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RUSVM Clinical Pathology > Renal Function > Flashcards

Renal Function Flashcards

(78 cards)

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1
Q

USG <1.007

A

Hyposthenuria

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2
Q

Markedly decreased urine production

A

Oliguria

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3
Q

No urine produced

A

Anuria

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4
Q

Straining to urinate

A

Stranguria

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5
Q

Increased frequency of urination

A

Pollakiuria

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6
Q

Increased urea nitrogen with/without increased creatinine

A

Azotemia

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7
Q

Excessive urea in blood with clinical signs of renal failure

A

Uremia

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8
Q

T/F: with the loss of nephrons, unaffected nephrons will compensate by hypertrophy of function

A

True

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9
Q

Where is BUN synthesized?

A

Liver

Proteins form the small intestine -> amino acids –> deaminated in the liver –> amine group is used to make urea -> blood -> filtered by the glomeruli and excreted

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10
Q

What can cause the BUN concentration to vary?

A

Production by the liver

Reabsorption

  • kidney
  • GI tract

Excretion

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11
Q

Is BUN a good marker of kidney function in ruminants ? Why or why not?

A

Nope

BUN excretes into saliva and rumen
Rumen microflora create amino acid
Urea is lost in creation of proteins

Results in a net protein gain and BUN loss

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12
Q

Increased BUN due to liver production is usually due to?

A

Upper GI bleed (stomach or proximal duodenum)

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13
Q

How is BUN increased by the kidney?

A

Decreased GFR

Renal resorption varies with rate of flow through tubules

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14
Q

If flow through the renal tubules is flow, what will occur to the serum BUN?

A

Increased

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15
Q

If there is a fast flow rate through the renal tubules, what will occur to the serum BUN”?

A

Decreased

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16
Q

What can caused decreased production of BUN by the liver?

A

Decreased aa delivery to liver

  • portosystemic shunt (PSS)
  • decreased protein in the diet

Hepatic insufficiency (80% loss)

Intestinal loss of proteins

  • monogastric species
  • cattle (lost through microbiota and loss in saliva)
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17
Q

What problems associated with the kidney cause a decreased BUN?

A

Decreased water resorption in proximal convoluted tubules

  • increased GFR
  • increased tubular flow
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18
Q

Where is creatinine produced?

A

Endogenous muscle catabolism
- creative phosphate
(Proportional to muscle mass)

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19
Q

T/F: creatinine is NOT reabsorbed by the kidney and is an excellent indicator of GFR

A

True

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20
Q

Will an old cat with muscle wasting have high OR low creatinine levels

A

Lower

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21
Q

If CREA is increased, what does it imply?

A

Decrease in GFR

Possibly altered nephron function

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22
Q

The concentration of BUN is dependent on ..

A. Dietary protein
B. Liver function
C. Glomerular filtration rate
D. Body condition

A

A
B
C

Not body condition because that is creatinine

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23
Q

What renal biomarker is released into circulation by all nucleated cells and is freely filtered by the glomerulus ?

A

Symmetric demethylarginine

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24
Q

You will see an increase in symmetric dimethylarginine with ___% loss of renal tubular function

