SAM II Exam II Material - Urology Flashcards by Chris Bessette

Which is the least helpful indirect measure of GFR?

Creatinine
Cystatin C
Urea
Urine output

Urea

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A dog with proteinuria due to glomerular disease is considered to have which one of the following problems?

Renal failure
Renal disease
Azotemia
Uremia

Renal disease

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T/F: When proteinuria is demonstrated by a urine protein:creatinine ratio (UPCR), the etiology can be assumed to be glomerular in origin

False

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A dog 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 < 1.022) with dehydration. Select the potential differential diagnoses.

Renal failure
Hyperadrenocorticism
Furosemide treatment
Phenobarbitone

Renal failure
Hyperadrenocorticism
Furosemide treatment
Phenobarbitone

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Which 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 < 0.5 ml/kg/hr
Normal USG is 1.007‐1.015

Normal USG is 1.007‐1.015

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In cardiac disease we employ angiotensin converting enzyme inhibitors (ACEi). What effect will this have on the kidney?

Efferent vasodilator
Afferent vasodilator
Increase ultrafiltrate volume
Stimulate aldosterone and cause hypertension

Efferent vasodilator

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When ACEi Rx is started we repeat blood tests 3 days later to monitor for which laboratory change?

Rise in sodium concentration
Rise in packed cell volume
Rise in creatinine
Rise in calcium

Rise in creatinine

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A 6 year old Persian, FeLV positive, presents with PU/PD, bilateral renomegaly, irregular, painful kidneys on palpation. What is the most likely diagnosis?

Renal carcinoma
Lymphoma
PKD
Amyloidosis

PKD

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A 4 year old 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
Bladder
Lower urinary
Coagulopathy

Renal

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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 year old Beagle presents to your clinic with anorexia. Biochemistry detects mild azotemia and a BG of 7.5 mmol/l (RI 3.3 – 5.5 mmol/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?

Diabetic ketoacidosis
Renal tubular acidosis
Cushing’s syndrome with garbage disease
Acute on chronic kidney disease

Renal tubular acidosis

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Humpty, a Tonkinese, 2 year old, M(N) cat, visits your clinic as the owner has read on the internet that Tiger lilies are toxic and she saw Humpty chewing some leaves that morning. You run some biochemistry and UA screening tests but all the results are WNL. Which statement is correct?

He is in the initiation phase of AKD
He is in the extension phase of AKD
He is in the progression phase of AKD
It is unlikely that Humpty ingested the leave and there is no reason to worry

He is in the initiation phase of AKD

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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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A dog with an USG of 1.018 but no azotemia can be classified as having?

Renal failure
Renal insufficiency
Renal disease
Uremia

Renal insufficiency

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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?

IRIS III, NP, RND
IRIS III, BP, RND
IRIS III, BP, AP0
IRIS III, P, AP0

IRIS III, BP, RND

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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?

In hospital
Stage I
Stage II
Stage III
Stage IV

Stage II

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You diagnose hypertension in a dog with TOD from CKD (IRIS stage III, BP, AP3(C)). What therapy do you recommend at this stage?

Nothing yet, it must be repeatable
Benazepril (ACEi)
Telmisartan (ARI)
Amlodapine (Ca channel blocker)

Benazepril (ACEi)

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A dog with an USG of 1.018 but no azotemia can be classified as having?

Renal failure
Renal insufficiency
Renal disease
Uremia

Renal insufficiency

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Which biochemical abnormality is not associated with CKD?

High total Ca
Low ionized Ca
High K⁺
Low K⁺
High PO₄
High H⁺

High K⁺

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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?

IRIS III, NP, RND
IRIS III, BP, RND
IRIS III, BP, AP0
IRIS III, P, AP0

IRIS III, BP, RND

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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?

Amlodipine
Benazepril
Propanolol
Hydralazine

Benazepril

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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?

Amlodipine
Benazepril
Propanolol
Furosemide

Amlodipine

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Which is not a strategy for managing proteinuria?

