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From Flashcardlet > Renal and Repro > Flashcards

Renal and Repro Flashcards

1
Q

After ureteral obstruction, RBF decreases ___ % of normal in 24 h and drops to ___% of normal by 2 weeks.

A

40%, 20%

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2
Q

Ureteral pressures increase immediately after obstruction and can take ___ to decrease after removing obstruction.

A

24h

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3
Q

7 days after obstruction, GFR permanently diminished by ___%, and after 14 days ___ %

A

35, 54

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4
Q

Normal diameter of canine ureter based on CT

A

1.3-2.7 mm (3.9-8.1 F)

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5
Q

Normal internal and external diameter of feline ureter

A

0.4 mm (1.2 F), 1 mm (3 Fr)

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6
Q

What is a circumcaval ureter?

A

passes dorsal to the CVC (right ureter normally passes lateral to CVC)

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7
Q

___% cats anemic on presentation with ureteral obstruction

A

48%

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8
Q

___ % dogs thrombocytopenic on presentation with ureterolithiasis obstruction

A

44%

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9
Q

___% dogs and ___% cats azotemic on presentation from unilateral obstructions

A

50%, 83%

Not associated with outcome if early decompensation performed

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10
Q

Amitriptyline MOA on ureter?

A

SM relaxation by opening of voltage-gated potassium channels

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11
Q

What % of dogs with ureteral obstruction have associated pyelonephritis and cystitis?

A

77% - so give them all abs

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12
Q

Why are IVPs not helpful in animals with ureteral obstructions?

A

Poor filling of obstructed kidney and risk of nephrotoxicity

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13
Q

What % of patients were reported to have movement of their ureteral stones to either either complete or partial passage with aggressive medical mgmt?

A

17%

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14
Q

What are antisposmotid meds?

A 
tramsulosin (alpha-adrenergic atagonist)
prazosin (alpha-1 non-selective adrenergic antagonist)
verapamil (CCB)
papaverine (phosphodiesterase inhibitor)
beta-agonist
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15
Q

What are the goals accomplished by relieving the obstruction in uretO?

A
  1. improve azotemia and e-lytes
  2. prevent further hydrostatic damage
  3. alleviation of ureteral pain
  4. potential for retrograde migration
  5. allow time for postobstructive diuresis
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16
Q

How do you relieve a ureteral obstruction?

A

Nephrostomy tube placement (percutaneous dogs, surgical cats with nephropexy - need >10 mm pelvis), or something more permanent if stable

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17
Q

What are surgical techniques for ureteral obstruction?

A

Ureterotomy, ureteral reimplantation, ureteronephrectomy, renal transplant

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18
Q

What % of dogs and cats remain azotemic after tx of a ureteral obstruction?

A

50% cats, 40% dogs

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19
Q

What is the most common long-term complication of ureteral stent in cats?

A

UTI (20%), others pollakiuria (17%), stent migration, ureteritis, tissue ingrowth around stent, chronic mild hematuria, ureterovesicular reflux

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20
Q

Ureteral extracorporeal shock wave lithotripsy can be used on ureteral calculi of what sizes?

A

< 5mm dogs, 3-5 mm cats

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21
Q

Stages of AKI

A

Initiation, extension, maintenance, recovery

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22
Q

At what stage of AKI does irreversible damage occur?

A

Maintenance

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23
Q

List methods to measure GFR

A

Iohexol clearance
Endogenous creatinine clearance
Scintigraphy
Inulin clearance

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24
Q

Infectious diseases that can cause AKI

A 
Rickettsia richettsii (RMSF)
Borrelia burgdorferi (Lyme)
Babesia
Leishmania
Leptospirosis
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25
Q

List methods of renal biopsy

A
  1. Percutaneous US guided needle biopsy
  2. Laparoscopy
  3. Surgical wedge through keyhole incision in flank
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26
Q

What is the formula to calculate bicarbonate dose?

A

0.3 x wt (kg) x base deficit = bicarb (mEq/L)

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27
Q

Contraindications for sodium bicarbonate?

A
  1. Chronic respiratory acidosis (can cause paradoxical CNS acidosis if lungs can’t get rid of CO2)
  2. Hypernatremia
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28
Q

List H2 blockers.

