reduction is indicated for ocular or neurologic complications.

Answer 172

* Pallor * Weakness * Anorexia * Exercise intolerance ## Footnote These signs indicate reduced oxygen delivery to tissues.

Answer 173

15% in IRIS stage 3, 53% in IRIS stage 4 ## Footnote This highlights the severity of metabolic disturbances in later CKD stages.

Answer 174

* Renal diets * Potassium citrate * Sodium bicarbonate ## Footnote Each option has specific benefits and should be tailored to the patient's needs.

Answer 175

35 days median survival ## Footnote This indicates a poor prognosis at this advanced stage.

Answer 176

47% (101/213) ## Footnote This indicates that not all cats with chronic kidney disease show a consistent increase in creatinine levels.

Answer 177

CKD progression is slower in cats than in dogs ## Footnote This difference may influence treatment strategies and prognosis.

Answer 178

They may tolerate high creatinine levels for longer ## Footnote This suggests a difference in renal function resilience between species.

Answer 179

1151 days (95% CI: 1014–1565) ## Footnote This reflects a relatively good prognosis at this stage.

Answer 180

226 days ## Footnote This indicates a generally poorer prognosis compared to cats.

Answer 181

2.6× higher mortality ## Footnote This highlights the increased risk associated with advancing CKD stages.

Answer 182

* Hyperphosphatemia * ↑ FGF-23 * Proteinuria * Anemia * Body weight/muscle mass * Uremic toxin levels ## Footnote These indicators help assess the severity and progression of the disease.

Answer 183

* Hypertension * ↑ Ca × P product * Low BCS and muscle mass ## Footnote These factors provide a broader understanding of CKD effects in dogs.

Answer 184

Accumulation of fluid between renal cortex and capsule (no epithelial lining, hence “pseudo”) ## Footnote This condition is commonly associated with CKD in cats.

Answer 185

May cause abdominal discomfort, reduce GFR (by mass effect) ## Footnote This can lead to worsening kidney function and quality of life.

Answer 186

* Temporary relief via ultrasound-guided aspiration * Surgical fenestration or laparoscopic drainage for permanent resolution ## Footnote These approaches aim to alleviate symptoms and improve kidney function.

Answer 187

* Stable cats in late IRIS stage 3 or early stage 4 CKD * Not suitable: end-stage uremia or severe azotemia ## Footnote Selecting appropriate candidates is crucial for successful outcomes.

Answer 188

* FeLV or FIV infection * Moderate to severe cardiac disease * Neoplasia * Recurrent infections * Fractious temperament * Other significant comorbidities * Inability of the owner to provide post-op care ## Footnote These factors can complicate the transplantation process and affect outcomes.

Answer 189

* Cyclosporine (lifelong) * Prednisolone (started at surgery, tapered over months) ## Footnote Lifelong immunosuppression is necessary to prevent allograft rejection.

Answer 190

* Hemorrhage * Uroabdomen * Thromboembolism * Seizures * Delayed allograft function * Acute rejection ## Footnote Monitoring for these complications is essential for postoperative care.

Answer 191

* Malaise * Anorexia * Worsening azotemia * Leukocytosis * Fever or hypothermia * Enlarged graft ## Footnote Prompt intervention is necessary upon observing these signs.

Answer 192

613–653 days in two separate studies ## Footnote This represents a significant improvement over medical management.

Answer 193

* Chronic allograft nephropathy (occurs in ~70% of feline grafts) * Retroperitoneal fibrosis (up to 21% of recipients) * Infections due to lifelong immunosuppression * Neoplasia and diabetes mellitus (increased risks) ## Footnote Awareness of these potential complications is critical for long-term management.

Answer 194

43–90% ## Footnote The prevalence of glomerular lesions increases with age.

Answer 195

Immune-Complex Glomerulonephritis (ICGN)

Answer 196

* Immune-Complex Glomerulonephritis (ICGN) * Amyloidosis * Glomerulosclerosis * Membranous * Membranoproliferative * Mesangioproliferative * Lupus nephritis * Minimal change glomerulopathy * IgA nephropathy * Hereditary nephritis * Crescentic and proliferative types

Answer 197

Plasma ultrafiltration barrier

Answer 198

* Type IV collagen * Laminin * Heparan sulfate proteoglycans

Answer 199

~60–70 kDa

Answer 200

* Labrador Retrievers * Golden Retrievers

Answer 201

* Severe proteinuria * Hyaline casts * Dysmorphic erythrocytes * Cylindruria

Answer 202

Glomerular disease over tubular or interstitial causes

Answer 203

* Persistent, progressive, or severe proteinuria * Not indicated if underlying disease is treatable

Answer 204

* Highest median UPC * Highest serum creatinine * Lowest albumin * Most frequent hypertension

Answer 205

Urine Protein Electrophoresis (SDS-PAGE)

Answer 206

Brittany Spaniels

Answer 207

Transmission Electron Microscopy (TEM) ## Footnote Histology alone is insufficient for diagnosis

Answer 208

29% ## Footnote Based on a study of 24 cats

Answer 209

IgG or C3 deposition, stage of lesions ## Footnote Longer survival associated with IgG or C3, shorter with IgM or IgA

Answer 210

7–9 years ## Footnote This is the typical age range for presentation

Answer 211

Extracellular deposition of amyloid fibrils ## Footnote Amyloid fibrils have a β-pleated sheet structure

Answer 212

Congo red staining ## Footnote Under polarized light, it shows apple-green birefringence

Answer 213

Reactive (AA) amyloidosis ## Footnote This type is most commonly observed in dogs

Answer 214

Serum amyloid A (SAA) ## Footnote It is produced by hepatocytes under cytokine stimulation

Answer 215

Colchicine ## Footnote It may prevent renal amyloidosis in humans with FMF

Answer 216

Defects in type IV collagen ## Footnote This leads to premature GBM breakdown and progressive glomerular disease

Answer 217

Proteinuria, hematuria, and progressive renal failure ## Footnote Similar to familial Alport syndrome in humans

Answer 218

Podocyte foot process effacement ## Footnote Diagnosed via Transmission Electron Microscopy (TEM)

Answer 219

~20% ## Footnote GS is a significant type of lesion in dogs

Answer 220

Median survival post-biopsy is 258 days ## Footnote Disease is progressive; treatment is supportive

Answer 221

Protein overload cytotoxicity ## Footnote Excess filtered proteins can harm nephron structures

Answer 222

Worse outcomes; proteinuria is a negative prognostic factor for survival. ## Footnote Therapies that reduce proteinuria are linked to slower CKD progression and improved survival.