Low protein diet
Telmesartan
Benazepril
Hydralazine

Hydralazine

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Multiple myeloma and Bence‐Jones proteinuria is an example of which category of proteinuria? * Pre‐renal * Renal * Post‐renal * Physiologic

**Pre‐renal**

What would be a contraindication for renal biopsy in the investigation of renal proteinuria? * Hypoalbuminemia * A breed with familial history * IRIS stage IV azotemia * Hypertension

**IRIS stage IV azotemia**

What is an example of immune‐complex glomerulonephritis? * Shar pei amyloidosis * X linked hereditary proteinuria in Samoyed * Ehrlichiosis * Alport syndrome in Cocker spaniels

**Ehrlichiosis**

The complications of a glomerulonephritis syndrome include all of the following except? * Hypertension * Azotemia * Hypoalbuminemia * Hypocoagulable state

**Hypocoagulable state**

Which is the most appropriate fluid to administer in a dog with PLN that is euvolemic? * Hypertonic saline * 0.9% saline * Ringer lactate * Hetastarch

**Hetastarch**

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

**Mycophenolate mofetil**

‘Peanut butter’, 7 year old MN DSH. Complaint: PU/PD. On clinical examination you palpate one large kidney. The most likely differential is? * Lymphoma * Carcinoma * Ureteral obstruction * PKD

**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? * IVP with CT * IVP with radiographs * US guided pyelography * Retrograde cystogram

**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 * Watch and wait, ‘first do no harm’ * Nephrectomy * Ureteral stent * Ureteral implantation * Subcutaneous ureteral bypass (SUB) implantation

**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? * Sedate and attempt to ‘unblock’ the urethra * Collect blood (Creat/BUN, electrolytes, acid base) measurement and start IVF * Start with a Ca‐gluconate infusion while ECG monitoring, as it is cardioprotective * Warm Kintaro as hypothermia is associated with mortality

**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? * Start with cephalexin while waiting for C&S * Radiograph and ultrasound of the abdomen * Potassium citrate since she is a Min Schnauzer * A prescription diet to prevent supersaturation and increase thirst due to high sodium content

**Radiograph and ultrasound of the abdomen**

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

**Relapse**

What immunosuppressive protocol is least desirable for ICGN? * Prednisolone * Mycophenolate mofetil * Mycophenolate + prednisolone * Mycophenolate + azathioprine * Mycophenolate + chlorambucil

**Prednisolone**

When is immunosuppressive therapy contraindicated? * When the cause of proteinuria is not known * If there is no kidney biopsy to support ICGN diagnosis * If the patient is azotemic * If the patient is hypoalbuminemic * If the patient is hypertensive

**When the cause of proteinuria is not known**

A female (S) crossbreed, ‘Sunshine,’ has a urine C&S, 7 days post 6 week course of Abx for a complicated UTI. The bacteria is E. coli with the same spectrum of sensitivity. You find she has a lower motor neuron disease causing urinary retention. What protocol do you recommend to control the relapse UTI? * Treat with full course antibiotics for 1 year * Treat with 30-50% daily in morning for 6 months * Treat with 30-50% of total dose daily in evening for 6 months * Treat at 60% of dose for 3 months

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

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

**Complicated UTI**

An 8 year old M(N) min schnauzer presents with stranguria. Examine the radiograph and make the most likely diagnosis: * Cysteine * CaOx * Magn ammonium phosphate * Urate

**CaOx**

An 8 year old M(N) min schnauzer presents with stranguria. You diagnose calcium oxalate. What is your recommended treatment? * Dietary dissolution with antibiotics * Surgery * Basket retrieval * Urohydropulsion * Mini-laparotomy cystotomy

**Mini-laparotomy cystotomy**

An 8 year old F(S) Shih Tzu presents with stranguria and hematuria. Examine the radiograph and make the most likely diagnosis: * Cysteine * CaOx * Magn Ammonium Phosphate * Urate

