Bryan - La Med Ii - Equine & Ruminant Urinary Dz - Winter 3Rd Year

Front 1

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

Back 1

a) nephrosplenic ligament
b) bladder
(ureters usually only palpable w/pathology or per vaginum)

Front 2

OK here is a review...what are the functions of the kidney?

Back 2

Regulate water/electrolyte balance.
Control of acid-base balance.
Eliminate waste.
Regulate arterial pressure.
Erythropoietin production.
Vitamin D activation.

Front 3

What is the normal urine production of horses? What is normal daily water requirement for horses?

Back 3

15-30ml/kg/day; 5-15L/d urine;
25-70 ml/kg/day (2.5 - 7%) water

Front 4

T or F:
Low USG in the face of clinical dehydration is strong evidence of renal disease.

Back 4

True!

Front 5

Dysuria/stranguria can be evidence of which of the following:
a) urinary obstruction
b) sabulous urolithiasis
c) pyelonephritis
d) uremia

Back 5

a) urinary obstruction
b) sabulous urolithiasis

Front 6

Anorexia and weight loss can be evidence of which of the following:
a) urinary obstruction
b) sabulous urolithiasis
c) pyelonephritis
d) uremia

Back 6

d) uremia

Front 7

Bladder stones are typically palpated at _________ depth.

Back 7

wrist depth

Front 8

Characterize equine urine in terms of:
USG
pH
WBC/RBC

Back 8

USG 1.010 - 1.050
pH alkaline
WBC/RBC <10/<5

Front 9

T or F:
It is normal for neonatal but not adult horses to have a trace amount of proteinuria.

Back 9

False!
It is normal for BOTH

Front 10

In terms of sediment, horses normally have a large amount of ___________ in their urine.

Back 10

Calcium carbonate

Front 11

What are the MAIN clinical signs of urinary disease in horses?

Back 11

PU/PD
Discolored urine
Unusual micturation
Weight loss

Front 12

Which of the following can cause red urine staining on bedding?
a) hematuria
b) myoglobinuria
c) buscopan
d) pyrocatechin
e) hemoglobinuria

Back 12

a) hematuria
b) myoglobinuria
d) pyrocatechin
e) hemoglobinuria

Front 13

Predict the following chemistry values in a case of equine renal disease.
Potassium
Sodium
Phosphorus
Chloride

Back 13

HYPERkalemia (K is variable but hyperK is bad!)
HYPOnatremia
HYPOphosphatemia
HYPOchloremia

Front 14

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

Back 14

c) High CREATININE values are expected in foals <24h.
e) NO casts are normal!

Front 15

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

Back 15

b) normal equine CREATININE is between 1.2 and 1.7 mg/dL
(BUN is between 10-27)

Front 16

What are the most common causes of equine acute renal failure?

Back 16

Toxic nephropathy
Ischemic events

Front 17

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

Back 17

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)

Front 18

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

Back 18

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)

Front 19

Which region of the kidney is more susceptible to toxins? To ischemic events?

Back 19

Toxins (cortex)
Ischemia (medulla)

Front 20

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

Back 20

a) decreased water intake
b) oliguria
c) dehydration

Front 21

In severe cases of acute renal failure, which drugs are considered nephroprotective?

Back 21

Furosemide (reduce oxygen demand of tubule cells)
Dopamine (increases renal blood flow)
Mannitol (osmotic diuretic)

Front 22

What condition could be confused with DI in horses? How can this be managed?

Back 22

Primary pars intermedia dysfunction (underproduction of ADH - essentially central DI)
Manage with pergolide

Front 23

What are some lab findings concurrent with primary pars intermedia dysfunction in horses?

Back 23

Hyperglycemia
Glucosuria
mild neutrophilia, lymphopenia

Front 24

What is the "magic SG value" for horses?

Back 24

1.025; greater than this indicates concentrating ability

Front 25

What are the major categories of equine chronic renal failure?

Back 25

Tubulointerstitial disease
Glomerular disease
Congenital disease

Front 26

What are major categories of glomerular disease?

Back 26

Amyloidosis
Glomerulonephritis

Front 27

What are the MAJOR clinical signs of chronic renal failure in horses? Which is the MOST COMMON sign?

Back 27

Weight loss (MOST COMMON)
Lethargy/inappetance
PU/PD
Mild ventral edema

Front 28

What three things must be present to diagnose chronic renal disease in horses?

Back 28

Persistent isothenuria (1.008-1.014)
Persistent azotemia
Clinical signs

Front 29

A BUN:Creatinine ratio of 11:1 indicates...

Back 29

...chronic renal failure

Front 30

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

Back 30

b) azotemia with high BUN:Creatinine ratio
c) hyperkalemia
e) hypophosphatemia
(HYPERcalcemia, HYPOnatremia, chloremia, and low bicarb)

Front 31

A urine protein:creatinine ratio of >2:1 is suggestive of...

Back 31

...glomerular disease

Front 32

Predict changes in the following in chronic equine renal failure?
Size
Echogenecity
Calcium
Potassium
Phosphorus

Back 32

SMALL Size
INCREASED Echogenecity
HIGH Calcium
HIGH Potassium
LOW Phosphorus

Front 33

What are some medical management options for a horse in chronic renal failure?

Back 33

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

Front 34

What are common bacteria involved in adult equine cystitis and/or pyelonephritis?

Back 34

Gram neg (E. coli, Proteus, Klebsiella, Pseudomonas, Enterobacter)
Gram pos (Strept and Staph)

Front 35

What are common organisms implicated in foal pyelonephritis?