Answer 223

Excess proteins trigger pro-inflammatory and pro-fibrotic signaling in tubular cells, leading to inflammation and fibrosis. ## Footnote Albumin activates NF-κB and STAT pathways, upregulating chemokines like MCP-1 and RANTES.

Answer 224

A condition where filtered proteins precipitate with Tamm–Horsfall mucoprotein, forming casts that obstruct tubular lumens. ## Footnote Recognized in myeloma kidney in humans and can cause focal tubular injury.

Answer 225

Sustained tubular injury and influx of inflammatory cells and activated fibroblasts. ## Footnote This results in extracellular matrix deposition, replacing functional parenchyma.

Answer 226

It is a hallmark of progressive CKD, leading to chronic hypoxia and worsening tubular atrophy and fibrosis. ## Footnote Loss of functional nephrons converges on a pathway of tubulointerstitial fibrosis and nephron dropout.

Answer 227

Podocyte loss leads to synechiae, allowing protein-rich filtrate to leak into the interstitium, causing localized injury. ## Footnote This can choke off the glomerulo-tubular junction, causing nephron atrophy.

Answer 228

Proteinuria is both a marker and a maker of renal injury, driving deterioration of renal function. ## Footnote Antiproteinuric interventions are central to managing glomerular diseases.

Answer 229

It alleviates glomerular hypertension, lowers proteinuria, and protects the kidney. ## Footnote Evidence shows RAAS blockade slows CKD progression and improves survival.

Answer 230

Enalapril significantly reduced proteinuria compared to placebo, with improved clinical outcomes. ## Footnote Mean UPC dropped by ~4.2 units in the enalapril group.

Answer 231

Benazepril significantly reduces proteinuria and may improve outcomes in heavily proteinuric cats. ## Footnote It is well-tolerated and recommended for cats with renal proteinuria.

Answer 232

They block Ang II type-1 receptors, preventing downstream effects like efferent vasoconstriction and aldosterone release. ## Footnote ARBs provide a more complete RAAS blockade than ACE inhibitors.

Answer 233

Telmisartan was noninferior to Benazepril for proteinuria control ## Footnote The trial showed significant reduction in UPC for Telmisartan compared to Benazepril.

Answer 234

Mean change –0.05, P=0.016 ## Footnote This indicates a statistically significant reduction in UPC from baseline.

Answer 235

Emerging as an important tool for suboptimal response or intolerance to ACEIs ## Footnote Although ACEIs remain first-line, ARBs like Telmisartan show promise.

Answer 236

Marked UPC reduction and clinical improvement after failing to respond to Enalapril ## Footnote This highlights Telmisartan's potential in refractory cases.

Answer 237

* Proven efficacy in clinical trials * Reduce systemic and intraglomerular pressure * Favorable effects on endothelium and sympathetic tone * Inexpensive and well-established dosing * Increase bradykinin for potential antifibrotic effects ## Footnote Examples include Enalapril in dogs and Benazepril in cats.

Answer 238

* Do not completely shut off Ang II production * Aldosterone levels can escape back to normal * Non-responders may experience inadequate proteinuria reduction * Side effects include mild gastrointestinal upset and hyperkalemia ## Footnote Monitoring of renal values is crucial after initiation.

Answer 239

* Directly block AT₁ receptors * Prevent Ang II action regardless of Ang II levels * Overcome ACE escape issue * Potentially superior antiproteinuric potency * Do not inhibit bradykinin breakdown ## Footnote This makes ARBs like Telmisartan an attractive option in cats.

Answer 240

* Limited published clinical data * Dosing can be trickier * Potential side effects similar to ACEIs * Risk of hypotension and hyperkalemia ## Footnote Monitoring is essential, especially when combined with ACEIs.

Answer 241

* Moderate protein restriction * Phosphorus control * Omega-3 fatty acids ## Footnote These changes can synergize with RAAS blockade in reducing proteinuria.

Answer 242

Blocking RAAS at two steps may have an additive antiproteinuric effect ## Footnote This approach is considered when a single agent fails to control proteinuria.

Answer 243

* Risk of significant reduction in glomerular filtration pressure * Increased risk of azotemia and hyperkalemia ## Footnote Close monitoring of renal values is imperative during dual therapy initiation.

Answer 244

Do not combine as first-line in newly diagnosed patients ## Footnote Maximize one agent before considering the addition of the second, with close monitoring.

Answer 245

The use of two agents, typically an ACE inhibitor and an angiotensin receptor blocker (ARB), when proteinuria remains severe despite single-agent treatment. ## Footnote Combination therapy may involve enalapril + telmisartan or benazepril + losartan, especially in dogs with refractory proteinuria.

Answer 246

Adding omega-3 fatty acids, addressing hypertension more aggressively, and using antithrombotic therapy in cases of severe PLN with hypoalbuminemia. ## Footnote Omega-3 fatty acids have mild antiproteinuric and anti-inflammatory effects.

Answer 247

ACE inhibitors (ACEIs) are often effective for lowering mild-to-moderate hypertension in dogs. ## Footnote ACEIs typically reduce systolic BP by ~10–15 mmHg.

Answer 248

Amlodipine is a calcium channel blocker that effectively lowers blood pressure, often by 30–50 mmHg. ## Footnote It should not be used as monotherapy in proteinuric dogs.

Answer 249

Start both an ACEI and amlodipine concurrently. ## Footnote This approach achieves rapid blood pressure reduction while protecting glomeruli.

Answer 250

Amlodipine is the first-line therapy, often combined with RAAS blockers like ACEIs or ARBs. ## Footnote RAAS blockers alone may not be sufficient for treating hypertension in cats.

Answer 251

Aim for UPC <0.5 or at least a 50% reduction from baseline. ## Footnote If goals are not met, consider increasing the ACEI dose or adding an ARB.

Answer 252

An increase in creatinine levels or the development of azotemia. ## Footnote If creatinine climbs too high, the dose should be adjusted.

Answer 253

A declining UPC indicates that therapy is effective; unchanged or rising UPC suggests the need for dose adjustments or additional therapies. ## Footnote Regular monitoring helps optimize treatment outcomes.