**Magn Ammonium Phosphate**

An 8 year old F(S) Shih Tzu presents with stranguria and hematuria. You diagnose magn ammonium phosphate. What is your recommended treatment? * Dietary dissolution with antibiotics * Surgery * Basket retrieval * Urohydropulsion * Mini-laparotomy cystotomy

**Dietary dissolution with antibiotics**

‘Benji,’ 8 year old M(N) Golden Retriever presents with a history of hematuria. Rectal examination detects a large, irregular, painless, asymmetrical prostate. What is the most likely etiology? * Benign prostatic hyperplasia (BPH) * Acute prostatitis * Chronic prostatitis * Prostatic abscess * Prostatic carcinoma

**Prostatic carcinoma**

A dog presents with a 24 hour history of weakness and anorexia. Clinical exam: pale mm and tachycardia. The owner complaint is red urine. Hematology detects a moderate anemia (PCV 25%), non-regenerative, normocytic, normochromic. The serum is red discolored. What is your likely diagnosis? * Intravascular hemolytic anemia * Bone marrow destruction * Blood loss anemia * Extravascular hemolysis

**Intravascular hemolytic anemia**

Hansel, a 6 year old, M(N) Bernese mountain dog (50 kg) arrives at your clinic. He is 10% dehydrated and azotemic. How much fluid do you administer in the first 6 hours? * 1500 mL * 2200 mL * 5550 mL * 8500 mL

**5550 mL** * Replacement (dehydration) - 10% = 5000 mL * Maintenance: 44-66 mL/kg/day = 540 mL * 5000 mL + 540 mL = 5540 mL

Hansel, a 6 year old, M(N) Bernese mountain dog (50 kg) arrives at your clinic. He is 10% dehydrated and azotemic. You find out from the history that Hansel (50 kg) drank ethylene glycol yesterday. You suspect AKD based on azotemia. Hansel is fully hydrated after 6 hours. You place an indwelling catheter and he produces on average 20 mL/hr. Hansel has? * Polyuria * Oliguria * Anuria

**Oliguria**

What are prognosticators (independent or dependent risk factors) for outcome in a cat or dog diagnosed with CKD? * Creatinine concentration * Phosphorous * Renal proteinuria * Blood pressure * Elevated BUN * Decreased Hg or PCV * Hypokalemia * Hypocalcemia * Vomiting

* **Creatinine concentration** * **Phosphorous** * **Renal proteinuria** * **Blood pressure** * **Elevated BUN** * **Decreased Hg or PCV**

A 12 year old M(N) British shorthair, “Churchill,” is currently being IRIS staged in your clinic. You submitted urine 48 hours prior to IDEXX and the result returns as follows: sediment: negative, C&S: nil, UPCR is 0.5. What do you recommend? * This is proteinuria. Start ACEi and ARI * Repeat the sample in 2 weeks time to demonstrate persistent proteinuria * Recommend an investigation including an abdominal US * Ignore this proteinuria, it is tubular and expected in a cat with CKD

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

There must be \>\_\_\_% kidney damage before **creatinine** is elevated

**75%** *There must be **_\>75%_** kidney damage before creatinine is elevated*

What are the four phases of **acute renal failure**?

1. **Initial phase** 2. **Extension phase** 3. **Maintenance phase** 4. **Recovery phase**

**Oliguria** is present when there is less than ____ mL/kg/hr of urine production

Oliguria is present when there is less than **_0.5 mL/kg/hr_** of urine production

A 3-year old female spayed Yorkie has lower urinary tract disease signs and a normal physical exam. Urinalysis on urine obtained by cystocentesis shows abundant bacterial cocci, WBCs and epithelial cells. What is the best course of action? * Antibiotic treatment started and reassessed with pending sensitivity results * Antibiotic treatment delayed until culture and sensitivity results are available * Broad spectrum antibiotic and do not submit for urine culture and sensitivity * Cranberry extract supplement and increase water intake

**Antibiotic treatment started and reassessed with pending sensitivity results**

You are treating an anuric renal failure dog. Which statement best describes your fluid therapy plan? * Do not give fluids until dog becomes oliguric * Provide replacement fluids and then no further fluids until urine is formed * Provide replacement fluids and then consider diuretic therapy * Start maintenance fluid therapy

**Provide replacement fluids and then consider diuretic therapy**

A mature female dog presents for voiding urine on her dog bed in her sleep. A urinalysis is unremarkable. What is the most likely diagnosis?

