Mod:renal Disease

Front 1

Define renal disease

Back 1

renal disease is the functional or structural abnormalities in one or both kidneys regardless of location or severity. Not the same as renal failure

Front 2

Define renal failure

Back 2

Implies that a certain degree of kidney disease has occurred resulting in the inability to maintain normal kidney function (urine concentration, azotemia, EPO production).

Front 3

T/F In renal failure patients there must always be azotemia.

Back 3

False. In tubular kidney failure patients often become isothenuric before they are azotemic or compensation may prevent azotemia but not isosthenuria.

Front 4

Renal failure of the tubules often results in _______ while renal failure of the glomerulus causes ________.

Back 4

Tubules= azotemia
Glomerulus= proteinuria

Front 5

T/F Kidneys that do not concentrate urine in the face of azotemia are suspected to be failing

Back 5

True. However this isn't always the case. Hypoadrenocorticism, hyperadrenocorticsim or drug therapy may indirectly affect the kidenys' ability to concentrate

Front 6

A patient comes into the clinic with an increased BUN, creatinine and isothenuria, what does this imply?

Back 6

Renal failure- the kidney structures are damaged and cannot rid toxins or concentrate urine in the dehydrated patient.

Front 7

Define kidney insufficiency?

Back 7

implies a certain degree of kidney injury but to a lesser degree than kidney failure. Can concentrate urine just not as well as a normal kidney.

Front 8

what is the normal progression of renal disease?

Back 8

renal disease--> renal insufficiency--> renal failure. HOWEVER may NOT progress.

Front 9

T/F All renal disease will progress to renal failure

Back 9

False

Front 10

What is considered "chronic" renal disease?

Back 10

Renal disease, insufficiency, and failure are all considered chronic if and when the disease is IRREVERSIBLE. It is often slowly progressive but doesn't have to be.

Front 11

What are the functions of the kidneys?

Back 11

excrete metabolic waste
retrieve filtered material
maintain acid/base balance
regulate BP
stimulate RBC production (EPO)

Front 12

What are some clinical signs of renal disease?

Back 12

changes in drinking/urinating
uremic syndrome
GIT signs
Hypertension signs (eyes and brain)

Front 13

Describe PU/PD and how it relates to renal disease?

Back 13

Polyuria renal disease causes lack of renal tubule concentrating ability so urine is isothenuric. Polydipsia is compensatory.

Front 14

T/F: in cases of renal failure the urine is typically isosthenuric.

Back 14

True.

Front 15

What is isothenuria?

Back 15

urine with a specific gravity equal to plasma (1007-1015) Un-concentrated urine

Front 16

What causes isosthenuira?

Back 16

increased solute load per surviving neprhon, medullary washout, lack of response to ADH

Front 17

Which animal has a better prognosis: one with polyuria, oliguria, or anuria?

Back 17

polyuric animals have the best prognosis. Anuria and oliguria indicate severe renal injury and are seen in acute renal injury.

Front 18

What is normal urine output for small animals?

Back 18

1-2 ml/kg/hr

Front 19

What is uremic syndrome?

Back 19

various signs involving many body systems to indicate renal disease. These include GI signs like anorexia, nausea, vomiting, oral ulceration, stomatitis, halitosis, and tonghe necrosis, weight loss, muscle wasting hypothermia, lethargy, weakness, muscle tremors, etc

Front 20

Why does uremic syndrome occur?

Back 20

disturbed excretion of electrolytes/ H2O
Reduced excretion of organic solutes
impaired hormone synthesis

Front 21

Acute kidney injury is defined as?

Back 21

rapid and progressive decline in the ability of the kidney to regulate electrolytes, maintain fluid balance, and filter metabolic waste. May be fatal! Result of damage to the renal parenchyma as a result of toxins, ischemia, infectious agents and systemic disease.

Front 22

Chronic renal failure is defined as?

Back 22

irreversible, progressive structural lesion in which compensatory mechanism has occured to improve function. Decreased GFR evidenced by azotemia and isothenuria for longer than 3 months.

Front 23

How is treatment of acute kidney injury different from chronic renal injury?

Back 23

Treatment of direct cause for a cure is the aim of acute renal disease treatment. Treatment is directed at controlling signs in chronic renal disease.

Front 24

How does azotemia differ from uremia

Back 24

Uremia is a clinical syndrome where there is an elevation of BUN and creatinine. The patient is sick (lethargy, vomiting, anorexia) resulting in acumulation of metabolic waste products due to renal failure
Azotemia - is a condition where there are no clincal signs but on paper there is an increased BUN and creatintine.

Front 25

T/F: All uremic patients are azotemic

Back 25

True

Front 26

T/F: All azotemic patients are uremic

Back 26

False

Front 27

In acute renal injury there are a combination of factors that result in renal dysfunction and reduced GFR. These include:

Back 27

tubular obstruction
back leak
vasoconstriction
decreaded capillary permeability

Front 28

There are four phases of acute kidney injury:

Back 28

1. induction
2. extension
3. maintenance
4. recovery

Front 29

Describe the induction phase of acute kidney injury

Back 29

insult occurs, no clinical signs, best time to intervene, duration is variable.

Front 30

Describe the extension phase of acute kidney injury

Back 30

insult still present, enough damage has occurred that clinical signs are present.

Front 31

Describe the maintenance phase of acute kidney injury.

Back 31

Cause of injury is gone now left with damage. May go into recover, CRF, or worsen into anuric renal failure. May last 1-3 weeks.

Front 32

Describe the recovery phase of acute kidney injury.

Back 32

This is the healing phase that lasts between 6 weeks and 3 months. Patients may slowly improve if damage to cells is sublethal (tubular basement membrane remains intact). During this time kidney function slowly improves.

Front 33

Causes of acute renal injury are...

Back 33

lack of blood or toxins (anesthesia, NSAID therapy, grapes, xylatol, Lepto, Lilies_

Front 34

Clinical findings of acute renal injury depend on stage and severity of injury but can include:

Back 34

none, uremic syndrome signs, anuria/oliguria, good BCS, enlarged and painful kidney

Front 35

How do we differentiate acute renal injury from chronic renal injury?

Back 35

Both have signs of uremia (lethargy, vomiting, anorexia)
Animals with chronic renal failure have poor body condition small non painful kidneys, anemia, hypokalemia, and polyuria. ANimals with actue renal injury typically have good body condition, large painful kidenys, hyperkalemia, and polyuria/anuria

Front 36

What are some characteristics of chronic kidney failure?

Back 36

common in dogs and cats.
irreversible loss of neprons
stable to slowly progressive
initial inciting cause is generally gone.
Tx: not curative and already max compensating.

Front 37

Which develops more quickly: glomerular disease or tubulointerstitial disease?

Back 37

glomerular disease progresses more quickly because it will lead to tubulointerstitial disease.

Front 38

Chronic kidney disease often progresses more quickly in dogs then in cats. Explain.

Back 38

Dogs are more likely to have glomerular disease than cats.

Front 39

What are some clinical findings associated with chronic kidney disease?

Back 39

weight loss (acidosis can lead to protein catabolism, anorexia).
small kidneys
weakness/lethargy (secondary to anemia, decreased potassium, neurologic disease, dehydration)