Answer 254

ACE inhibitors like enalapril and benazepril have been shown to reduce proteinuria and delay the progression of azotemia. ## Footnote Enalapril is dosed at 0.5–1.5 mg/kg PO q12h for dogs.

Answer 255

Dogs often require aggressive RAAS blockade, while cats typically need amlodipine for hypertension. ## Footnote Enalapril is dosed differently in dogs (BID) than in cats (QD).

Answer 256

Cats that remain proteinuric despite good BP control have a worse prognosis. ## Footnote Monitoring both BP and UPC is crucial for optimizing outcomes.

Answer 257

They block ACE-independent angiotensin II generation and have fewer bradykinin-mediated side effects.

Answer 258

Start at reduced doses (½ or ¼ of standard starting dose).

Answer 259

Dogs: < 0.5, Cats: < 0.4, or ≥ 50% reduction from baseline.

Answer 260

Consider potassium-restricted diet or switch from ACEI to ARB.

Answer 261

No, it is not recommended due to risks and is reserved for life-threatening hypoalbuminemia unresponsive to monotherapy.

Answer 262

It acts as an antihypertensive at higher doses.

Answer 263

* Biopsy-confirmed immune-mediated GN * Serum creatinine >3.0 mg/dL * Serum albumin <2.0 g/dL * Glomerular origin proteinuria with no hereditary nephropathy or amyloidosis.

Answer 264

* Mycophenolate * Cyclophosphamide ± short-term corticosteroids.

Answer 265

* UPC <0.5 * Creatinine <1.4 mg/dL * Albumin >2.5 g/dL.

Answer 266

Furosemide.

Answer 267

Hepatic lipoprotein synthesis from hypoalbuminemia.

Answer 268

Body fluid balance, drug secretion, acid-base homeostasis, electrolyte regulation

Answer 269

Ultrafiltrate through reabsorption and secretion

Answer 270

Active Na⁺ transport across the basolateral membrane

Answer 271

Reabsorbs 60–65% of ultrafiltrate; actively reabsorbs Na⁺, glucose, amino acids, HCO₃⁻; secretes organic anions/cations and H⁺

Answer 272

Reabsorbs ~30% of NaCl; establishes medullary osmotic gradient; generates hypoosmolar tubular fluid

Answer 273

Fine regulation of Na⁺, K⁺, Ca²⁺; final acid-base regulation and urine concentration via water reabsorption

Answer 274

* Urinary calculi (e.g., cystine stones) * Metabolic acidosis * Glucosuria and aminoaciduria (with normal blood levels) * Electrolyte imbalances * Impaired urine concentrating ability (e.g., hyposthenuria, isosthenuria)

Answer 275

* English Bulldog * Staffordshire Bull Terrier * Chihuahua * Newfoundland * Dachshund * Welsh Corgi * Rottweiler * Miniature Pinscher * Jack Russell Terrier

Answer 276

* Type I (autosomal recessive) * Non-Type I (autosomal dominant with incomplete penetrance) * Type III (sex-linked)

Answer 277

* Medical or surgical removal (e.g., urethrotomy, cystotomy) * Manage urinary tract infections if present

Answer 278

* Protein-restricted diets * Alkalinizing diets (target urine pH ≥7.5) * Increased water intake (feed canned food, add water to dry food)

Answer 279

Cofactor in mitochondrial fatty acid transport—crucial for energy generation

Answer 280

* Defective biosynthesis * Impaired tissue uptake or retention * Excessive renal excretion (carnitinuria)

Answer 281

* Dalmatians * English Bulldogs * Black Russian Terriers

Answer 282

Inherited defect in hepatic uric acid transport, not in uricase function itself

Answer 283

3.5 months

Answer 284

* Type 1 (Distal) * Type 2 (Proximal) * Type 4

Answer 285

Impaired H⁺ secretion in the distal tubule

Answer 286

Impaired HCO₃⁻ reabsorption in the proximal tubule

Answer 287

* PU/PD * Muscle weakness * Growth delay (in young animals) * Metabolic acidosis

Answer 288

Impaired reabsorption of multiple solutes in the proximal tubule leading to metabolic acidosis

Answer 289

Variable; some dogs remain stable for years

Answer 290

Non-anion gap (hyperchloremic) metabolic acidosis due to impaired renal acid-base handling despite normal GFR.

Answer 291

Hyperchloremic metabolic acidosis with urine pH <6 during systemic acidosis.

Answer 292

Potassium citrate over sodium bicarbonate.

Answer 293

Urine pH >6.

Answer 294

Nephrolithiasis.

Answer 295

Potassium and sodium citrate.

Answer 296

Failure to concentrate urine after ADH administration.

Answer 297

Receptor interference or damage from toxins or drugs.

Answer 298

Glomerular filtration and glomerular leakage ± proximal tubule reabsorption failure.

Answer 299

N-acetyl-β-D-glucosaminidase (NAG).

Answer 300

* Biological variability * Assay interference * Lack of assay standardization

Answer 301

Potassium citrate

Answer 302

* Proximal RTA: <6.0 * Distal RTA: >6.0

Answer 303

Mild hypovolemia increases proximal Na⁺/H₂O reabsorption, reducing urine volume.

Answer 304

* Congenital/anatomic: renal dysplasia, ectopic ureters, ureteral strictures, ureteropelvic junction abnormalities * Obstructive: nephroliths, ureteroliths, neoplasia, hydronephrosis/hydroureter * Functional: impaired ureteral peristalsis, urine retention from neurologic or muscular dysfunction * Urinary incontinence and vulvar conformation abnormalities in females * Innate protective mechanisms: narrow ureteral papillae, ureteropelvic junction angle, coordinated ureteral peristalsis ## Footnote These factors contribute to urine stasis or reflux, increasing susceptibility to infection.

Answer 305

* E. coli * Proteus spp. * Staphylococcus spp. * Enterococcus spp. ## Footnote E. coli is the most frequent isolate in cases of pyelonephritis.

Answer 306

7.7% ## Footnote In a study of 1,028 dogs with UTIs, 7.7% had complicated UTIs due to pyelonephritis.

Answer 307

True ## Footnote Fluid overload and other severe symptoms may be observed in cases of pyelonephritis.

Answer 308

* Fluoroquinolone (e.g., enrofloxacin) * 2nd/3rd generation cephalosporin (e.g., cefpodoxime, cefovecin) ## Footnote Immediate treatment is critical while awaiting culture results.