**urethral sphincter incompetence**

A male cat presents with lower urinary tract obstruction. What is the most likely cause of obstruction? * Bacterial cystitis * Crystalluria * Idiopathic * Urolithiasis

**Idiopathic**

A female cat presents with inappropriate urination. Her physical examination is unremarkable. What test do you perform first? * Abdominal radiographs * Complete blood count and serum biochemistry profile * Urinalysis * Urine culture

**Urinalysis**

A 7- year old male neutered beagle is found to have 3+ proteinuria on pre-anesthetic evaluation. Further work up shows no cells or debris on urine sediment analysis, negative urine culture and marked elevation of the urine protein: creatinine ratio. What is the diagnosis? * Liver insufficiency * Glomerulonephropathy * Chronic renal failure * Lower urinary tract disease

**Glomerulonephropathy**

In a neutered male dog with pollakiuria and hematuria with a normal physical examination, a urinalysis is recommended. Which of the following techniques and justifications is best with regards to how you should obtain the urine sample? * Catheterize to obtain sample while assessing urethra patency * Cystocentesis to obtain a sterile sample * Free catch sample to assess prostate * Manually express bladder to assess patency of urethra

**Catheterize to obtain sample while assessing urethra patency**

A 10-year old neutered male dog presents with pollakiuria. Which of the following is a possible differential diagnosis? * Renal failure * Struvite crystalluria * Ureteroliths * Urethral calculi

**Urethral calculi**

This classification system uses creatinine concentration in a normally hydrated animal as estimate for degree of decline of GFR:

**IRIS classification** *Only applies in chronic disease where creatinine is reasonably stable*

\_\_\_\_\_\_\_\_ are primary route of phosphate excretion

**kidneys** *Reduced renal function results in phosphate retention* ***Hyperphosphatemia is a hallmark of stage III and IV kidney disease***

Abnormal increase in the concentration of non‐protein nitrogenous wastes (e.g. urea and creatinine) in blood is termed:

**azotemia** * Azotemia is either prerenal (perfusion), renal (parenchymal) or postrenal (obstructive)* * Azotemia ≠ uremia*

What is the **gold standard** technique for measuring glomerular function?

**renal scintigraphy** * This is the only technique that will allow individualized glomerular filtration (you can tell which kidney is f\*\*\*ed)* * Most clinics won't have this as an option, so we usually use UREA to measure glomerular filtration*

T/F: Urea clearance is a reliable estimate of GFR

**False** *But it is helpful in determining treatment*

T/F: In geriatric patients, creatinine is **NOT** a very good index of kidney failure

**TRUE** *Especially if the patient has lost muscle mass*

Which is a better indicator of GFR: **creatinine** or **urea**?

**creatinine**

This is a small polypeptide protease inhibitor that is freely filtered by the glomeruli and is produced at a constant rate in all tissues. Its excretion is not dependent on age, sex, or diet.

**Cystatin C** *Tests GFR*

T/F: **SDMA** is able to detect kidney disease up to 17 months earlier in cats and 9 months earlier in dogs than creatinine, but it is heavily impacted by extrarenal factors and lean body mass

**False** ***SDMA** is able to detect kidney disease up to 17 months earlier in cats and 9 months earlier in dogs than creatinine, _and it is not heavily impacted by extrarenal factors and lean body mass_*

T/F: **Dipstick analysis** is the gold standard for measuring urine concentration

**False** * *Gold standard is osmolality (U_osm)* * *This is a measure of the number of particles in a solution.* * *In practice we use specific gravity*

Isosthenuria corresponds to a USG of ________ to \_\_\_\_\_\_\_\_

**1.008 - 1.012**

painful or difficult urination is termed:

**dysuria**

T/F: Signs of **dysuria** are commonly seen with renal hematuria

**False** *Unless concurrent lower urinary tract disease*

Is **renal carcinoma** more common in dogs or cats?

