Renal and Urinary Disease Flashcards by Adrienne Pesavento

Which is the least helpful indirect measure of GFR ?

Creatinine 
Cystatin C
Urea
Urine output
SDMA

Urea

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A dog with kidney disease has isosthenuric urine (USG 1.008-1.012) without azotemia. What percentage of the kidney is damaged?/

66%

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A dog has azotemia and inadequately concentrated urine (USG

Renal Failure
Hyperadrenocorticsm
Furosemide Treatment
Phenobarbitone

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What statement is incorrect?

Normal water intake is 60-80 ml/kg/d
Normal urine production is 1-2 ml/kg/hr
Oliguria is urine production

Normal urine SG is 1.007-1.015

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An owner brings in a free catch urine sample from a dog with a history of polyuria. The USG is 1.026, with no glucosuria. Name the most likely etiology

Lower UTI

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A 10 year old Maltipoo has PU/PD, with a USG=1.007. What is the most likely diagnosis?

Cushings

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A 6 year old Persian, FeLV positive, presents with PU/PD, bilateral renommegaly, irregular, painful kidney’s on palpation. What is the most likely DX?

PKD

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A 4 year old male Corgi presents with pigmenturia that occurs at the end of urination. Urinalysis confirms both Hguria and ghost RBC. The dog is proteinuric and azotemic. What is the most likely diagnosis?

Renal Pelvis

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Potential causes of hospital acquired AKI include all of the following except?

Radiocontrast agent
NSAID
Gentamycin
Leptospirosis
Septic Shock

Leptospirosis

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A 4 YO beagle presents to you clinic with anorexia. Biochemistry detects a mild azotemia and a BG of 7.5mmol/L (RI 3.3-5.5mmol/L) and blood gas detected a metabolic acidosis. Urinalysis has the following abnormalities, USG: 1.022, glucose 1+, protein 1+, sediment: RTE cells. What is the most likely problem?

Renal tubular acidosis

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What is not a feature of acute renal tubular injury?

renal tubular epithelial cells on sediment
Glucosuria 
Proteinuria
High fractional excretion of sodium 
Alkalosis

Alkalosis

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Humpty, a Tonkinese, 2 YO, MN, visits your clinic as the owner has read on the internet that tiger lilies are toxic and she saw Humpty chewing some leaves this morning. You run some biochemistry and UA screening tests but all the results are WNL. What is going on?

He is in the initiation phase of AKI

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Hansel, a 6 YO MN Bernese Mt dog, (50kg) arrives at you clinic. He is 10% dehydrated and azotemic. How much do you administer in the first 6 hours (dehydration & maintenance)

Replacement (dehydration) -10%= 5000mL
Maintenance: 44-66 ml/kg/d
Giant breed therefore choose 44ml/kg/d (1.8ml/kg/hr)
Therefore for 6 hours: 540mL 
5540mL

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You find out from the history that Hansel (50kg) drank ethylene glycol yesterday. You suspect AKD based on azotemia. Hansel is fully hydrated after 6 hours. you place an indwelling urinary catheter and he produces on average 20ml/hr. Hansel has?

Oliguria

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Hansel has oliguric renal failure. As
part of his fluid calculation plan, the
total insensible loss is:

22 ml/kg/d

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Hansel has been on 2 x maintenance for the last 12 hours but
gaining weight and no change in urine output (20 ml/hr). You
now decide to come up with a new fluid plan to prevent fluid
overload. The total IVF (crystalloids) that you administer is at the
rate of?

66 ml/hr

Insensible loss: 22 ml/kg/d (22x50/24hr =
45.83 ml/hr)
• Sensible loss: urine output: 20 ml/hr
• Ongoing loss: no V+/D+
• Total fluids/hr: 46 ml + 20 ml = 66 ml/hr

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You read on Gretel’s ICU sheet (BW:10 kg) that she is
producing 7 ml/hr of urine (closed collection bag).
Considering her ‘ins’ and ‘outs’ per hour i.e. what do
we set her drip rate at?

16 ml/hr

Insensible loss: 22 ml/kg/d
Gretel: 10 x 22 / 24 hr = 9.1 ml/hr
Urine output: 7 ml/hr
Ongoing loss: none recorded
Total fluid rate: ‘ins’: 9.1 + 7 = 16 ml/hr

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A dog with CKD, IRIS stage III and UPCR of 0.4, did
not have blood pressure measured. Which is the correct
classification?

A. IRIS III, NP, RND
B. IRIS III, BP, RND
C. IRIS III, BP, AP0
D. IRIS III, P, AP0

B. IRIS III, BP, RND

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What are prognosticators (independent or
dependent risk factors) for outcome in a cat or
dog diagnosed with CKD?