A

40

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25
What is indicated if SDMA is increased but CREA is normal?
You must rule out all other causes of decreased GFR
26
For the kidney to concentrate and dilute urine, it requires ____% functional neurons
33
27
The function of the kidney to concentrate/dilute urine is depended on production/responsiveness to _________ and maintaining ___________
ADH (vasopressin) Medullary hypertonicity
28
How is urine specific gravity measured?
Refractometer
29
The higher the urine specific gravity, the more ________ the urine
Concentrated
30
Lower limit of USG in active concentration of urine in cat ?
1.035
31
Lower limit of USG with ability to concentrate urine in a dog?
1.030
32
Lower limit of USG where equine and ruminants are still concentrating urine?
1.025
33
T/F: USG should always be interpreted with hydration status
True
34
Polyuria occurs with loss of ______% of functional renal mass
66
35
You get azotemia with ____% loss of nephrons
75
36
What is azotemia?
Retention of nitrogenous waste products in blood
37
Categorize the azotemia.. Increased BUN Increased CREA Increased USG
Pre-renal
38
What are your two most common DDx for pre-renal azotemia?
Dehydration (decrease renal blood flow) | Upper GI bleed (increased urea production )
39
What 3 renal analyses affected by decreased GFR
BUN CREA SDMA
40
T/F: persistently decreased blood flow will cause renal damage
True
41
An increased production of urea can be due to?
Upper GI bleed Decreased rumen motility Endogenous protein catabolism Liver takes aa -> urea -> measured as BUN
42
What are pre-renal causes of increased creatinine
Increased muscle mass Neonatal foals -> dysfunctional prevent clearance of fetal CREA
43
# Define the azotemia... Increased BUN Increased CREA Decreased USG
Renal azotemia
44
In renal azotemia, what happens to the serum phosphorus levels
Increased
45
What are the causes of renal azotemia?
``` Infectious Toxin Hypoxia Neoplasia Congenital Hydronephrosis ```
46
What infectious agents can cause renal damage
Pyelonephritits | Leptospirosis
47
What toxins can cause renal damage
``` Ethylene glycol Drugs Grape Asiatic lilies Melamine ```
48
T/F: an animal with azotemia and polyuria is NOT always in renal failure
True
49
What other conditions can appear like renal failure?
Hypercalcium Diabetes insipidus Endocrine: cortisol or glucose Franconi syndrome
50
A post renal azotemia can be caused by?
Urolithiasis (castrated males) Trauma Feline lower urinary tract disease Uroabdomen (urine leaks into peritoneal cavity
51
What is the most likely cause of this azotemia.. Patient has tacky mucus membranes Increased BUN Increased CREA Increased USG Increased PCV Increased TP Increased Alb
Pre-renal azotemia -> dehydration
52
# Define the azotemia Increased BUN Increased CREA Low USG Straining to urinate Large turgid bladder
Post renal azotemia USG is variable in these cases-> looks to signalment and PE findings
53
Will phosphorous be increased or decreased in renal azotemia
Hyperphosphatemia -> when GFR drops below 25% of normal phosphorus excretion is impaired
54
Most animals with renal failure are _____calcemic
Normo Early/mid stages of renal failure
55
What are the mechanisms by which hypocalcemia develops in renal azotemia
Decreased renal tubular Ca resorption Decreased renal tubular production of vit D Hyperphosphatemia -> mineral depot
56
What occurs to PTH in renal azotemia?
Hyperparathyroidism -> hypocalcemia stimulates PTH production (mobilize Ca from bone)
57
In what species can you see hypercalcemia in renal azotemia?
Horse and cat | Usually chronic renal failure
58
What is the expected USG of a patient with hypercalcemia due to renal azotemia?
Hyposthenuric Calcium interferes with ADH receptors
59
In cats and cattle, what will occur to the levels of potassium in renal azotemia?
Hypokalemia Cats-> hypokalemic nephropathy
60
Hyperkalemia due to renal azotemia is caused by what mechanisms?
Oliguria/anuria (decreased excretion) -> end stage chronic renal failure or acute renal failure Metabolic acidosis -> hydrogen ions move intracellularly and potassium moves extracellularly
61
In most cases of renal failure, what are the levels of sodium and chloride?
Normal Chronic renal failure can sometimes cause hyponatremia and hypochloremia
62
Hyponatremia and hypochoremia are always a finding in _________
Uroabdomen
63
What is the mechanism by which you get metabolic acidosis in renal disese?
Increased urinary loss of bicarbonate Decreased tubular secretion of H+ Production of sulfate and phosphates - unmeasured anions - increased anion gap
64
The UA dipstick is best at detecting what protein?
Albumin
65
What are causes of physiological pre-renal proteinuria?
Hypertension Fever Seizure Strenuous exercise
66
What proteins can be increased in pre-renal proteinuria?
Hemoglobin Myoglobin Para-proteins (bence-jones)
67
Renal proteinuria can be due to what causes ?
Glomerulonephritis (damaged barrier) - Ag-Ab - amyloid Tubular proteinuria - acute renal disease - fanconi's syndrome
68
What would the urine protein : creatinine ratio be in a glomerulonephritis ?
UPCR > 1.0
69
If the UPCR is greater than 0.5 what is the cause of the proteinuria?
Tubular proteinuria Acute renal disease Fanconi's syndrome
70
What is the only time you will see hypoalbuminemia?
Glomerular proteinuria
71
A secondary globmerulonephropathy can be due to???
Chronic infectious disease Non-infectious inflammatory disease Neoplasm
72
What is the pathogenesis of glomerulonephropathy?
Renal glomerular damage -damage to podocytes (AgAb complex or amyloid deposits) Podocyte retraction Filtration of larger proteins Albumin -> hypoalbuminemia Antithrombin -> hypercoagulability
73
What is nephrotic syndrome?
Protein losing enteropathy that leads to abdominal effusion - proteinuria - hypoalbuminemia - abdominal effusion - hypercholesterolemia - hypercoaguable state
74
Acute renal failure can have what etiologies?
Toxicant (eg lilies or ethylene glycol) Renal ischemia Infection (lepto)
75
What is this ? Azotemia Hyperkalemia Acidemia Oliguria/anuria Proteinuria
Acute renal failure
76
What is the etilogy of chronic renal fialure in cats
Irreversible chronic interstitial fibrosis
77
Cat with.. Poor BCS Dehydration Polyuria Hypertensive ``` Non-regenerative anemia Azotemia Hyperphosphatemia Hypokalemia Metabolic acidosis ``` Polyuria Isosthenuria
Chronic renal failure
78
``` Abdominal effusion Serum electrolyte imbalances -azotemia (increased BUN) -hyperkalemia -hyponatremia -hypochloremia ```
Uroabdomen (Hyperkalemia and hyponatremia due to urine on serosal surfaces -> sodium moves out of abdominal cavity and potassium diffuses into the GI)

RUSVM Clinical Pathology (18 decks)

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