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70 Cards in this Set

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Which of the following are normally palpable per rectum in the horse?
a) nephrosplenic ligament
b) bladder
c) right kidney
d) ureters
e) urethral diverticulum
a) nephrosplenic ligament
b) bladder
(ureters usually only palpable w/pathology or per vaginum)
OK here is a review...what are the functions of the kidney?
Regulate water/electrolyte balance.
Control of acid-base balance.
Eliminate waste.
Regulate arterial pressure.
Erythropoietin production.
Vitamin D activation.
What is the normal urine production of horses? What is normal daily water requirement for horses?
5-15L/d urine;
25-70 ml/kg/day (2.5 - 7%) water
T or F:
Low USG in the face of clinical dehydration is strong evidence of renal disease.
True!
Dysuria/stranguria can be evidence of which of the following:
a) urinary obstruction
b) sabulous urolithiasis
c) pyelonephritis
d) uremia
a) urinary obstruction
b) sabulous urolithiasis
Anorexia and weight loss can be evidence of which of the following:
a) urinary obstruction
b) sabulous urolithiasis
c) pyelonephritis
d) uremia
d) uremia
Bladder stones are typically palpated at _________ depth.
wrist depth
Characterize equine urine in terms of:
USG
pH
WBC/RBC
USG 1.010 - 1.050
pH alkaline
WBC/RBC <10/<5
T or F:
It is normal for neonatal but not adult horses to have a trace amount of proteinuria.
False!
It is normal for BOTH
In terms of sediment, horses normally have a large amount of ___________ in their urine.
Calcium carbonate
What are the MAIN clinical signs of urinary disease in horses?
PU/PD
Discolored urine
Unusual micturation
Weight loss
Which of the following can cause red urine staining on bedding?
a) hematuria
b) myoglobinuria
c) buscopan
d) pyrocatechin
e) hemoglobinuria
a) hematuria
b) myoglobinuria
d) pyrocatechin
e) hemoglobinuria
Predict the following chemistry values in a case of equine renal disease.
Potassium
Sodium
Phosphorus
Chloride
HYPERkalemia (K is variable but hyperK is bad!)
HYPOnatremia
HYPOphosphatemia
HYPOchloremia
Which of the following is NOT true regarding equine urinary disease?
a) Fractional excretion of Na is often >1%.
b) BUN:Creatinine ratios <10 suggest acute failure.
c) High BUN values are expected in foals <24h.
d) Animals in diseased states can hold up to 4L of urine in their bladders.
e) <2 casts/hpf are normal in sediment analysis
c) High CREATININE values are expected in foals <24h.
e) NO casts are normal!
Which are NOT TRUE regarding BUN...
a) higher BUN values are less indicative of pre-renal causes in horses
b) normal equine BUN is between 1.2 and 1.7 mg/dL
c) ruminants can have high BUN with pre-renal causes
d) BUN:Creatinine ratios <10 suggest acute failure
b) normal equine CREATININE is between 1.2 and 1.7 mg/dL
(BUN is between 10-27)
What are the most common causes of equine acute renal failure?
Toxic nephropathy
Ischemic events
Which of the following are true regarding aminoglycoside use in horses?
a) neomycin is the MOST nephrotoxic
b) Doses should be safe as long as an appropriate dosage regimen is followed with adequate hydration
c) creatinine values >0.3mg/dL is an indication for withdrawal
d) discontinuation of therapy shows rapid reduction in toxicity
a) neomycin is the MOST nephrotoxic
c) creatinine values >0.3mg/dL is an indication for withdrawal
(note: don't dose over 1200lbs ever!!!; also toxicity can continue after drug discontinuation)
Regarding NSAID use and equine nephropathy, which are tru?
a) aspirin is the MOST nephrotoxic
b) Doses should be safe as long as an appropriate dosage regimen is followed with adequate hydration
c) hyperalbuminemia is an indication for withdrawal
d) GI signs are often seen before renal signs
b) Doses should be safe as long as an appropriate dosage regimen is followed with adequate hydration
(note: she didn't mention the most nephrotoxic NSAID; also HYPOALBUMINEMIA is indicative of RDC)
Which region of the kidney is more susceptible to toxins? To ischemic events?
Toxins (cortex)
Ischemia (medulla)
Which of the following are signs of equine acute renal failure?
a) decreased water intake
b) oliguria
c) dehydration
d) PU/PD
e) straining to urinate
a) decreased water intake
b) oliguria
c) dehydration
In severe cases of acute renal failure, which drugs are considered nephroprotective?
Furosemide (reduce oxygen demand of tubule cells)
Dopamine (increases renal blood flow)
Mannitol (osmotic diuretic)
What condition could be confused with DI in horses? How can this be managed?
Primary pars intermedia dysfunction (underproduction of ADH - essentially central DI)
Manage with pergolide
What are some lab findings concurrent with primary pars intermedia dysfunction in horses?
Hyperglycemia
Glucosuria
mild neutrophilia, lymphopenia
What is the "magic SG value" for horses?
1.025; greater than this indicates concentrating ability
What are the major categories of equine chronic renal failure?
Tubulointerstitial disease
Glomerular disease
Congenital disease
What are major categories of glomerular disease?
Amyloidosis
Glomerulonephritis
What are the MAJOR clinical signs of chronic renal failure in horses? Which is the MOST COMMON sign?
Weight loss (MOST COMMON)
Lethargy/inappetance
PU/PD
Mild ventral edema
What three things must be present to diagnose chronic renal disease in horses?
Persistent isothenuria (1.008-1.014)
Persistent azotemia
Clinical signs
A BUN:Creatinine ratio of 11:1 indicates...