A. Creatinine
concentration
B. Phosphorous
C. Renal proteinuria
D. Blood pressure
E. Elevated BUN
F. Decreased Hg or PCV
G. Hypokalemia
H. Hypocalcemia
I. Vomiting

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A. Creatinine
concentration
B. Phosphorous
C. Renal proteinuria
D. Blood pressure
E. Elevated BUN
F. Decreased Hg or PCV

Renal diets have strong evidence to support their use
due to the benefits of prolonged survival.
When should you recommend starting a renal diet in a
cat with CKD?

A. In hospital
B. Stage I
C. Stage II
D. Stage III
E. Stage IV

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C. Stage II

A 12 yr, M(N) British shorthair, “Churchill”, is currently being
IRIS staged in your clinic. You submitted urine 48 hr prior to
IDEXX and the result returns as follows:, sediment: negative,
C&S: nil, UPCR is 0.5. What do you recommend?

A. This is proteinuria. Start ACEi
and ARI
B. Repeat the sample in 2 weeks
time to demonstrate persistent
proteinuria
C. Recommend an investigation
including an abdominal US
D. Ignore this proteinuria, it is
tubular and expected in a cat
with CKD

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B. Repeat the sample in 2 weeks
time to demonstrate persistent
proteinuria
C. Recommend an investigation
including an abdominal US

A WHWT diagnosed with CKD and BP. Blood pressure
(Systolic, Doppler, non-invasive) is 168 mmHg measured on 3
different occasions 30 min apart. There are no clinical signs
related to hypertension (TOD). What do you recommend

A. “Watch and wait”
B. Start ACEi
C. Start amlodipine
D. Hospitalize, restrict fluids,
induce with amlodipine
and then beta blockers if
necessary
“

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A. “Watch and wait”

A 5 year old male neutered Scottish terrier with IRIS III, BP, AP3
has persistent severe hypertension (190 mmHg) for 2 weeks with
no TOD. What is your first choice of antihypertensive agent?

A. Amlodipine
B. Benazepril
C. Propanolol
D. Hydralazine

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B. Benazepril

A 11 year old female Abyssinian with IRIS stage II, NP,
AP3 (persistent severe hypertension for 2 weeks). What
is your first choice of treatment?

A. Amlodipine
B. Benazepril
C. Propanolol
D. Furosemide

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A. Amlodipine

When ACEi Rx is started we repeat blood tests 3 days later to monitor for which laboratory change? ``` A. Rise in sodium concentration B. Rise in packed cell volume C. Rise in creatinine D. Rise in calcium ```

C. Rise in creatinine

Multiple myeloma and Bence-Jones proteinuria is an example of which category of proteinuria? A. Pre-renal B. Renal C. Post-renal D. Physiologic

A. Pre-renal

What would be a contra-indication for renal biopsy in the investigation of renal proteinuria? ``` A. Hypoalbuminemia B. A breed with familial history C. IRIS stage IV azotemia D. Hypertension ```

C. IRIS stage IV | azotemia

What is an example of immunecomplex glomerulonephritis ``` A. Shar pei amyloidosis B. X linked hereditary proteinuria in Samoyed C. Ehrlichiosis D. Alport syndrome in Cocker spaniels ```

C. Ehrlichiosis

The complications of a glomerulonephritis syndrome include all of the following except? ``` A. Hypertension B. Azotemia C. Hypoalbuminemia D. Hypocoagulable state ```

D. Hypocoagulable | state

You have diagnosed ICGN in a 5 year old dog with diabetes. What is the most appropriate therapy? ``` A. Prednisolone B. Mycophenolate mofetil C. Azathioprine D. Cyclosporin ```

B. Mycophenolate | mofetil

What immunosuppressive protocol is least desirable for ICGN ``` A. Prednisilone B. Mycophenolate mofetil C. Mycophenolate + Prednisilone D. Mycophenolate + azathioprine E. Mycophenolate + chlorambucil ```

A. Prednisilone

When is immunosuppressive therapy contraindicated ``` A. When the cause of proteinuria is not known B. If there is no kidney biopsy to support ICGN diagnosis C. If the patient is azotemic D. If the patient is hypoalbuminemic E. If the patient is hypertensive ```

A. When the cause of | proteinuria is not known

‘Peanut butter’, 7 year old MN DSH. Complaint: PuPd. On clinical examination you palpate one large kidney. The most likely differential is? A. Lymphoma B. Carcinoma C. Ureteral obstruction D. PKD

C. Ureteral obstruction

‘PB’ has an abdominal ultrasound. The LK has hydronephrosis and the RK is small and shrunken. PB is azotemic. You cant find a ureterolith. What is the best diagnostic test? ``` A. IVP with CT B. IVP with radiographs C. US guided pyelography D. Retrograde cystogram ```