A

Ranitidine
Famotidine
Cimetidine

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29
Q

IV famotidine in cats can cause what…

A

hemolysis

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30
Q

If you have to split omeprazole tablets, what should you do?

A

dissolve in sodium bicarb to protect it from degradation in stomach

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31
Q

List 5 phosphate binders

A 
aluminum hydroxide
aluminum carbonate
calcium acetate
sevelamer hydrochloride
lanthanum carbonate
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32
Q

How do you supplement bicarb?

A

Calculate amt to supplement (0.3 x kg x base deficit), give 1/4 IV then give another 1/4 IV over 4-6h, reassess, continue giving if needed

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33
Q

Define diffusion.

A

Solute removal relying on random particular motion, particles arbitrarily encounter dialyzer membranes and may pass thru channels; odds are directly proportional to concentration and thermodynamic energy

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34
Q

Define ultrafiltration.

A

removing excess plasma water via outward transmembrane hydraulic pressure generated by the blood pump, plus a vacuum applied to the dialysate side

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35
Q

Define convection.

A

Aka solvent drag, refers to movement of dissolved solutes in conjunction with movement of fluid across the dialysis membrane during ultrafiltration; minor role during standard dialysis and only occurs with UF

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36
Q

What is hemodiafiltration?

A

Maximizing convection by performing simultaneous high rate UF and IV fluid replacement, maximizes removal of middle molecular weight solutes (12,000 kD)

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37
Q

What is URR?

A

Urea reduction ratio = 1 - (postBUN/preBUN)

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38
Q

What is the standard guidelines for URR in dialysis?

A

Tx 1: URR 0.3-0.6 (no > 0.1 URR/hr)

Tx 2: URR 0.5-0.8
Tx 3: 0.9-0.95 URR

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39
Q

What is dialysis disequilibrium syndrome?

A

manifestation of cerebral edema from rapid changes in osmolality

C/S: ataxia, altered mentation, pupillary abnormalities, seizures, coma, death

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40
Q

What makes peritoneal dialysis easier?

A

ometectomy

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41
Q

What are 3 major indications for dialysis?

A

Oliguric/anuric acute kidney injury
Fluid overload (kidney or heart)
Intoxications

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42
Q

HD risks

A 
Hemorrhage
Catheter-related infection
PTE
Sepsis
Dialysis disequilibrium
Hypotension
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43
Q

PD risks

A

septic peritonitis
catheter occlusion
catheter dyfunction
dialysate leakage

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44
Q

CDC indications for indwelling urinary catheter

A

urinary obstruction
neurogenic bladder dysfxn
lower urinary tract sx
need for urine output quantity

NOT: recumbency or preventing pet from soiling itself

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45
Q

What is related to u-cath associated UTIs?

A

Duration of catheterization

Absence of closed urinary collection system

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46
Q

What is biofilm?

A

matrix of microorganisms and their produced glycocalyces, host salts, and proteins

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47
Q

In order from decreasing urethral reactivity and increasing biofilm resistance, list u-cath material order of suitability for long-term indwelling catheter

A 
plastic
red rubber
latex
siliconized elastomer or Teflon-coated latex
hydrogen-coated latex
pure silicone
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48
Q

1 French equals

A

1/3 mm or 0.33 mm

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49
Q

When do pyometra occur?

A

diestrus; when corpora lutea are present and serum progesterone is high

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50
Q

Pathogenesis of pyometra usually preceded by…

A

cystic endometrial hyperplasia

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51
Q

Treatment options for pyometra?

A
  1. OHE and antibiotics

2. Prostaglandin F2alpha and antibiotics

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52
Q

Most common bacteria isolated from pyometra?

A

E.coli

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53
Q

Mean age dog vs. cat with pyometra?

A

Dog 8-9 y, cat 32 mos

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54
Q

Avg interval from onset of proestrus to diagnosis of CEH-pyometra in dogs? cats?

A 
35 d (20-70 d) dogs
8 wks cats
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55
Q

Pyometra ddx

A

pregnancy (<42d), mucometra, hydrometra, CEH, uterine neoplasia

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56
Q

What is speculated to cause PU/PD in dogs with pyometra?