Back 35

Actinobacillus equulli (septic embolic nephritis)
Candida cystitis (d/t abx)

Front 36

What are common antibiotics for pyelonephrits/cystitis and how long should they be used?

Back 36

TMS, Ceftiofur, Penicillin + aminoglycoside
Cystitis (10d min)
Pyelo (2-4 wks)

Front 37

What are some neurologic causes of equine incontinence? Which have good prognoses?

Back 37

Cauda equine syndrome
Illicit tail block
EHV1 (will get better)
EPM
Trauma/neoplasia
Toxins (sorghum/sudan grass)

Front 38

Choose UMN or LMN lesion...
...difficult to express bladder.

Back 38

UMN

Front 39

Choose UMN or LMN lesion...
...no voluntary micturation

Back 39

UMN or LMN still!

Front 40

Choose UMN or LMN lesion...
...easy to express

Back 40

LMN

Front 41

Choose UMN or LMN lesion...
...urine dribbling

Back 41

LMN

Front 42

What drug decreases urethral resistance? Which drug improves detrusor tone?

Back 42

Phenoxybenzamine for urethra
Bethanechol for detrusor

Front 43

What is the chem panel signature for uroperitoneum in foals?

Back 43

Low NaCl
High K
(Peritoneal fluid creatinine 2x higher than serum)

Front 44

What is a very important pre-op measure in foal uroperitoneum?

Back 44

Reduce serum K to <5.5meq/L
(use dextrose/bicarb, glucose/insulin, Ca gluconate)

Front 45

What drug reduces straining with urachal diverticulum?

Back 45

Phenazopyridine

Front 46

Idiopathic renal hematuria is most common in which type of horse?

Back 46

Arabians!

Front 47

How can bovine kidneys be evaluated? Sheep/goat kidneys?

Back 47

Bovine (per rectum; only L kidney)
Sheep/goat (r-side via ultrasound)

Front 48

Why can't male ruminants be catheterized?

Back 48

Urethral process
Sigmoid flexure
Dorsal diverticulum

Front 49

What kind of azotemia is caused by dehydration, shock, or hemorrhage?

Back 49

Pre-renal

Front 50

Describe the changes in the following for ruminant acute renal azotemia:
Na
K
Ca
P
Urine pH

Back 50

LOW Na
LOW K
LOW Ca
HIGH P
LOW Urine pH

Front 51

Why do GI obstructed ruminants get paradoxic aciduria?

Back 51

Obstruction causes Cl sequestration leading to hypochloremia. Low Cl prevents Na resorption so H is excreted to maintain Na levels.

Front 52

Describe the changes in the following for ruminant chronic renal azotemia:
Na
K
Ca
P
Cl

Back 52

LOW Na
LOW K
LOW Ca
HIGH P
LOW Cl

Front 53

How often should a cow urinate per day? How much?

Back 53

5-8 times (total of 8-12 L)

Front 54

Indistinct kidney lobulation on palpation in a cow is suggestive of...

Back 54

...nephrosis or pyelonephrosis

Front 55

What drug should NOT be used in ruminants with suspected urinary blockage?

Back 55

Xylazine (diuretic)

Front 56

T or F:
High BUN is more suggestive of pre-renal issues.

Back 56

False! The higher BUN is, the LESS likely the cause is pre-renal.

Front 57

What are some drugs that are linked with ruminant nephrosis?

Back 57

Aminoglycosides
Sulfonamides
Oxytetracycline
Vitamin D (camelids)
Monensin

Front 58

A ruminant with isothenuria and high protein likely has...

Back 58

...nephrosis!

Front 59

How should ruminant nephroses be treated?

Back 59

usu due to toxicities thus RUMENOTOMY and removal of crap in there + activated charcoal
Give fluids
Diuretics to increase renal flow

Front 60

What are common bacteria in ruminant UTIs?

Back 60

E. coli (assoc w/chronic dz)
Truperella pyogenes
Corynebacterium renale (gram +)

Front 61

How can you tell acute cystitis from acute pyelonephritis?

Back 61

Pyelonephritis will have FEVER, drop in MILK, and COLIC

Front 62

What is the common treatment for ruminant cystitis? What is the withdrawal time?

Back 62

PPG (for C. renale); 3 wk withdrawal

Front 63

What bacteria and/or management practice causes pizzle rot?

Back 63

C. renale d/t high protein diet

Front 64

What two lepto serovars have the most clinical significance in ruminants? Which ruminants are the most susceptible?

Back 64

Serovars pomona and grippotyphosa;
mostly in CALVES

Front 65

What is the cause of enzootic hematuria? How is this linked to neoplasia?

Back 65

Ptaquiloside from bracken fern can cause BVP-2 viral recrudescence.

Front 66

The most common type of urolith in ruminant is __________.

Back 66

struvite

Front 67

What can cause mucoprotein plugs in ruminants?

Back 67

Subterranean clover
Hormone implants

Front 68

Low Na, Cl, and high K is indicative of...

Back 68

...BLADDER RUPUTER (uroperitoneum)

Front 69

How can struvites be prevented?

Back 69

1. improve Ca:P ratio to 2:1
2. avoid pelleted feeds and increase forage
3. add NaCl at 3-5%
4. add ammonium chloride at 0.5-1% of ration
5. improve water intake
6, Urinary acidification

Front 70

What are the three procedures for high value/pet ruminants with urolith blockages?

Back 70

Urethral process amputation
Tube cystostomy
Bladder marsupialization