C. US guided | pyelography

You confirm an obstruction midway down the ureter. ‘PB’ has been on fluids for 3 days, he has normal urine output but remains azotemic. The urinalysis from the pyelocentesis is normal. What treatment do you recommend ``` A. Watch and wait, ‘first do no harm’ B. Nephrectomy C. Ureteral stent D. Ureteral implantation E. Subcutaneous ureteral bypass (SUB) implantation ```

E. Subcutaneous ureteral bypass (SUB) implantation

‘Kintaro’ 4 year old M(N) DSH presented with a history of unproductive straining in the litter tray overnight. You palpate a large firm painful bladder. The owner wants to do everything she can for her little ‘Japanese hero’. What is the next most appropriate thing to do for Kintaro? ``` A. Sedate and attempt to ‘unblock’ the urethra B. Collect blood (Creat/BUN, electrolytes, acid base) measurement and start IVF C. Start with a Ca-gluconate infusion while ECG monitoring, as it is cardioprotective D. Warm Kintaro as hypothermia is associated with mortality ```

B. Collect blood (Creat/BUN, electrolytes, acid base) measurement and start IVF

‘Jelly bean’ a F(S) 3 year old Miniature schnauzer. Primary complaint: stranguria, pollakiuria. Cystocentesis confirms a UTI (bacteria and leukocytes with RBC) What do you recommend to the owner? ``` A. Start with cephalexin while waiting for C&S B. Radiograph and ultrasound of the abdomen C. Potassium citrate since she is a Min Schnauzer D. A prescription diet to prevent supersaturation and increase thirst due to high sodium content ```

A. Start with cephalexin while waiting for C&S B. Radiograph and ultrasound of the abdomen

A female (S) crossbreed, “Sunshine”, has a urine C&S, 7 days post 6 weeks course of Abx for a complicated UTI. The bacteria is E. coli with the same spectrum of sens. What is the diagnosis? A. Superinfection B. Relapse C. Reinfection D. Uncomplicated

B. Relapse

What do you recommend to “Sunshine’s” owner. ``` A. Repeat a 6 week course of Abx B. Rx for 6 months with urinary disinfectants C. Recommend MDB, radiographs and US of bladder D. Cranberry juice extract ```

C. Recommend MDB, radiographs and US of bladder

You investigate Sunshine and find she has a lower motor neuron disease causing urinary retention. What protocol do you recommend to control the relapse UTI? ``` A. Treat with full course Abx for 1 year B. Treat with 30-50% daily in morning for 6 months C. Treat with 30-50% of total dose daily in evening for 6 months D. Treat at 60% of dose daily for 3 months ```

C. Treat with 30-50% of total dose daily in evening for 6 months

A 12 month old, F(S) Shih tsu presents with stranguria, incontinence and hematuria. You treat with TMS for 14 days. 7 days later the clinical signs recur. What is the diagnosis? ``` A. Uroliths B. Complicated UTI C. Superinfection D. Cushing’s E. Ectopic ureters ```

B. Complicated UTI

An 8 year old M(N) Min Schnauzer presents with stranguria. Examine the radiograph and make the most likely diagnosis. ``` A. Cysteine B. CaOx C. Magn Ammonium Phosphate D. Urate ```

B. CaOx

Recommend Rx ``` A. Dietary dissolution with Abx B. Surgery C. Basket retrieval D. Urohydropulsion E. Mini-laparotomy cystotomy ```

E. Mini-laparotomy | cystotomy

Which is not a potential Rx option after surgery, considering there is a high recurrence rate? A. Thiazide diuretics B. Potassium citrate C. Acidifying diet

C. Acidifying diet

An 8 year old F(S) Shih tsu presents with stranguria and hematuria. Examine the radiograph and make the most likely diagnosis ``` A. Cysteine B. CaOx C. Magn Ammonium Phosphate D. Urate ```

C. Magn Ammonium | Phosphate

Recommend Rx ``` A. Dietary dissolution with Abx B. Surgery C. Basket retrieval D. Urohydropulsion E. Mini-laparotomy cystotomy ```

A. Dietary dissolution | with Abx

‘Benji’ 8 y.o. M(N) Golden retriever presents with a Hx of hematuria. Rectal examination detects a large, irregular, painless, asymmetrical prostate The most likely etiology is? ``` A. BPH B. Acute prostatitis C. Chronic prostatitis D. Prostatic abscesses E. Prostatic carcinoma ```

E. Prostatic carcinoma

Renal and Urinary Disease Flashcards

(47 cards)