**dogs**

Is **renal lymphoma** more common in dogs or cats?

**cats**

T/F: multi-agent chemotherapy is indicated in the treatment of **renal lymphoma** and **renal carcinoma**

**FALSE** * **renal lymphoma** responds to chemotherapy * **renal carcinoma** does not (only treatment is nephrectomy)

The leading cause of **acute renal failure** in cats:

**hydronephrosis**

Polycystic kidney disease is the result of a mutation to the ________ gene

**PKD-1** *Autosomal dominant; Genetic test available*

T/F: The term **acute kidney injury** infers reversibility

**True** *Acute kidney injury (AKI) encompasses mild damage, that does not cause azotemia, to severe damage, associated with complete anuria. The cause can be pre-renal, intrinsic renal or post- renal. The term infers reversibility*

What etiology for **acute renal injury** is characterized by reduced fractional excretion of sodium?

**pre-renal** * Insufficient blood flow to the kidneys including hypoxia, ischemia, dehydration, hypovolemia, hypotension, decreased effective circulatory volume, anesthesia, hypoadrenocorticism, trauma, surgery, shock, heatstroke, hypoalbuminemia, hypoperfusion (PGE inhibitors from NSAIDs)* * Can be rapidly reversed if underlying cause is corrected*

At what phase of acute renal failure does urine become isosthenuric?

**maintenance phase**

What are two contraindications for the use of **mannitol** in acute renal failure?

**anuria** (*failure to produce urine*) and **dehydration** ## Footnote *Mannitol increases solute excretion and decreases cellular swelling*

**Furosemide** increases urine production without increasing GFR. Output should increase within ________ minutes after administration

**_2-60 minutes_** * *Those that respond most likely have less severe renal damage* * *Benefit, it is easier to manage a non-oliguric than oliguric patient* * *MOA: Na-K-2Cl channel pump inhibitor, decreasing transcellular Na secretion* * *Side effects: ototoxicity*

What is the MOA of **calcium channel blockers** in treatment for acute renal failure?

**pre-glomerular vasodilation** * *Prevent Ca moving intracellularly* * *Used in post-transplant as renoprotective* * *Standard of care in _leptospirosis_*

What is the first step when investigating a cat with chronic kidney disease?

**Blood pressure** *Do this before doing anything else so your blood pressure measurement isn't taken after stressing the cat out*

T/F: Based on IRIS classification of chronic kidney disease, an animal at **Stage 1** has a mild renal azotemia and clinical signs are usually mild to absent

**False** * Based on IRIS classification of CKD, an animal at _**Stage 1** is non-azotemic_* * An animal at _**Stage 2** has a mild renal azotemia and clinical signs are usually mild to absent_*

What blood creatinine value is associated with **Stage 3 CKD** (IRIS CKD Classification)?

**2.1 - 5.0**

Based on IRIS classification for chronic kidney disease, what UP/C value corresponds with a **proteinuric (P)** substage in dogs? Cats?

**\> 0.5 in dogs, \>0.4 in cats**

Based on IRIS classification for risk of target organ damage, what blood pressure reading is the cutoff for hypertension?

**\>180mmHg in dogs**

The most important nephrotoxin in a dog or cat with chronic kidney disease is:

**PTH** *An increase in parathyroid hormone with progressive increases in phosphorous is the reason dogs and cats become so sick with CKD*

What is the #1 treatment consideration for animals with **CKD**?

**DIET** ## Footnote *The goal is to correct the hyperphosphatemia (occurs due to Vit D3 abnormalities)*

What are the general laboratory findings seen with chronic renal failure?

**azotemia combined with an inappropriately low USG**

Why do we bother staging **CKD**?