Answer 309

10–14 days ## Footnote The duration remains controversial due to limited veterinary studies and evolving antimicrobial resistance.

Answer 310

2/3 of dogs ## Footnote Survival rates vary based on underlying conditions.

Answer 311

* Dilation of renal pelvis >2.0 mm * Pyelactasia visualized in 66% of dogs with pyelonephritis * Ureteral dilation in 41% * Urolithiasis in 27% ## Footnote Median pyelonephritis dilation is 3.6 mm in dogs and 4.0 mm in cats.

Answer 312

* Ureteral stent placement * Nephrostomy tube * Subcutaneous ureteral bypass (SUB) * Renal pelvic lavage ## Footnote These interventions can help relieve obstruction and promote recovery.

Answer 313

Follow-up cultures and imaging ## Footnote These are critical to confirm resolution and prevent chronicity or relapse.

Answer 314

A term for diseases with a suspected but undetermined pattern of inheritance.

Answer 315

A clinical descriptor for CKD occurring in animals under 5 years of age.

Answer 316

* Immature/fetal glomeruli * Regions devoid of tubules * Tortuous arteries * Persistent metanephric ducts * Other architectural abnormalities

Answer 317

Incompatible with life.

Answer 318

Abnormal differentiation of renal tissue, histopathologically defined.

Answer 319

* Immature/fetal glomeruli and tubules in radial segments * Persistent immature mesenchyme * Secondary changes such as interstitial nephritis and fibrosis

Answer 320

* Preserve remaining kidney function * Delay progression * Manage complications

Answer 321

* Hypoalbuminemia * Azotemia * Thromboembolism and systemic hypertension

Answer 322

Proteinuria (UPC).

Answer 323

* English Cocker Spaniel * Samoyed * Dalmatian * Bulldog

Answer 324

* COL4A3 * COL4A4 * COL4A5 All collagen IV

Answer 325

~40% worldwide.

Answer 326

A C→A transversion in exon 29 of the PKD1 gene.

Answer 327

* Lhasa Apso * Shih Tzu * Soft-Coated Wheaten Terrier * Cavalier King Charles Spaniel * Bulldog

Answer 328

Juvenile CKD animals may live longer than those with acquired CKD at the same stage.

Answer 329

Low PKD likelihood ## Footnote This suggests that if a cat does not show signs of PKD by 6 months, it is less likely to develop the disease.

Answer 330

PKD1 mutation ## Footnote This mutation confirms the diagnosis in predisposed breeds.

Answer 331

* Acquired CKD (typically small kidneys) * Neoplasia or renal dysplasia (focal lesions) * Hepatic cysts or bile duct malformations (if hepatomegaly present) ## Footnote These conditions must be considered when diagnosing PKD.

Answer 332

* Phosphate control * Nutritional modification * Monitoring anemia, acidosis, and GI signs * Anti-hypertensives if needed ## Footnote These strategies are similar to those used in managing chronic kidney disease (CKD).

Answer 333

False ## Footnote While they can occur, they are less common in PKD cats and should still be monitored.

Answer 334

Abdominal discomfort from large kidneys or cyst infection ## Footnote Cyst infections can also occur, with incidence unknown in cats but significant in humans.

Answer 335

* Ultrasound-guided aspiration * Cytology * Culture/sensitivity ## Footnote These methods help diagnose cyst infections in PKD patients.

Answer 336

Aspirate + local antibiotic injection ## Footnote This is a specialist procedure that carries risks such as cyst rupture and peritonitis.

Answer 337

* Genetic screening of all breeding animals * Removal of any PKD-positive cats from breeding colonies * Supplement with ultrasound as a secondary tool ## Footnote This systematic screening can help eliminate PKD from breeding populations.

Answer 338

* Bull Terrier * Cairn Terrier * West Highland White Terrier ## Footnote PKD is uncommon in dogs but has been documented in these breeds.

Answer 339

Suspected autosomal dominant, PKD1 gene mutation ## Footnote This indicates that the disease can be passed from one generation to the next.

Answer 340

* Primary glucosuria * Aminoaciduria (e.g., cystinuria) * Electrolyte handling defects * Acid-base disorders * Water metabolism disorders ## Footnote These categories help classify different types of renal tubular disorders.

Answer 341

Highly variable ## Footnote Some dogs may maintain normal lifespans with supportive care.

Answer 342

* Rare congenital tubular defects * Unclassified glomerulopathies * Breed-associated structural anomalies ## Footnote These conditions require further study to better understand their genetic basis.

Answer 343

* PKD in cats can be eliminated through genetic testing and ultrasound screening * PKD in dogs is rare but can significantly impact renal and hepatic function * Fanconi syndrome in Basenjis is a well-known familial tubular disorder ## Footnote Early identification and genetic counseling are essential strategies in managing inherited renal diseases.

Answer 344

* Outer adventitia * Muscular layer (outer longitudinal, middle circular, inner longitudinal) * Submucosa * Mucosa (lined with transitional epithelium)

Answer 345

* Dogs: <2.7 mm * Cats: 0.3–0.4 mm

Answer 346

Helps prevent reflux and ascending infections.

Answer 347

More caudally than in dogs, typically in the proximal urethra, just caudal to the UVJ.

Answer 348

* Alpha-1 * Alpha-2 * Beta adrenergic receptors * Muscarinic cholinergic receptors

Answer 349

Myogenic activity originating in the renal pelvis.

Answer 350

Induces spasmodic contractions, inhibiting normal peristalsis.

Answer 351

* Intraluminal (ureteroliths, blood clots, neoplasia) * Intramural (strictures, tumors) * Extramural (compression from circumcaval ureters, retroperitoneal masses)

Answer 352

Subcutaneous ureteral bypass (SUB).

Answer 353

* Misses non-opaque stones * Misses very small stones

Answer 354

Only 13% success rate for medical management.

Answer 355

* Complete obstruction * Worsening azotemia * Anuria * Hyperkalemia * Refractory pain

Answer 356

Promote spontaneous passage of ureteroliths by relaxing ureteral smooth muscle and increasing urine flow.