A

E.coli LPS causes insensitivity to ADH at the DCT and collecting ducts –> can’t concentrate urine

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57
Q

What tests can be done to differentiate pyometra from CEH with mucometra?

A

band neutrophils
ALP
CRP
prostaglandin-F metabolites

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58
Q

What lab test is most sensitive to differentiate pyometra from CEH with mucometra?

A

band neutrophils

>19.9% bands is 94.2 sensitive and 70% specific

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59
Q

PGFM of 3054 pmol/L indicates…

A

greater than 95% chance pyometra

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60
Q

Combining bands and PGFM increases sensitivity of detecting pyometra to..

A

100%

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61
Q

What is the lethal level of LPS?

A

0.7 to 1 ng/ml

62
Q

What medication can be used to open the cervix in pyometra for medical mgmt?

A

aglepristone (MOA: progesterone receptor antagonist, competes at a rate 3X higher than progesterone; mean time to open cervix is 25 h)

63
Q

What is medical mgmt pyometra?

A

PGF2alpha or PGF2alpha analogs, progesterone receptor antagonists, dopamine antagonists, antibiotics, IVF, anti-LPS plasma

64
Q

MOA of PGF2alpha

A

Myometrial contractility to expel uterine contents, causes luteolysis to remove source of progesterone

65
Q

Side effects of PGF2a?

A

panting, salivation, anxiety, vomiting, diarrhea, urination, abd contractions, ataxia

Queen (add’l): vocalization, grooming, kneading, mydriasis, lordosis

66
Q

What is cloprostenol?

A

PGF2a analog, longer acting and more potent than natural PGF2a; less side effects (nausea, v, d)

67
Q

What is dinoprost?

A

natural PGF2a; lethal dose 5.13 mg/kg

68
Q

When is medical mgmt for pyometra contraindicated?

A 
Liver/kidney dysfxn (takes 2 days to open cervix with aglepristone)
Closed pyo (unless in UK with anglepristone)
69
Q

How is dopamine agonists helpful with pyometra?

A

Causes luteolysis by reducing prolactin concentrations

Drug: cabergoline

70
Q

Gestation cats?

A

63-65 d (ovulation to partition)

71
Q

Gestation dogs?

A

56-58 d from onset cytologic diestrus

64-66 days from LH surge

72
Q

What is uteroverdin?

A

dark green uterine discharge riginating from the uteroplacental marginal hematomas

73
Q

What coag factors increase significantly before parturition?

A

VII, IX, XI, and fibrinogen

74
Q

Physiologic changes during pregnancy:

A
  1. insensitivity to insulin, not glucagon
  2. increased CO
  3. increased SVR and PVR
  4. increased venous distensibility
  5. increased minute ventilation
  6. decreased FRC
  7. delayed gastric emptying
75
Q

What does a tocodynamometer do?

A

Detect changes in intrauterine and intraamniotic pressures

76
Q

Sequelae to dystocia

A

fetal death, maternal death, retained fetal membranes, uterine prolapse, rectovaginal fistulae, perineal trauma

77
Q

Paraphimosis

A

inabiilty to redue the penis into prepuce

78
Q

priapism

A

erection in absence of sexual stimulation

79
Q

phallopexy

A

creating a permanent adhesion b/t the shaft of the penis and the dorsal or dorsolateral preputial mucosa

80
Q

High-flow priapism is more common than low-flow priapism. T/F

A

F - low flow more common

81
Q

Low-flow priapism carries a better prognosis than high flow priapism. T/F

A

F - low flow worse

82
Q

What are the proposed mechanisms for low-flow priapism (in men):

A
  1. failure of endothelin prod’n necessary for SM contraction
  2. inhibited alpha-adrenertid stimulation
  3. altered vascular endothelial cell fxn causing thrombosis
  4. altered intracellular metabolism of cofactors b/c of hypoxic and acidotic environment
  5. PDE 5A dysregulation of NO production
83
Q

The bulbus glandis is part of the corpus cavernosum in dogs. T/F

A

F - bulbus spongiosum

84
Q

What are general causes of pathologic oliguria?