* **Goals of management change** * *Stage 1 - ID primary disease and start specific therapy to eliminate the disease if possible* * *Stage 2 and 3 - renoprotective therapy to try and slow progression* * *Late Stage 3 and Stage 4 - symptomatic therapy* * **Prognostic guide** * **Useful in research**

Cat presents with low BCS, small knobby kidneys, low USG, what is the diagnosis?

**chronic renal failure**

At what stage of CKD do we expect to see **hyperphosphatemia**?

**Stage III and Stage IV** * *In Stages I and II, compensatory mechanisms lead to increased phosphate loss from surviving nephrons* * *Phosphate rarely increased*

T/F: **Proteinuria** increases risk of developing end-stage CKD in both dogs and cats

**True**

What is the preferred **ACE inhibitor** for treating hypertension in dogs with CKD?

**Benazepril** *Benazepril is liver excreted. Enalapril is kidney-excreted*

What is the preferred treatment for hypertension in cats with **CKD**?

**Amlodipine** * calcium channel blocker* * \*\*Fun fact - absorption of Amlodipine is just as good rectally as it is orally. So if your cat is super hypertensive and you don't want to restrain it around the neck, etc... just pop the Amlodipine up its butt.* * Damn cat will never see it coming.*

T/F: In general, **hypertension** is much harder to control in dogs than in cats

**True**

When controlling hypertension in dogs with CKD, if an ACE inhibitor is not giving you the response that you want, you can add on an **angiotensin receptor blocker**. Name the angiotensin receptor blocker that is used in this scenario:

**Telmisartan**

When treating hypokalemia in cats with CKD, what is the best route for supplementing potassium?

**oral**

T/F: In cats with **Stage II CKD**, the MST is about 3 years, but can be up to 8.5 years

**True** *In cats with Stage IV CKD, MST is ~35 days*

Urine dipstick is more sensitive to ________ than to other proteins

**albumin**

What is the **gold standard** test for quantifying proteinuria?

**24 hour urine protein measurement** *Difficult, so not used clinically. Instead, we use the urine protein:creatinine ratio, which correlates well with the 24-hour urine protein excretion*

If inflammation has been excluded and your patient has a urine protein:creatinine ratio \>8, what is the most likely diagnosis?

**amyloidosis**

**Nephrotic Syndrome** is a group of findings which include:

* **Proteinura** * **Hy**_po_**albuminemia** * **Ascites/edema** * **Hy**_per_**cholesterolemia**

T/F: **Immunosuppressive treatment** may be indicated if proteinuria has been confirmed to be glomerular in origin and a biopsy has confirmed ICGN

**True** *immunosuppressive therapy is contraindicated with pancreatitis, bone marrow suppression, diabetes mellitus etc*

When choosing an **immunosuppressive agent** for treatment of proteinuria, ________ is recommended as the first choice

**mycophenolate** *rapid onset of action, low rate of adverse drug reaction, but may cause vomiting*

The #1 cause of uremia in cats in North America is:

**ureteral obstruction** *STONES (most commonly calcium oxalate)*

This common presentation is seen in cats with a **past unilateral ureteral obstruction that has caused the kidney to progress to a fibrotic end-stage**. Subsequently, the **contralateral, hypertrophied kidney becomes acutely obstructed** by a ureterolith causing further enlargement and characteristic renal asymmetry,

**Big Kidney-Little Kidney Syndrome** *This common presentation is seen in cats with a past unilateral ureteral obstruction that has caused the kidney to progress to a fibrotic end-stage. Subsequently, the contralateral, hypertrophied kidney becomes acutely obstructed by a ureterolith causing further enlargement and characteristic renal asymmetry, abdominal pain, progressive severe azotemia, and variable urine production. Prognosis is good if the obstruction is alleviated because adequate renal mass persists, but reoccurrence in the big kidney is common*

When investigating azotemia or any ureteral obstruction in the cat, it is crucial to combine *what two diagnostic modalities*?