Answer 357

* No UTI or sepsis * No severe obstruction * Adequate renal reserve * Stable patient

Answer 358

* IV fluid therapy * Diuretics (e.g., mannitol) * Alpha-adrenergic antagonists (e.g., prazosin, tamsulosin)

Answer 359

* Cats: 24–48 hours * Dogs: up to 1–2 weeks

Answer 360

* Staphylococcus pseudintermedius * Klebsiella * Corynebacterium * Mycoplasma

Answer 361

* Initial obstruction relief * IV antibiotics guided by urine culture * Struvite dissolution diet

Answer 362

* Ureteral stent placement * SUB device placement * Shockwave lithotripsy * Ureterotomy

Answer 363

* Stent obstruction * Ureteral stricture ingrowth * Ureteritis * Mineral encrustation

Answer 364

68% pass spontaneously.

Answer 365

0.3–0.4 mm.

Answer 366

~95% with experience

Answer 367

* Stent obstruction due to: * Ureteral stricture ingrowth * Ureteritis * Mineral encrustation

Answer 368

Requires surgical antegrade placement via nephropyelostomy

Answer 369

SUB device

Answer 370

* Temporary or long-term * Easily removed via cystoscopic retrieval in most dogs and female cats * Mineral encrustation may require replacement or exchange

Answer 371

Non-severe, non-infected, non-obstructive ureteroliths

Answer 372

Low success in cats, moderate success in dogs

Answer 373

Cats with IRIS stage 1–2 CKD live significantly longer than those with stage 3–4 CKD

Answer 374

* Single ureterolith without nephroliths * No concurrent stricture * Failure of minimally invasive options

Answer 375

Higher mortality and complication rates than: * Ureteral stenting in dogs * SUB placement in cats

Answer 376

~80% of ureteroliths resolved

Answer 377

* Transient obstruction by fragmented ureteroliths * ~50% require ≥2 treatments

Answer 378

* Very small ureteral diameter (<1 mm) * Calcium oxalate stones are more resistant to fragmentation * Shockwave damage to kidneys occurs at <50% of therapeutic dose used in dogs

Answer 379

* Urothelial carcinoma * Leiomyoma / Leiomyosarcoma * Sarcoma * Mast cell tumor * Hemangiosarcoma * Fibroepithelial polyp (most common in dogs)

Answer 380

Ureteronephrectomy

Answer 381

* Retroperitoneal urine accumulation * Postrenal azotemia * Hyperkalemia * Metabolic acidosis * Retroperitoneal abscesses and urosepsis

Answer 382

* Ureteronephrectomy * Ureteroneocystostomy * Conservative urine diversion * Ureteral stents or SUB

Answer 383

Periureteral pseudocyst (urinoma)

Answer 384

* Ectopic ureters * Ureterocele * Ureterovesicular junction (UVJ) stenosis * Ureteral agenesis * Ureteral duplication * Ureteral atresia

Answer 385

Twice as likely ## Footnote This statistic highlights a significant risk factor for UTIs in spayed females.

Answer 386

45–55% ## Footnote E. coli is the most prevalent isolate in canine urinary tract infections.

Answer 387

>100,000 CFU/mL ## Footnote This threshold is used to determine significant bacteriuria.

Answer 388

3–5 days ## Footnote Short-duration therapy has been shown to have similar cure rates compared to longer treatments.

Answer 389

* Amoxicillin * Cephalexin * Trimethoprim-sulfonamides (TMS) ## Footnote Fluoroquinolones and cephovecin should not be used as first-line options.

Answer 390

≥3 documented infections with clinical signs in a 12-month period ## Footnote This condition indicates a pattern of recurring urinary tract infections.

Answer 391

Susceptibility patterns may help ## Footnote Different susceptibility patterns indicate reinfection, while the same patterns suggest a relapse.

Answer 392

Prevent bacterial adherence to urothelium ## Footnote This allows urination to clear pathogens from the urinary tract.

Answer 393

Cranberry and Proanthocyanidins (PACs) ## Footnote PACs may prevent binding of P-fimbriated E. coli to uroepithelial cells.

Answer 394

Targets specific bacterial strains for lysis ## Footnote This therapy is still investigational in veterinary medicine.

Answer 395

Identify and eliminate bacterial reservoirs ## Footnote Treatment duration is typically longer (7–14 days up to 4–6 weeks) depending on the site of infection.

Answer 396

In vitro reduction in E. coli adherence; in vivo benefit unproven ## Footnote Cranberry PACs have shown potential in laboratory studies but lack clinical validation in dogs.

Answer 397

Positive results in rodent studies; urinary concentrations unclear ## Footnote D-Mannose has shown promise in preclinical models but its effectiveness in veterinary applications is not well established.

Answer 398

Successful in human trials; oral/IM ineffective in dogs ## Footnote GAGs have been effective for humans but do not translate well to canine treatment.

Answer 399

Reduced recurrent UTI by 50%; limited pilot data in dogs (4/9 cure) ## Footnote This bacterium shows promise in human studies, but results in dogs are preliminary.

Answer 400

No effect in dogs ## Footnote Although probiotics are beneficial for human vaginal flora, they do not appear to help with canine urinary health.

Answer 401

Effective in women; unknown effect in animals ## Footnote While estrogen therapy is known to help women, its implications for animal treatment remain unclear.

Answer 402

Bacteriostatic in acidic urine; no current vet guidance ## Footnote Methenamine salts can inhibit bacterial growth in acidic conditions, but veterinary guidelines are lacking.

Answer 403

Investigational only; theoretical benefit ## Footnote Bacteriophage therapy is still being researched and not yet widely applied in veterinary practices.

Answer 404

Not curative; infection often recurs once antibiotics are discontinued ## Footnote Prophylactic antibiotics can temporarily alleviate symptoms but do not resolve the underlying infection.

Answer 405

Creates selective pressure; may lead to multidrug-resistant uropathogens ## Footnote This phenomenon increases the likelihood of treatment failure in subsequent infections.

Answer 406

One-third to one-half of the normal daily dose ## Footnote Adjusting the dose helps minimize resistance while still providing some protective effect.

Answer 407

At night after the final urination ## Footnote Timing is crucial to maintain adequate antibiotic levels overnight.

Answer 408

Achieve overnight bladder antibiotic concentration to prevent colonization ## Footnote Effective prophylaxis requires maintaining sufficient drug levels in the bladder.

Answer 409

6 months ## Footnote This duration is suggested to monitor and manage recurrent infections effectively.

Answer 410

Show reduction in recurrence but recurrence resumes post-discontinuation ## Footnote This highlights the temporary benefit of prophylactic treatment.