...chronic renal failure
Which of the following lab values are congruent with chronic renal failure in horses?
a) hypocalcemia
b) azotemia with high BUN:Creatinine ratio
c) hyperkalemia
d) hypernatremia
e) hypophosphatemia
b) azotemia with high BUN:Creatinine ratio
c) hyperkalemia
e) hypophosphatemia
(HYPERcalcemia, HYPOnatremia, chloremia, and low bicarb)
A urine protein:creatinine ratio of >2:1 is suggestive of...
...glomerular disease
Predict changes in the following in chronic equine renal failure?
Size
Echogenecity
Calcium
Potassium
Phosphorus
SMALL Size
INCREASED Echogenecity
HIGH Calcium
HIGH Potassium
LOW Phosphorus
What are some medical management options for a horse in chronic renal failure?
Decrease Ca intake (no alfalfa)
reduce protein <10%
Maintain BUN:Cr between 10 and 15
Fluids
Free choice water & salt
B vitamins & steroids
Omega-3s
What are common bacteria involved in adult equine cystitis and/or pyelonephritis?
Gram neg (E. coli, Proteus, Klebsiella, Pseudomonas, Enterobacter)
Gram pos (Strept and Staph)
What are common organisms implicated in foal pyelonephritis?
Actinobacillus equulli (septic embolic nephritis)
Candida cystitis (d/t abx)
What are common antibiotics for pyelonephrits/cystitis and how long should they be used?
TMS, Ceftiofur, Penicillin + aminoglycoside
Cystitis (10d min)
Pyelo (2-4 wks)
What are some neurologic causes of equine incontinence? Which have good prognoses?
Cauda equine syndrome
Illicit tail block
EHV1 (will get better)
EPM
Trauma/neoplasia
Toxins (sorghum/sudan grass)
Choose UMN or LMN lesion...
...difficult to express bladder.
UMN
Choose UMN or LMN lesion...
...no voluntary micturation
UMN or LMN still!
Choose UMN or LMN lesion...
...easy to express
LMN
Choose UMN or LMN lesion...
...urine dribbling
LMN
What drug decreases urethral resistance? Which drug improves detrusor tone?
Phenoxybenzamine for urethra
Bethanechol for detrusor
What is the chem panel signature for uroperitoneum in foals?
Low NaCl
High K
(Peritoneal fluid creatinine 2x higher than serum)
What is a very important pre-op measure in foal uroperitoneum?
Reduce serum K to <5.5meq/L
(use dextrose/bicarb, glucose/insulin, Ca gluconate)
What drug reduces straining with urachal diverticulum?
Phenazopyridine
Idiopathic renal hematuria is most common in which type of horse?
Arabians!
How can bovine kidneys be evaluated? Sheep/goat kidneys?
Bovine (per rectum; only L kidney)
Sheep/goat (r-side via ultrasound)
Why can't male ruminants be catheterized?
Urethral process
Sigmoid flexure
Dorsal diverticulum
What kind of azotemia is caused by dehydration, shock, or hemorrhage?
Pre-renal
Describe the changes in the following for ruminant acute renal azotemia:
Na
K
Ca
P
Urine pH
LOW Na
LOW K
LOW Ca
HIGH P
LOW Urine pH
Why do GI obstructed ruminants get paradoxic aciduria?
Obstruction causes Cl sequestration leading to hypochloremia. Low Cl prevents Na resorption so H is excreted to maintain Na levels.
Describe the changes in the following for ruminant chronic renal azotemia:
Na
K
Ca
P
Cl
LOW Na
LOW K
LOW Ca
HIGH P
LOW Cl
How often should a cow urinate per day? How much?
5-8 times (total of 8-12 L)
Indistinct kidney lobulation on palpation in a cow is suggestive of...
...nephrosis or pyelonephrosis
What drug should NOT be used in ruminants with suspected urinary blockage?
Xylazine (diuretic)
T or F:
High BUN is more suggestive of pre-renal issues.
False! The higher BUN is, the LESS likely the cause is pre-renal.
What are some drugs that are linked with ruminant nephrosis?
Aminoglycosides
Sulfonamides
Oxytetracycline
Vitamin D (camelids)
Monensin
A ruminant with isothenuria and high protein likely has...
...nephrosis!
How should ruminant nephroses be treated?
usu due to toxicities thus RUMENOTOMY and removal of crap in there + activated charcoal
Give fluids
Diuretics to increase renal flow
What are common bacteria in ruminant UTIs?
E. coli (assoc w/chronic dz)
Arcanobacterium pyogenes
Corynebacterium renale (gram +)
How can you tell acute cystitis from acute pyelonephritis?
Pyelonephritis will have FEVER, drop in MILK, and COLIC
What is the common treatment for ruminant cystitis? What is the withdrawal time?
PPG (for C. renale); 3 wk withdrawal
What bacteria and/or management practice causes pizzle rot?
C. renale d/t high protein diet
What two lepto serovars have the most clinical significance in ruminants? Which ruminants are the most susceptible?
Serovars pomona and grippotyphosa;
mostly in CALVES
What is the cause of enzootic hematuria? How is this linked to neoplasia?
Ptaquiloside from bracken fern can cause BVP-2 viral recrudescence.
The most common type of urolith in ruminant is __________.
struvite
What can cause mucoprotein plugs in ruminants?
Subterranean clover
Hormone implants
Low Na, Cl, and high K is indicative of...
...BLADDER RUPUTER (uroperitoneum)
How can struvites be prevented?
Increase Ca:P ratio to 2:1
Add NaCl or NH4Cl
Remove grain/alfalfa
What are the three procedures for high value/pet ruminants with urolith blockages?
Urethral process amputation
Tube cystostomy
Bladder marsupialization