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Flashcards in Urinary tract disease Deck (100)
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Give the USG reference ranges for the "normal", isosthenuria, hypersthenuria and hyposthenuria in the cat

- Normal: 10.015-1.060 (healthy cat usually 1.035)
- Iso: 1.008-1.012
- Hyper: >1.012
- Hypo: <1.008


List the tests that can be used in the examination of urinary tract disease

- Urinalysis
- Clinical pathology (haem, biochem, +/-SDMA, UPCR)
- Imaging: radiography, ultrasound, CT
- Surgical


What lateral radiographic view gives the least superimposition of the kidneys?

Right lateral


What contrast medium is generally used in the investigation of urinary tract disease?

Iodine salts e.g. iohexol


Define azotaemia

Increased concentration of non-protein nitrogenous compounds in the blood


Define uraemia

Clinical syndrome associated with renal failure


Outline the measurement and interpretation of urea in the investigation of urinary tract disease (causes of increase/decrease, when to sample)

- May be elevated if high protein diet or just eaten (wait 12hours after meal ideally)
- Also elevated by GI haemorrhage
- Increases with: fever, starvation, sepsis, burns, dehydration (mild elevation)
- Decreases with: severe hepatic dysfunction, protein restricted diets


Discuss the limitations of urea measurements in the investigation of urinary tract disease

- Reflects gut microbiome more than kidney in ruminants and horses
- Birds/reptiles excrete nitrogen as uric acid rather than urea
- Must be measured in relation to hydration status and urine output
- >70% renal function loss before sustained changes in levels of urea and creatinine


Outline the sources of creatinine in the blood

- Majority from skeletal muscle breakdown (constant rate)
- Increased by increased muscle breakdown
- Small amounts from diet


Outline the use of creatinine in the diagnosis of urinary tract disease

- Used for IRIS staging of CKD
- Less sensitive than urea to changes in plasma concentrations
- Better indicator of renal function due to free filtering at glomerulus and no reabsorption


What may lead to a falsely low pH reading on urine dipstick?

Urine spilling from protein to pH pad (protein pad uses acid)


Give the USG reference ranges for the "normal", isosthenuria, hypersthenuria and hyposthenuria in the dog

- Normal: 10.015-1.050
- Iso: 1.008-1.012
- Hyper: >1.012
- Hypo: <1.008


Give the normal values for UP:CR in dogs and cats

Dogs <0.5
Cats <0.4


What are the indications for use of cystoscopy in the investigation of urinary tract disease?

Recurrent or persistent lower urinary tract disease


List the uses of cystoscopy in the investigation of urinary tract disease

- Visualisation, biopsy/removal of masses/polyps
- Evaluation of recurrent urinary tract infection
- Diagnosis of ectopic ureters
- Localisation of haematuria
- Aid removal of uroliths
- Dilating urethral strictures


Give the indications for renal biopsy

- Suspected neoplasia
- Famillial nephropathy which might have an impact on other animals
- Non-azotaemic PLN
- Haematuria or protenuria
- Diagnosis of glomerular disease/AKI


List the contraindications for renal biopsy

- Hydronephrosis
- Renal cysts
- Pyelonephritis/abscessation


What are the possible complications of renal biopsy?

- Haemorrhage/clots in kidney
- Further compromise of renal function
- If performed blind, risk of rupturing renal artery


Give the options for method of renal biopsy

- Percutaneous ultrasound guided (needle, trucut, spring biopsy needle)
- Surgical methods: laparoscopy, laparotomy


What USG indicates pre-renal azotaemia in a cat and dog?

Cat: >1.045
Dog: >1.035


What USG indicates renal azotaemia in a cat and dog?

Cat: 1.008-1.035
Dog: 1.008-1.029


What USG indicates post-renal azotaemia in a cat and dog?

Variable - decreased elimination of urine rather than alteration in production


Outline the 3 presentations of renal failure

- AKI: renal, pre-renal or post-renal causes
- CKD: renal causes
- Acute decompensation of CKD: underlying renal cause with pre-renal factors causing decompensation
- All will be azotaemic


List potential nephrotoxins

- Organic compounds e.g. ethylene glycol
- Drugs incl. antibiotics, antifungals, amphotericin B, NSAIDs, ACEIs, diuretics, contrast agent, chemotherapy agents, immunosuppressive agents e.g. cyclosporine
- Heavy metals
- Mushroom, grapes/raisins, rodenticides
- Myoglobin, haemoglobin


Which antibiotic is directly nephrotoxic?



Give the possible causes of pre-renal proteinuria

Increased small size plasma proteins e.g. Hb, myoglobin, immunoglobulin Bence Jones light chains


Give the possible causes of post-renal proteinuria

Protein from urinary tract, usually inflammatory disease


Outline the investigation of proteinuria

- Identify as pre, post or intrinsic renal
- Rule out pre and post renal causes
- Aim to identify underlying cause - infectious, endocrine, neoplastic
- Assess sequelae (azotaemia, hypoalbuminaemia, hypertension)
- Do the above using urinalysis, CBC, biochem, test for infectious diseases, immune mediated disorders, DNA mutations


Outline the role of the kidney in acid base balance

- Excrete H+ via Na/H exchange in PCT and active H+ATPase pump in collecting tubules
- Reabsorption of HCO3- in PCT


List the differentials for hyperkalaemia

- Increased intake
- Translocation from ICF to ECF (insulni deficit, tumour lysis syndrome, acidosis, drugs)
- Decreased urinary excretion: renal failure, ruptured bladder, obstruction, GI disease, hypoadrenocorticism