Answer 411

Disruption of equilibrium, leading to crystallization, aggregation, and growth of crystals within a protein matrix.

Answer 412

* Increased solute concentration * Decreased urine volume * Decreased excretion of natural crystallization inhibitors * Changes in urine pH * Presence of foreign material * Incomplete voiding or urinary stasis * Failure of innate defense mechanisms

Answer 413

Urinary tract infections (UTIs) with urease-producing bacteria.

Answer 414

~40–43%.

Answer 415

Urease converts urea to ammonia, which increases urine pH and favors struvite precipitation.

Answer 416

Idiopathic hypercalciuria.

Answer 417

~35–42%.

Answer 418

* Miniature Schnauzers * Yorkshire Terriers * Shih Tzus * Bichon Frise * Lhasa Apsos

Answer 419

~1% of submissions.

Answer 420

Cystinuria, a hereditary defect in amino acid transport.

Answer 421

~5% of submissions.

Answer 422

Congenital portosystemic shunts (PSS).

Answer 423

High dietary silica intake.

Answer 424

Dalmatians.

Answer 425

Alkaline urine.

Answer 426

Promote water intake to target USG ≤1.020.

Answer 427

50–60% success rate Median dissolution time: ~1 month ## Footnote If no progress by 4–6 weeks or signs persist >2 weeks, consider removal.

Answer 428

No dissolution possible Strategies to reduce recurrence: * Therapeutic diet low in oxalate precursors and high in moisture * Potassium citrate for persistent acidic urine * Hydrochlorothiazide for recurrent formers ## Footnote Must exclude hypercalcemia before prescribing hydrochlorothiazide.

Answer 429

Urinary cystine quantification Genetic testing in: * Type I: Labrador Retrievers, Newfoundlands * Type IIa: Australian Cattle Dogs, Border Terriers * Type IIb: Miniature Pinschers ## Footnote Genetic testing helps identify predisposed breeds.

Answer 430

Castration of intact males Low animal protein, alkalinizing diet Potassium citrate (75 mg/kg PO q12h) Tiopronin (20 mg/kg PO q12h) if diet/castration insufficient ## Footnote Success rate is ~60% with a median dissolution time of ~2 months.

Answer 431

Bile acids test if portosystemic shunt is suspected Genetic testing for hereditary hyperuricosuria in: * Dalmatians * Black Russian Terriers * English Bulldogs * 30 other breeds ## Footnote Identifying genetic predisposition aids in management.

Answer 432

Low-purine, alkalinizing diet Potassium citrate if urine remains acidic Allopurinol for dogs with hereditary hyperuricosuria ## Footnote Must be combined with a low-purine diet to prevent xanthine uroliths.

Answer 433

Urethral obstruction Inability to feed a urinary diet due to concurrent illness or dietary intolerance ## Footnote These conditions could complicate treatment efforts.

Answer 434

Feed a low-purine, alkalinizing therapeutic diet Administer allopurinol (15 mg/kg PO q12h) ## Footnote Indicated for dogs with hereditary hyperuricosuria (HHU).

Answer 435

Increase water intake to target urine specific gravity (USG) ≤1.020 Frequent monitoring with: * Urinalysis at 1 month, then every 3–6 months * Imaging at 3–6 months, then every 6–12 months ## Footnote Early detection allows for timely intervention.

Answer 436

50% recurrence within 2–3 years ## Footnote This highlights the need for ongoing monitoring and management.

Answer 437

75 mg/kg PO q12–24h if urine pH remains <6.5 ## Footnote This aims to maintain urine alkalinity.

Answer 438

Avoid citrate supplements with cranberry extract ## Footnote Cranberry extract may increase oxalate excretion.

Answer 439

Check serum calcium before initiating ## Footnote Especially in dogs with suspected primary hyperparathyroidism.

Answer 440

Low animal protein, low sodium diet ## Footnote This helps to manage cystine levels in urine.

Answer 441

Target pH ~7.5 ## Footnote Maintaining this pH helps to prevent stone formation.

Answer 442

Urine cystine:creatinine ratio >178 µmol/g ## Footnote This ratio is crucial for diagnosis.

Answer 443

Success rate: ~60% with a median dissolution time of 2 months ## Footnote Thiopronin is used when cystinuria persists.

Answer 444

* Myopathy * Proteinuria * Thrombocytopenia * Aggression * Dermatologic signs ## Footnote These effects can be dose-dependent.

Answer 445

Low-purine, alkalinizing formulation ## Footnote This diet helps to reduce urate levels in urine.

Answer 446

Add potassium citrate (goal pH ≥7.0) ## Footnote This helps to alkalinize the urine.

Answer 447

Targeting one mineral type often concurrently reduces the formation of the other ## Footnote Shared risk factors include urine pH and dietary components.

Answer 448

* Struvite (magnesium ammonium phosphate) * Calcium oxalate

Answer 449

* Purines (urate, xanthine) * Cystine * Calcium phosphate * Mixed/compound stones

Answer 450

* Acidic pH: urate, silica, cystine less soluble. * Alkaline pH: struvite, calcium phosphate, calcium carbonate less soluble.

Answer 451

Hill’s Prescription Diet s/d (canned/dry): dissolution only.

Answer 452

* Middle-aged to older, male neutered cats * Burmese, Himalayan, and Persian breeds

Answer 453

Relative supersaturation (RSS) of calculogenic materials.

Answer 454

* Dietary intake * GI absorption * Renal excretion

Answer 455

Increases calciuria and decreases oxalate excretion.

Answer 456

Prevent recurrence by minimizing RSS of calcium and oxalate in urine.

