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Flashcards in Urinary tract disease Deck (100)
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1

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

2

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

3

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

Right lateral

4

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

Iodine salts e.g. iohexol

5

Define azotaemia

Increased concentration of non-protein nitrogenous compounds in the blood

6

Define uraemia

Clinical syndrome associated with renal failure

7

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

8

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

9

Outline the sources of creatinine in the blood

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

10

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

11

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

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

12

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

13

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

Dogs <0.5
Cats <0.4

14

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

Recurrent or persistent lower urinary tract disease

15

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

16

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

17

List the contraindications for renal biopsy

- Hydronephrosis
- Renal cysts
- Pyelonephritis/abscessation

18

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

19

Give the options for method of renal biopsy

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

20

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

Cat: >1.045
Dog: >1.035

21

What USG indicates renal azotaemia in a cat and dog?

Cat: 1.008-1.035
Dog: 1.008-1.029

22

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

Variable - decreased elimination of urine rather than alteration in production

23

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

24

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

25

Which antibiotic is directly nephrotoxic?

Gentamicin

26

Give the possible causes of pre-renal proteinuria

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

27

Give the possible causes of post-renal proteinuria

Protein from urinary tract, usually inflammatory disease

28

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

29

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

30

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