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Titi Pipi > Renal review papers > Flashcards

Renal review papers Flashcards

1
Q

test strip urine leucocytes

A

reliability of reagent strips for detecting leucocytes in equine urine is unknown.

does not detect lymphos but only granulom leuc

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2
Q

protein on urine dipstick?

A

poorly sensitive and poorly specific

dont use

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3
Q

which problems can result in acidic urine in adults?

is reagent strip testing relieable?

A
  • normal in foals
  • Metabolic acidosis,
  • proximal renal tubular acidosis and
  • paradoxically, hypochloraemic metabolic alkalosis
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4
Q

Bilirubinuria may represent

A

negative energy balance,

haemolysis,

hepatic disease or

post hepatic obstruction.

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5
Q

is crea sensitive for renal insuff?

A

Serum creatinine levels are not a sensitive measure of renal disease as approximately 75% of nephrons may be nonfunctional before increases in serum levels are observed

beware that crea conc in the blood is directly correlated with muscle % of the body

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6
Q

SDMA for dignosis of kidney patho?

A

not yet published evidence that SDMA levels can be used to diagnose renal disease in the horse

produced by all nucleated cells and directly associated with GFR

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7
Q

What are the three most common electrolyte derangements in chronic renl failure?

Why?

A

hypercalcaemia (67%) ->

. Horses absorb excessive amounts of dietary calcium across the intestinal tract -> urinary calcium excretion is reduced with chronic renal failure (nothing to do with PTH)

hyponatraemia (65%),

hyperkalaemia (56%)

when GFR is reduced below a certain threshold, potassium excretion is reduced by an alternative mechanism and circulating potassium levels increase

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8
Q

specific gravity?

A

hyposthenuric

iso: 1.008-1.014

hyper

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9
Q

which level of protein is normal in urine?

A

urine protein: creatinine ratio (UPC)

range of 0.03–0.93

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10
Q

does blood GGT influence urine GGT?

A

Circulating levels of this enzyme should not affect urinary GGT levels as this enzyme is not filtered by the glomerulus

ACHTUNG, nornmal indicator of tubular damage BUT

urinary levels may also be increased in the presence of glomerular damage

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11
Q

Normal GGT: Cr ratios

when is there a relevant elevation?

A

<25 IU/g

clinical relevance of GGT: Cr ratios between 25 and 100 IU/g Cr remains debatable.

happens f.e. with aminoglycosides

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12
Q

other enzymes currently studied to detect renal damage?

A

NGAL secreted by tubular cells

NAG: proximal tubular lysosomal enzyme

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13
Q

Normal equine urine is usually rich in which crystals?

A

calcium carbonate crystals #rund/oval

with calcium oxalate being common too #quadrat

occasionally others: calcium phosphate, struvite ( längliche vierecke) or hydroxyapatite

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14
Q

Which observations in urine sediment lead to suspicion of renal disease?

A
  • Granular casts (see in 10 magni)
  • renal tubular epithelial cells
  • > 8 leucocytes per high power field (40 magnification)
  • > 8 erys per ….
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15
Q

fractional excretion of electrolytes is a useful diagnostic tool in the identification of patients with

A

Fanconi’s syndrome

= rare tubule disfunction that results in excess EXCRETION of

POTASSIUM

glucose

bicarb

phosphates

case report of 2 QH

can not be cured but controlled

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16
Q

VAKI staging system.

A
  • Stage 0 : increase in sCr <150% from baseline
  • Stage 1 :
    • increase of 150%-199% or
    • sCr 0.3 mg/dL (≥26.5 μmol/L) from baseline
  • Stage 2 : increase from 200-299% from baseline
  • Stage 3 :
    • increase of ≥300% from baseline or
    • absolute sCr 4.0 mg/dL (>354 μmol/L)
17
Q

prevalence of hospital-acquired AKinjury

A

SAVAGE: 14.8% of 325 horses

presence of azotemia within 24 hours of admission or the development of an AKI while hospitalized

did not affect survival to discharge in this population of horses

18
Q

DD hematuria

A

Cystolith, Nephrolithiasis

Exercise-induced haematuria

Haemorrhagic cystitis

Idiopathic renal haematuria (arabians)

infection: pyelonephritis, lepto

neoplasia

19
Q

pyuria define

A

WBC of at least 10 WBCs/ mm3

or

<5 (some say 8) WBCs per high-powered field

20
Q

Difference of findings between horses with hemorrhagic cystitic and bladder neoplasia

A

Horses with bladder neoplasia

lower hematocrits,

older,

more likely to be female,

more likely to have a mass detected on ultrasonographic examination of the bladder

cystitis resolves after 3-8 weeks

21
Q

two main stimuli of thirst

A

increased plasma osmolality

hypovolemia/hypotension

22
Q

true or false?

stressed horses produce less vasopressin

A

FALSE

during stress: 10 fold INCREASE

23
Q

daily sodium requirement for a 500kg horse

A

6-12g

24
Q

effect of dopamine on kidneys

A

has been shown to increase

renal blood flow and urine output by 30%-190%

useful in AKI

25
Q

albumine does not got through glomerular filtration bc of

A

its negative charge

might leak in cases of meta acidosis

26
Q

what is GFR, how is it measured and how high is it in the horse?

A

volume of PLASMA filtered per time

gold standard: INULIN CLEARENCE , also radionucleotid clearance or Crea clearance

1,6-2ml/kg/min

GFR = CreaU:Crea blood) x urine flow

27
Q

proximal tubules reabsorp..

A

all glucose and AA

90% bicarb

70% Na

60% Cl

28
Q

what does loop of henle do?

A

maintain osmotic gradient in medulla

descending limb permeable for water (less electr)

ascending permeable for electrolytes (not water)

29
Q

serum osmolality is

A

260-300mOsm/kg

30
Q

if glucosuria in the absence of hyperglycemia one should suspect

A

prox tubular disfunction

fanconi syndrome

31
Q

prox tubular brush border associated encymes

A

ALP

GGT

32
Q

normal response to water deprivation test

are there alternative tests?

A

production of concentrated urine

typiclly > 1.045 after 24 hrs

hickey hare (hypertonic challenge)

vasopressin/desmopressin response

33
Q

indications for renal biopsies

A

remain controversial

risk: hematuria and perirenal hemmorrh

ONLY if result alters

  • therapeutic plan
  • prognosis
34
Q

can beta lactams an sulfonamides damage the kidney?

A

YES

acute interstitial nephritis

(often not recognised)

35
Q

the cause of glomerulonephritis is most often

A

immune mediated

give steroids

36
Q

what is the tubuloglomerular feedback?

A

mechanism that lowers GFR whenever NaCl concentration is increased at the macula densa

37
Q

endogenous pigments cause which type of renal filure?

A

pigmentary nephropathy

(tubular obstruction by heme proteins, radical formation and Fer)

38
Q

why does calcium protect against aminoglyc toxicity?

A

20mg/kg BID

Ca competitively inhibits aminoglycoside binding in prox conv tubule

39
Q

Treatment for diabetes insipidus?

A

subcutaneous injection of desmopressin acetate for over 5 years worked in one case report

Titi Pipi (4 decks)

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