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Urinary Pathophysiology > Urinalysis part 2 > Flashcards

Urinalysis part 2 Flashcards

1
Q

what does hemoglobin bound to haptoglobulin cause?

A

hemolyzed plasma

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2
Q

where does excess unbound hemoglobin go?

A

urine
+/- hemoglobin casts
+/- damage to proximal tubular cells

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3
Q

what happens with acute syndrome of copper toxicity in sheep?

A

bolus of excessive amounts: feed/pastures
severe gastroenteritis and then hemolysis

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4
Q

what happens in chronic syndrome of copper toxicity in sheep?

A

days to weeks: low molybdenum/sulfur intake and/or hepatotoxic plants
precipitating stressors lead to disease

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5
Q

what do horses and camelids need to ingest to get red maple toxicosis?

A

wilted leaves of Acer rubrum

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6
Q

what does copper and red maple leaves cause to red blood cells?

A

oxidative injury
methemogloninemia
intravascular hemolysis due to oxidation
Heinz bodies due to denaturation of oxidized hemoglobin: extravascular hemolysis

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7
Q

what is a common cause of hemolysis in dogs?

A

zinc toxicity

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8
Q

what does zinc cause in dogs?

A

oxidation through inhibition of protective enzymes
possible multi-organ damage

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9
Q

what are some causes of intravascular hemolysis other than heavy metals and red maple?

A

infectious disease
immune mediated
red blood cell metabolic defects
envenomation

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10
Q

what is rhabdomyolysis?

A

muscle necrosis

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11
Q

what can be seen with rhabdomyolysis?

A

muscle enzymes elevated in serum: creatine kinase and AST

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12
Q

is anemia and hemolytic serum present with rhabdomyolysis?

A

not usually

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13
Q

in whom is pigment nephropathy common in?

A

large animals

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14
Q

what causes pigment nephropathy?

A

hemoglobin and myoglobin being broken down
nephrotoxic heme protein

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15
Q

what are the mechanisms of pigment nephropathy?

A

tubular obstruction by casts
tubular cells ingest hemoglobin
increased synthesis of vasoconstrictive molecules

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16
Q

_____________ can be toxic to renal tubules- cause of AKI
especially in humans and large animals

A

myoglobin

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17
Q

your patient has a positive heme (blood) reaction and red blood cells in the sediment. what is the best interpretation for these findings?

A

hemorrhage in the urinary tract
artifact if did cystocentesis (hit capillary)

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18
Q

your patient has a positive heme (blood) reaction, but there are no red blood cells in the sediment. what is the best interpretation for these findings?

A

skeletal muscle necrosis and myoglobinuria
intravascular hemolysis (red blood cells breaking down within blood vessels) and hemoglobinuria

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19
Q

where does bilirubin originate from?

A

destruction of old worn-out red blood cells by macrophages in the spleen

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20
Q

only _____________ bilirubin can cross the glomerular wall

A

conjugated

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21
Q

why can unconjugated bilirubin not cross the glomerular wall?

A

bound to albumin: too large
albumin already too large to cross

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22
Q

is bilirubin normal to have in the urine of most species?

A

no

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23
Q

in what species is some bilirubin normal in the urine? what amount?

A

dogs and ferrets with highly concentrated urine
trace to 1+

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24
Q

renal epithelium in ____________ can conjugate bilirubin

A

male dogs

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25
what are some causes of bilirubinuria?
hemolysis hepatic disease bile duct obstruction
26
what does extravascular hemolysis (increased rate) lead to?
anemia bilirubinuria jaundice icteric serum
27
what is the rate-limiting step of elimination of bilirubin?
gall bladder excreting conjugated bilirubin
28
what does increased intravascular hemolysis lead to?
anemia bilirubinuria jaundice increased bilirubin hemoglobinuria hemolyzed serum
29
what does hepatic disease lead to?
bilirubinuria jaundice icteric serum increased liver enzymes
30
what does biliary obstruction lead to?
bilirubinuria jaundice icteric serum increased liver enzymes
31
what in hepatic disease actually leads to accumulation of bilirubin?
excretion: conjugated (by liver) bilirubin accumulates
32
most glucose is absorbed in _______________
proximal tubules
33
when will you see glucosuria?
serum glucose exceeds renal threshold
34
what is the renal threshold for serum glucose for most species?
180 mg/dl
35
what are some things that can cause hyperglycemia that leads to glucosuria?
diabetes mellitus hyperadrenocorticism epinephrine secretion
36
what are some things that can cause the proximal tubule to be unable to handle the normal load of glucose?
acute renal failure congenital proximal tubular disorders
37
what breeds are predisposed to hereditary renal glucosuria?
norwegian elkhounds scottish terriers
38
what does hereditary renal glucosuria cause?
defective proximal tubular transport of glucose
39
what is fanconi syndrome caused by?
defect in multiple proximal tubule transporters
40
is GFR normal in fanconi syndrome?
yes: not usually azotemic
41
in fanconi syndrome, animals have high excretion of:
glucose amino acids bicarbonate electrolytes (Na, Cl, K, Phos)
42
who is hereditary fanconi syndrome common in?
basenjis
43
what is the urine like with fanconi syndrome?
glucosuria with normoglyemia, +/- proteinuria, ketonuria isosthenuric to minimally concentrated
44
what can cause acquired fanconi syndrome?
chicken jerky treats heavy metals copper storage chemicals
45
what leads to cystinuria?
sex-linked or autosomal recessive defect in cysteine transport
46
what causes hyperuricosuria?
missing transporter for uric acid uptake: liver, kidney
47
what does hyperuricosuria lead to?
urate crystals in urine
48
what is ketonuria caused by?
negative energy balance
49
what are some conditions that can lead to negative energy balance?
bovine ketosis and hypoglycemia pregnancy toxemia diabetes mellitus starvation
50
what do the urine tests for ketonuria detect?
acetoacetic acid also some for beta-hydroxybutyric acid
51
what does the proximal tubule of the kidney do for acid/base regulation?
NaBicarbonate absorbed in proximal tubule: carbonic anhydrase needed
52
what do alpha intercalated cells in the collecting duct and distal convoluted tubule do to the blood and urine (overall)?
alkalinize blood acidify urine
53
what are some causes of aciduria?
diet: normal in carnivores acidosis hypokalemia (associated with alkalosis)
54
hypochloremic metabolic alkalosis can be associated with ________________________
paradoxic aciduria
55
hypochloremic metabolic alkalosis starts with loss/sequesteration of gastric fluid, which leads to:
dehydration alkalosis hypochloremia hyponatremia hypokalemia
56
what are some causes of alkalinuria?
diet: normal in herbivores urease producing bacteria post-prandial alkalosis storage at room temperature
57
what are the clinically important urease-producing pathogens?
Staphylococcus Klebsiella Pseudomonas Proteus
58
how do the kidney proximal tubules respond to dehydration?
increases absorption of Na and water Na co-transported with HCO3- worsens alkalemia, acidifies urine
59
what makes up distal renal tubular acidosis- type I?
selective impairment of H+ secretion in collecting ducts
60
why is it a problem that tubular cells ingest hemoglobin?
free heme creates oxygen radicals membrane, mitochondria, DNA damage methemoglobin more toxic than hemoglobin
61
when can glucosuria occur secondary to renal disease?
acute renal failure congenital proximal tubular disorders
62
what is normal carnivore urine pH?
5.5-7.5
63
what is normal herbivore urine pH?
7.0-8.5

Urinary Pathophysiology (11 decks)

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