**radiographs and ultrasound**

**\_\_\_\_\_\_\_\_\_\_** and **\_\_\_\_\_\_\_\_\_\_** are the principal ultrasonographic features of **ureteral obstruction**

**Hydronephrosis** and **dilation of the proximal ureter** are the principal ultrasonographic features of ureteral obstruction

A patient presents to you with an elevated BUN and creatinine. USG is 1.040 and the patient is eating and drinking normally. Where do you classify this patient? * Renal failure * Renal disease * Azotemia * Uremia

**Azotemia**

Chester, a 13 year old, MN DSH presents to you looking rough and vomiting for the past week. You palpated bilaterally small, firm kidneys. What else would you expect on this History and PE? * Pale MM * Positive skin tent * Oralulceration * PU/PD * All of the above

**All of the above**

T/F: **Glomerular protein loss** tends to cause the most significant proteinuria

**True**

Wrinkles, a 5 year old FS Shar pei presents to you with a history of PUPD. You perform a urinalysis which indicates a significant proteinuria, USG= 1.020 and no other significant findings. You suspect she has glomerulonephritis secondary to amyloidosis. How do you confirm? * Bloodwork * Abdominal ultrasound * Renal biopsy * Cheek swab

**Renal biopsy**

Which of the following is _not_ a treatment option for a cat with a unilateral ureteral stone blockage? * Fluids and time * Electrocorporeal shockwave lithotripsy * SUB * Stent

**Electrocorporeal shockwave lithotripsy** * *Poor choice for cats* * *Resistant to fragmentation* * *Particles too large for 0.4 mm diameter lumen to pass*

T/F: Environmental enrichment is the only evidence based medicine shown to be beneficial in preventing FLUTD

**True**

What is the current **standard of care** for treatment of ureteral obstructions?

**SUB** * Subcutaneous Ureteral Bypass System* * The development of an indwelling ureteral bypass using a combination locking-loop nephrostomy/cystostomy tube*

Lord Crackers, a year old MN DSH presents to you for a 2 hour history of straining in the litterbox. You palpate an enlarged painful bladder on PE. You talk with the owner and they want to proceed with all diagnostics and therapies. What’s your next move?

**IV FLUIDS**

Shit, what happened?

**Urethral rupture**

T/F: Dogs that are neutered are at higher risk of developing **prostatic carcinoma** than intact male dogs

**TRUE**

What is the most common bacteria associated with **lower urinary tract disease**?

***E. coli***

T/F: Most cases of **lower urinary tract infection** are caused by a single species

**True** * *Occasionally two or more organisms* * *Route of infection:* * ***_Ascending most common_*** * *Hematogenous uncommon*

Identify.

**Struvite** * *Magnesium ammonium phosphate hexahydrate* * *Mainly lower urinary tract, occasionally upper* * *Radiodense but not as dense as CaOx* * *Struvite Therapy* * *Dietary (target pH as acid, USG dilute)* * *Infection (antimicrobials during calculolytic diets)* * *Note risk of inducing CaOx calculi on preventative diets*

Identify.

**Calcium Oxalate** * *Radio-opaque, small stones* * *More common in male dogs* * *Spiny, rarely cause obstruction* * *In Miniature Schnauzers, these are due to decreased amounts of citrate in the urine* * *Treatment* * *Therapy for hypercalcemia* * *Surgical/lithotripsy/cystoscopy* * *Prevention* * *Diet, Thiazide diuretics, Potassium citrate, Vitamins*

Name the radiological study:

**double contrast**

What is the gold standard for diagnosing **Feline interstitial cystitis**?

**cystoscopy** * *Feline Idiopathic Cystitis* * *Altered urinary glycosaminoglycan excretion* * *Increased ion leakage across urothelium* * *Sympathetic nervous system abnormalities and C-pain fibres* * *Hypothalamic pituitary adrenal axis abnormalities* * *Viral etiology*

What is the most common etiology associated with **urinary incontinence**?

**urinary sphincter mechanism incompetence (SMI)**

What is the treatment of choice for **ectopic ureter**?

**Cystoscopic laser ablation**

Normal **USG** in a dog?

**1.020 - 1.040**

What is the main cause of chronic kidney disease?

**Chronic interstitial nephritis**