A

Renal failure, increase FENa

85
Q

Features of physiologic oliguria

A

USG > 1.040, FENa < 1%

86
Q

Contributing mechanisms for oliguria in ATN

A
  1. Tubular cell apoptosis
  2. Tubular cell sloughing
  3. Alterations in tubular cell membrane polarity
  4. Loss of tight jxns
  5. Increased intracellular calcium
  6. obstruction of tubular lumens
  7. Inflammatory mediators
  8. Alterations in renal vascular tone
87
Q

Furosemide MOA

A

Inhibits Na-K-2Cl pump in thick ascending LoH

88
Q

Mannitol MOA with respect to oliguria

A

osmotic diuretic, free radical scavenger

89
Q

Fenoldopam MOA

A

DA-1 receptor antagonist

90
Q

The medullary osmotic gradient is created by:

A
  1. transport of salt w/o water into the medullary interstitium by the thick ascending limb
  2. low volume countercurrent blood flow in the vasa recta
  3. recycling of urea
91
Q

What is Renzhong?

A

GV26

92
Q

Fetal heart rates less than ___ require immediate intervention.

A

140-150

93
Q

T/F - Atropine is recommended for neonatal bradycardia.

A

F - no effect until day 14 puppies, day 11 kittens. Also hypoxia is most common cause of bradycardia in neonates to improve oxygenation and ventilation

94
Q

List safe antibiotics in neonates.

A 
cephalosporins
penicillins
clavulanic acid
macrolides
trimethoprim-sulfonamide
amikacin
95
Q

Surgical intervention required in ___% of dystocias

A

60-80

96
Q

Indications for c-section

A

fetal stress (HR <140-150), maternal abnormalities of birth canal, obstructive dystocia that cannot be manually corrected, inadequate response to medical mgmt, primary or secondary uterine inertia, suspicion of uterine torsion or rupture

97
Q

What are the most important components of anesthetic protocol for c-section?

A

time, uterine blood flow, ability to reverse agents in neonate

98
Q

What are advantages to flank approach for c-section?

A
  1. uterine horns easier to exteriorize
  2. reduces pressure on diaphragm
  3. reduces irritation to mammary glands
  4. Decreased chance of herniation or evisceration if sutures fail
99
Q

Disadvantages of flak approach c-section?

A
  1. Longer
  2. All abd muscles need to be closed separately
  3. inexperience
100
Q

How do you close the uterus after c-section?

A

2 layer: simple interrupted, then inverting Cushing with rapidly absorbable suture, bury all knots

101
Q

Reported survival in puppies/kittens from en bloc procedure?

A

75% puppies, 42% kittens

vs. 92% C-section

102
Q

When is en block removal of gravid uterus indicated?

A
  1. dam to be spayed and infectious material in uterus
  2. dam in critical condition (faster)
  3. litter known to be dead
103
Q

Lactation dependent on what hormones?

A

oxytocin and prolactin

104
Q

Where does relaxin come from?

A

placenta

105
Q

Oxytocin comes from where?

A

Hypothalamus, stored in posterior pituitary

106
Q

Effects of oxytocin?

A

labor contractions, milk ejection, NT that plays role in maternal behavior, also produced by large luteal cells of CL involved in luteolysis

107
Q

Causes of primary uterine inertia?

A

small litters, very large litters, hypocalcemia, obesity, uterine infection, uterine torsion, trauma, environmental

108
Q

Signs of fetal death on rads.

A

Skull overlap, gas, axial skeleton abnormalities

109
Q

Stages of labor

A
  1. inapparent uterine contractions and relaxation of uterus, nesting behavior (up to 4 h)
  2. fetal expulsion thru dilated cervix (30 min-2 h between puppies, 30-60 min b/t kittens)
  3. expulsion 0f fetal membranes
110
Q

Worwag, JAVMA 2008. What were negative prognostic indicators for survival in cats with AKI?

A

hypoalbuminemia, low bicarbonate, anuria or oliguria (all nonoliguric cats survived), hyperkalemia

111
Q

Worwag, JAVMA, 2008. What was the relationship between potassium on presentation and survival?