Answer 457

* Methionine * Calcium/sodium sulfate * Ammonium chloride

Answer 458

* Staphylococcus spp. * Enterococcus spp. * E. coli

Answer 459

Male, middle-aged, Burmese/Persian cats

Answer 460

Female, middle-aged, DSH/DMH cats

Answer 461

↑ urine pH, dilute urine

Answer 462

↓ urine pH, acidify urine

Answer 463

Radiopaque

Answer 464

Urate and Xanthine

Answer 465

* Oriental Shorthairs * Siamese * Burmese * Egyptian Mau

Answer 466

Purines → hypoxanthine → xanthine → uric acid → allantoin (via hepatic uricase)

Answer 467

Protein-restricted, alkalinizing, high-moisture diets

Answer 468

Inherited COLA transport defect in the proximal renal tubules

Answer 469

Increase urine pH to ≥7.5, ↓ dietary protein, ↑ water intake

Answer 470

* Hydroxyapatite * Carbonate apatite

Answer 471

* Hydroxyapatite * Carbonate apatite * Rare forms include: * Brushite * CaHPO₄ dihydrate * Whitlockite * Tricalcium orthophosphate * Octocalcium phosphate

Answer 472

1.8% of feline urolith submissions

Answer 473

* Urate: Young males, Oriental breeds * Xanthine: Rare; iatrogenic or genetic * Cystine: Young, intact males * Ca Phosphate: Middle-aged females * DSB: Middle-aged males * Silica: DSH (limited data)

Answer 474

Protein restriction, alkalinizing diet

Answer 475

Low protein, alkalinization, castration

Answer 476

Stores urine ~99% of the time and facilitates elimination ~1% of the time

Answer 477

Somatic and autonomic nervous systems, and conscious CNS input

Answer 478

Stretch receptors in bladder wall → pelvic nerve (S1–S3) → spinal cord → pontine micturition center (PMC) → cerebral cortex

Answer 479

Detrusor contraction via M3 muscarinic receptors

Answer 480

Relaxes detrusor (bladder filling)

Answer 481

Controls striated urethral sphincter (voluntary continence)

Answer 482

* Doberman Pinscher * Giant Schnauzer * Old English Sheepdog * Rottweiler * Weimaraner * Boxer

Answer 483

Decreased estrogen and increased LH/FSH may weaken urethral tone

Answer 484

* Pelvic bladder * Short urethra * Recessed vulva

Answer 485

* Leakage when recumbent * Sleep * Post-exercise

Answer 486

* Colposuspension * Trans-obturator vaginal tape * Urethropexy * Artificial urethral sphincter * Urethral bulking agents

Answer 487

Months to years post-neuter

Answer 488

* Decreased anal tone * Poor perineal reflexes * Easily expressible bladder

Answer 489

Manual bladder expression or intermittent catheterization

Answer 490

~17 months

Answer 491

Anecdotal evidence only, limited efficacy data

Answer 492

Integrates sensory info and coordinates detrusor contraction with urethral relaxation during voluntary voiding

Answer 493

Uncontrolled detrusor contractions at low bladder volumes.

Answer 494

Poorly characterized in animals.

Answer 495

* Increased frequency * Urgency * Small-volume voids * Absence of polyuria or LUT inflammation

Answer 496

Urodynamic studies (e.g., cystometrogram).

Answer 497

Antimuscarinic + alpha-agonist effects.

Answer 498

Large, flaccid bladder.

Answer 499

* Neurogenic: Pelvic nerve or S1–S3 spinal injury (LMN bladder) * Myogenic: Chronic overdistention (e.g., FIC obstruction, functional obstruction)

Answer 500

Bladder management: Manual expression or catheterization 2–4x/day.

Answer 501

Muscarinic agonist.

Answer 502

Inability of urethral sphincter to relax during detrusor contraction.

Answer 503

Middle-aged, large to giant breed male dogs (mean age ~4.9 yrs).

Answer 504

* Straining to urinate * Small/attenuated urine stream * Incomplete voiding * Overflow incontinence

Answer 505

Prazosin (alpha-1 blocker).

Answer 506

Alpha-1A blocker targeting internal urethral sphincter.

Answer 507

Spinal cord lesions cranial to S1–S3 (e.g., IVDD).

Answer 508

* Treat underlying neurologic condition * Supportive care: manual expression or catheterization, alpha-blockers

Answer 509

Bethanechol

Answer 510

Spinal cord trauma.

Answer 511

Use caution due to toxicity or poor safety profile.

Answer 512

1 mL/kg = abnormal; may suggest incomplete emptying.

Answer 513

Due to clinical similarities with human Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS), characterized by painful urinations without an identifiable cause.

Answer 514

A constellation of overlapping chronic conditions in cats, emphasizing the complexity and multisystemic nature of the disease.

Answer 515

A manifestation of persistent activation of the central threat response system (CTRS).

Answer 516

* Genetic differences in organ vulnerability * Intensity and timing of threatening stimuli * Prenatal stress exposure

Answer 517

58% of cats with a known diagnosis had at least one recurrence.

Answer 518

Multimodal Environmental Modification (MEMO).

Answer 519

* Changes in routine * Competition over resources * Lack of socialization

Answer 520

* One box per cat + one * Separated locations * Cleaned daily

Answer 521

* Prednisolone * Chloramphenicol * Pentosan polysulfate sodium * Propantheline * Meloxicam * Prazosin

Answer 522

They may benefit cats with frequent recurrences and comorbid anxiety.

Answer 523

The brain integrates input with context to anticipate future stimuli and modulate responses.

Answer 524

It can exacerbate pain syndromes and influence disease expression.

Answer 525

* General Temperament * Early Life Experience * Health Status * Perception of Safety * Resource Distribution * Routine * Social Relationships * Enrichment * Outdoor Access * Choice & Control

Answer 526

early life adversity.

Answer 527

MEMO, aiming to improve welfare by reducing perceived threats.

Answer 528

Begin with 1-2 tailored suggestions.

Answer 529

* Decrease perceived threat * Increase the cat's sense of control * Prolong symptom-free intervals * Reduce recurrence severity and frequency

Answer 530

Referral to veterinary behaviorists or specialty hospitals.

Answer 531

No robust studies support efficacy.

Answer 532

No statistically significant difference in days with clinical signs.

Answer 533

* Obesity * Nervous or fearful temperament

Answer 534

Provide appropriate pain control.

Answer 535

* Preserve and strengthen the human-cat bond * Improve overall quality of life for both the cat and the client

Answer 536

Dysuria, stranguria, pollakiuria, hematuria, poor or narrow urine stream, urinary incontinence or retention, urgency, penile or vulvar overgrooming, discharge from the genitalia, palpable distended bladder ## Footnote These signs often overlap with bladder disorders, necessitating urethral assessment.

Answer 537

Congenital Urethral Sphincter Mechanism Incompetence (USMI) ## Footnote Affects up to 20% of spayed female dogs, especially those over 20 kg.

Answer 538

Medical: Estrogen compounds (e.g., estriol), α-agonists (e.g., phenylpropanolamine). Surgical: Urethral bulking agents, artificial urethral sphincters (e.g., hydraulic occluders) ## Footnote Estrogen helps improve urethral tone.

Answer 539

20–30% ## Footnote Uroliths are significant contributors to urethral obstructions in male cats.

Answer 540

Trauma, catheterization-related injury, post-surgical changes, chronic inflammation ## Footnote Strictures can occur anywhere along the urethra.

Answer 541

Young to middle-aged large-breed male dogs ## Footnote This condition affects the reflex arc controlling urethral sphincter relaxation.

Answer 542

Urethral stenting, balloon dilation, medical therapy (antibiotics, anti-inflammatories, immunosuppressives) ## Footnote Recurrence rate is approximately 70%.

Answer 543

Primarily affects intact male dogs ## Footnote Risk factors include sexual arousal/activity, urolithiasis, and UTIs.

Answer 544

Imaging (radiography, CT), endoscopy (urethrocystoscopy), urinalysis ## Footnote Cystourethrogram is preferred for visualization.

Answer 545

False ## Footnote It is rare and usually an extension from the bladder or prostate.

Answer 546

38–71% ## Footnote Recurrence rates depend on postoperative care.

Answer 547

843 days ## Footnote This is compared to shorter relapse times for other treatments.

Answer 548

Uncommon but clinically significant conditions in both dogs and cats ## Footnote The most frequently encountered anomaly is ectopic ureters.

Answer 549

Ectopic ureters

Answer 550

* Renal dysplasia * Ureterocele * Urethral hypoplasia * Vestibulovaginal abnormalities

Answer 551

* Hydronephrosis * Hydroureter * Vesicoureteral reflux * Bladder hypoplasia

Answer 552

* Golden Retrievers * Labrador Retrievers * Newfoundlands * Siberian Huskies * Poodles * Soft-Coated Wheaten Terriers

Answer 553

73–100% depending on image quality and technique

Answer 554

Transurethral cystoscopic-guided laser ablation

Answer 555

Relocate the ureteral orifice to a normal position within the bladder trigone

Answer 556

Cystic dilatation of the submucosal distal ureter

Answer 557

* Orthotopic: Located within the bladder * Ectopic: Partially or entirely located within the urethra

Answer 558

Secondary to ectopic ureters or congenital urethral sphincter mechanism incompetence

Answer 559

* Patent Urachus * Urachal Cyst * Vesicourachal Diverticulum

Answer 560

Rare congenital defect causing bladder eversion through a ventral abdominal wall defect

Answer 561

Urine leakage from the umbilicus

Answer 562

Incomplete fusion of urogenital folds resulting in ventral urethral defect

Answer 563

Cryptorchidism

Answer 564

* Ureterorectal fistula (males) * Rectovaginal fistula (females)

Answer 565

* Feces or urine from abnormal orifices * Perineal bulging * Constipation or obstipation * Signs of UTI

Answer 566

Laxatives, highly digestible diet

Answer 567

Identification and ligation/suturing of the fistula, simultaneous repair of atresia ani, neutering recommended

Answer 568

A functional disorder of the urethra characterized by inadequate urethral tone leading to urinary incontinence

Answer 569

Urethral hypoplasia, proximal urethral dilation

Answer 570

Via retrograde urethrocystoscopy

Answer 571

Urodynamic testing

Answer 572

Urethral lengthening surgery

Answer 573

A rare congenital anomaly characterized by the presence of an accessory urethra

Answer 574

Urinary incontinence due to filling of the accessory urethra and delayed drainage into the normal urethra

Answer 575

Surgical ligation of the accessory urethra, minimally invasive coil embolization, cyanoacrylate glue ablation

Answer 576

Epithelial-lined outpouchings of the urethra

Answer 577

Urinary incontinence, recurrent UTIs

Answer 578

Surgical excision and urethral reconstruction, perineal urethrostomy

Answer 579

Annular constriction at the junction of the vestibule and vagina

Answer 580

Digital vaginal exam (presumptive), contrast vaginourethrogram or vaginoscopy/cystoscopy (definitive)

Answer 581

Hypothesized to cause incontinence, chronic vaginitis, or UTIs, but evidence is weak

Answer 582

Digital dilation, surgical resection, vaginoplasty (rarely necessary)

Answer 583

Result from incomplete regression of the paramesonephric ducts

Answer 584

May contribute to reproductive failure or lower urinary tract disease

Answer 585

Endoscopic laser ablation, endoscopic scissors, surgical resection via episiotomy

Answer 586

Do not breed animals with ectopic ureters or PPMRs until heritable abnormalities are ruled out

Answer 587

Benign prostatic hyperplasia (BPH) ## Footnote Approximately 80% of intact dogs over 5 years have gross or microscopic BPH.

Answer 588

Approximately 75% ## Footnote This indicates that many cases do not show overt clinical signs.

Answer 589

Large breed dogs, such as: * Doberman Pinschers * German Shepherds * Rhodesian Ridgebacks * Labradors

Answer 590

>95% ## Footnote This suggests a very high occurrence of BPH in older intact male dogs.

Answer 591

* Preputial bleeding * Tenesmus with thin feces * Constipation * Painful defecation * Subfertility

Answer 592

Correlates with BPH severity and prostate size ## Footnote Levels >90 ng/mL indicate prostates >2.5× normal size.

Answer 593

* Escherichia coli * Staphylococcus spp. * Streptococcus spp. * Proteus spp. * Pseudomonas spp. * Klebsiella spp. * Brucella canis

Answer 594

Culture of prostatic fluid with >10⁴ CFU/mL ## Footnote A two-log difference between prostatic fluid and urine CFU suggests prostatitis.

Answer 595

4–6 weeks

Answer 596

Feminization syndrome ## Footnote Symptoms include symmetric alopecia, skin hyperpigmentation, and gynecomastia.

Answer 597

* Adenocarcinoma * Undifferentiated carcinoma

Answer 598

Poor, survival measured in weeks to months

Answer 599

* Omentalization * Marsupialization * Penrose drains

Answer 600

* Surgical omentalization * Marsupialization * Penrose drain placement

Answer 601

Often subclinical, may include recurrent UTIs and poor semen quality

Answer 602

Leads to squamous metaplasia and may cause prostatitis or abscessation

Answer 603

For cytology, bacteriology, biochemical analysis

Answer 604

Omentalization

Answer 605

Marsupialization

Answer 606

Penrose drain placement

Answer 607

Castration or GnRH therapy

Renal Flashcards

(682 cards)