A

For every 1 mEq/L increase in K, there was 57% decrease in chance of survival

112
Q

Worwag, JAVMA, 2008. Creat, Phosphorus, AG, glucose, BUN on presentation were associated with survival likelihood. T/F

A

F - only prognostic variables albumin and bicarbonate

113
Q

Worwag, JAVMA, 2008. What was the most common cause of AKI in cats?

A

nephrotoxins (56%)

114
Q

Lee, JVECC, 2003. What % of blocked cats had hyperkalemia?

A

12%

115
Q

Lee, JVECC, 2003. What was * inversely correlated potassium?

A

pH, bicarbonate, pCO2, sodium, chloride, ionized calcium

116
Q

Lee, JVECC, 2003. What was * positively correlated with potassium?

A

BUN, creatinine

117
Q

Lee, JVECC, 2003. Ionized calcium was positively correlated with….

A

pH and bicarbonate

118
Q

Lee, JVECC, 2003. Of the cats with K>8 mmol/L, ___% had ionized calcium less than 1 mmol/L and ___% had pH <7.20

A

75%, 79%

119
Q

Mechanisms of hyperkalemia with UO.

A

cell loss of potassium exchange with hydrogen ions, retention due to decreased GFR, reabsorption from damaged bladder mucosa

120
Q

Acidemia normally causes higher ionized calcium. T/F

A

T

121
Q

Theories for ionized hypocalcemia with UO.

A
  1. chelation with Ph

2. impared action of PTH on calcium and synthesis of vit D

122
Q

RENAL, NEJM. Postdilution CVVHD with effluent flow of 40 ml/kg was superior to 25 ml/kg based on assessing mortality at 90 d. T/F

A

F - no difference b/t groups (6.8% survivors at 40, 4.44% survivors at 25)

123
Q

RENAL, NEJM. What electrolyte abnormality was more common in the higher intensity (40 ml/kg) group?

A

hypophosphatemia

124
Q

What is Kt/v?

A

dimensionless dialysis dose; K = urea clearance of dialyzer, t = duration of dialysis, v = volume of distribution of urea

125
Q

VA/NIH, NEJM 2008. What were the main findings?

A

No diff in mortality, renal recovery, rate of nonrenal organ failure between intensive vs. less intensive groups.

Suggest: outcomes not improved by providing IHD to hemodynamically stable patients more frequently than 3X per week with a target Kt/V 1.2-1.4, or providing CRRT to hemodynamically unstable patients at effluent flow rate of more than 20 ml/kg/hr

Hypophosphatemia and hypokalemia more common in intensive group

126
Q

What is 4 parameters define nephrotic syndrome?

A

proteinuria, hypoalbuminemia, hyperlipidemia, interstitial or third spacing

127
Q

Most common site for fluid accumulation in dogs with nephrotic syndrome?

A

peritoneal cavity (75%), then peripheral edema (60%)

128
Q

Theories for why hypercholesterolemia occurs with nephrotic syndrome.

A
  1. nonspecific upregulation of hepatic biosynthesis induced by hypoalbuminemia
  2. compensatory mechanism for low oncotic pressure
  3. compensatory mechanism for changes in blood viscosity
129
Q

What are the three theories for extravascular accumulation of fluid with NS.

A
  1. Underfill hypothesis
  2. Overfill or tubulointerstial inflammation hypothesis
  3. Vascular permeability hypothesis
130
Q

What does the underfill hypothesis say for NS?

A

Markedly low oncotic pressure from hypoalbuminemia causes net fluid flux out of vascular space faster than lymphatic system can reabsorb. Resultant hypovolemia and hypotension upregulate RAAS to distal nephron to reabsorb more sodium and water.

131
Q

What do the overfill and tubulointerstitial inflammation hypotheses say about NS?

A

Excessive tubular sodium reabsorption d/t primary or induced defect is teh primary cause of fluid accumulation in NS. Increase in apical ENaC in collecting duct (from proteinuria?). Comparatively, the T-I inflammation kids propose that ATII in situ by infiltrating leukocytes increases local aldosterone and secondary sodium reabsorption.

132
Q

What is the vascular hyperpermeability hypothesis for NS?

A

Fluid accumulation is due to an increase in endothelial cell permeability rather than an abnormality in Starling’s forces.

133
Q

T/F. Dogs with NS tend to be older than nonnephrotic dogs with glomerular dz.

A

F - they’re younger (6.2 y vs. 8.4 y)

134
Q

In dogs, what is the most common histopathologic diagnosis for NS?

A

membranous glomerulopathy > amyloidosis > membranoproliferative glomerulonephritis

135
Q

What are complications and consequences of NS?

A 
Azotemia
Hypernatremia
Hypertension
Hypercoagulability (venous thrombosis)
Hyperlipidemia
Secondary infections
136
Q

Complications reported with CRRT (Diehl, JVECC, 2008).

A 
Iatrogenic hypokalemia
Iatrogenic metabolic alkalosis
Clinical hypocalcemia
Total hypercalcemia
Filter clotting
Anemia
Hypothermia
Neurologic complications
137
Q

What are theoretical advantages of CRRT over IHD?

A
  1. Improved hemodynamic tolerance due to slower ultrafiltration
  2. Improved fluid balance
  3. Ability to provide unlimited nutrition
  4. Improved control of azotemia
  5. Improved control of e-lytes and AB derangements
138
Q

What causes ionized hypocalcemia, total hypercalcemia, and alkalosis in CRRT patients?

A

Anti-coagulant strategy. Citrate used to bind i-Ca to not clot filter, then the citrated-iCa sent back into patient, so patient develops ionized hypoCa and calcium supplemented via another catheter, when the citrated-iCa metabolized by liver –> bound iCa released and citrate metabolized to bicarbonate causing metabolic alkalosis

139
Q

What is the citrate gap?

A

Ratio between total calcium and ionized calcium

140
Q

Proposed VAKI staging system for dogs. JVECC 2011

A

0: Creat inc 0.3 mg/dl base
2: creat inc 200-200% base
3: creat inc >300% base OR absolute value of 4 mg/dL

141
Q

Findings from VAKI study, Thoen, JVECC, 2011.

A

VAKI stage 1-3 less likely to survive. No diff in SPI2 scores.

142
Q

When is PD not recommended or contraindicated?

A 
Severe coagulopathy
Peritoneal fibrosis or adhesions
Peritonitis
Vascular leak states
Severe hypoalbuminemia
Recent abd surgery
Hernias (DH, inguinal, abdominal)
143
Q

What are possible strategies for circuit anticoagulation during CRRT?

A

None, low dose prefilter heparin, medium dose prefilter heparin (5-10 U/kg/hr), full anticoagulation with heparin, regional prefilter heparin with post filter protamine, regional citrate, LMWH, prostacyclin prefilter, heparinoids in patients with heparin-induced thrombocytopenia, combo of prostacyclin with LD heparin

144
Q

MOA nephrotoxicity of cyclosporine and tacrolimus

A

afferent arteriolar vasoconstriction and interstitial nephropathy

145
Q

Most common triggers for AKI in human patients

A

sepsis/septic shock, major CV sx, cardiogenic shock, hypovolemia, major GI sx, drug toxicity, hepatorenal syndrome, obstructive uropathy

146
Q

Define ATN

A

development of persistent AKI from a prerenal insult

147
Q

Normal renal plasma flow in dogs vs. cats.

A

7-20 ml/min/kg dog

8-22 ml/min/kg cat

148
Q

Filtration fraction formula

A

FF = GFR/RPF

149
Q

Normal FF in dog vs. cats.

A
  1. 32-0.36 dog

0. 33-0.41 cat

150
Q

Results of PreCLOT study comparing heparin 3x/wk vs. heparin 2x/wk and tPA 1/wk at midpoint for dialysis catheters. NEJM, 2011

A
  1. Catheter malfunction heparin group 2X higher than hep/tPA
  2. Catheter related bacteremia 3X higher in heparin group compared to hep/tPA
  3. Risk of bleeding unchanged
151
Q

Lee, JVIM, 2012. Prognostic factors and prognostic index cats with AKI. Findings:

A
  1. temp, albumin, lactate used in prognostic index model to predict death (AUC 0.86) - nonsurvivors had lower body temp, albumin, and lactate; SN 77%, SP 90%
  2. BUN and creat not helpful for prognosis on admission, but decreasing 3 days was associated with survival.
  3. Nonsurvivors lower everything measured, higher age

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