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224 Cards in this Set

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Abrupt decline in renal function that occurs over a period of hours to days
Acute renal failure
Most common cause of acute tubular necrosis and its prevalence
Nephrotoxicosis (25%)
List some nephrotoxic substances
Ethylene glycol
Lily plants
Rodenticide
Raisins
Melamine/Cyanuric acid
Cisplatin
Percentage of cardiac output that goes to the kidney
20-25%
Two causes of renal vasoconstriction
NSAIDs
Hypercalcemia
Main cause of nephritis leading to acute renal failure
Leptospirosis
4 common causes of acute renal failure in dogs and cats
Ethylene glycol
NSAIDs
Idiopathic
Leptospirosis
CS associated with ARF
Acute onset
Lethargy
Depression
Inappetance
Vomiting and diarrhea
Oliguria or anuria
Kidneys normal to large and may be painful
Chemistry changes assoicated with ARF
Renal azotemia
Hyperphosphatemia
Metabolic acidosis
Increased AG
Hyperkalemia or rarely hypokalemia
Hypocalcemia or hypercalcemia
WIth renal azotemia, what will the urine SG be?
1.008-1.012
Two drugs that may affect USG
Diuretics
Corticosteroids
4 endocrine abnormalities that may affect USG.
Hypoadrenocorticism
Hyperadrenocorticism
Ketoacidosis with diabetes mellitus
Hyperthyroidism
Patient presents with lethargym depression, vomiting of 5 days duration, severely depressed. There has been no urine production observed since 2 days ago. The kidneys feel enlarged and painful. Radiographs show good bone density. If this patient is in renal failure, what kind is it?
Acute renal failure
A patient presents with a 2 month history of inappetance, weight loss, vomiting. He is BAR. Owner reports that he is drinking and peeing a lot. THe patient is thin. The kidneys feel small. If this animal is in renal failure, what kind is it?
Chronic renal failure
A patient has an increased Hct, and his BUN/Creatinine are progressively creeping up. Serum K is increased and the patient is severely acidotic. What is the likely syndrome taking place?
Acute renal failure
A patient has a non-regenerative anemia, and a BUN/creatinine that is elevated but stable. The serum K is decreased, and the patient is mildly acidotic. UA shows isosthenuria only. What is the likely problem based on this information?
Chronic renal failure
List two diagnostic tests used to pinpoint a specific cause of acute renal failure.
Lepto MAT
Ethylene Glycol test kit
This form of kidney failure is potentially reversible if diagnosed and managed early.
Acute renal failure
Treatment goals for ARF.
Keep hydrated to minimize damage.
Treat the treatable abnormalities
Promote diuresis and reverse oliguria
Combat uremic consequences
When treating ARF, over what period of time should deficit plus maintenance be administered?
6 hours
Urinary catheter should be indwelling in an ARF patient if the urine production is under...
1 mg/kg/h
Initial fluid rate in an ARF patient.
1.5-2X maintenance
Sensible losses and BW ahould be evaluated in an ARF patient every...
4 hours
Type of fluids a patient in ARF should be given
Low sodium
Estimated rate of insensible losses.
10 mL/kg/day
How can one reverse persistent oliguria?
Give additional 3% BW in fluid
Mannitol CRI or q 6-8h iff effective
Furosemide, CRI or q 8h if effective
3 drugs that may be given to normalize a high BP in an ARF patient
Norepinephrine
Dobutamine
Amlodipine
How can one treat hyperkalemia in ARF?
Bicarbonate
Dextrose/insulin
Ca gluconate for arrhythmias
At what level does serug potassium become life threatening?
Around 8 meq/L or of cardiotoxic effects seen
How can uremic ulceration be addressed?
Anti-emetics, H2 blockers
Oral chlorhexidine rinses BID
Nutrition (oral or enteral) ASAP
How frequently should the BW and BP of an ARF patient be checked?
2-4X daily
These parameters should be checked on an ARF patient at the end of rehydration, then daily
Hct/TP
Serum chemistries and electrolytes
In ARF, when can fluid therapy be tapered?
Once BUN and Creatinine are normal and oral fluids tolerated without vomiting
Prognosis for fulminant ARF
Grave (90-100% mortality)
A dog presents in ARF and you send off a Lepto titer. When should antibiotic therapy be initiated? What drugs should be used
Start penicillin, ampicillin or 2 weeks of doxycycline ASAP until titer comes back.
Prognosis for appropriately treated Leptospirosis
70-80% survival
Describe the "dose reduction" modification for ARF medications
dose/serum creatinine
Describe the "interval prolongation" modification for ARF medication
interval X serum creatinine
What is the outcome for survivors of ARF?
40% complete recovery
60% CRF
How can ARF be prevented?
Pre-anesthetic bloodwork and BP for at-risk patients (CRF, CHF, dehydrated, NSAIDs)
Avoid nephrotoxic drugs
IVF prior and during anesthesia
Monitor BP under anesthesia
Inform owners of toxins
After how long does kidney disease become "chronic?"
3 months
Inability of the kidneys to perform excretory, regulatory, and synthetic functions due to a loss of functional nephrons over months to years.
Chronic renal failure
Most common cause of chronic renal failure
Idiopathic
First noticeable sign of CRF in most animals is...
PU/PD
An animal presents with PU/PD, lethargy and weight loss, inappetance, vomiting, and weakness with anemia. This has been going on for several months. What kind of renal disease is likely the problem?
Chronic renal disease
DIsorders that may contribute to progression of CRF
UTI
Hypertension
Hyper/hypothyroidism
Hypercalcemia
Neoplasia
Urinary obstruction
Hereditary disease seen most commonly in Cairn terriers and Persian cats
Polycystic kidney disease
CS seen with polycystic kidney disease
Enlarging abdomen
Lumpy bumpy kidneys, usually large
Polycystic kidney disease is managed like what other disorder once patient becomes azotemic?
CRF
Genetic test for polycystic kidney disease in Persian cats
PCR for PKD1 mutation
UPC over 2 likely means...
Glomerular disorder
UPC between 0.5 and 2 likely means...
Tubulointerstitial disorder
Halmark of glomerular disease on urinalysis
Proteinuria with normal urine sediment
Two most common glomerular diseases
Glomerulonephritis
Amyloidosis
Are glomerular disorders more common in cats or dogs?
Dogs
Descrbe how glomerulonephritis happens.
Antigens trapped in glomerulus bind circulating Ab. Immune response that follows damages glomerular filter leading to protein loss.
Acute phase protein responsible for amyloidosis
Serum amyloid A
How does amyloidosis cause kidney disease?
Infiltration disrupts normal nephron function and leakage of vital serum proteins
Top two causes of glomerular disease
Idiopathic
Extra-renal neoplasia
Two drugs that may cause glomerular disease
Trimethoprim sulfa
Corticosteroids
Radiographic length of normal kidney
2X length of L2
Pros of kidney tranplantation in cats
70-85% survival and some cats live years!
Cons of kidney transplantation in cats
Lifelong immunosuppression required
Cost exceeds $5,000
Px for kidney transplantation in dogs
Poor. Many die during sx, and the rest live under 1 year.
How is CRF manages?
Treat any concurrent disease
Avoid nephrotoxic medications
Diatary management
Manage fluid/electrolyte/acid base disorders
Control hyperphosphatemia
Control hypertension
Treat anemia
List some principles for dietary management of CKD/CRF
Restrict protein, P, and Na
Benefit of special diets for renal disease
Prolongs survival and time before uremia
How should CKS patient be treated when he cannot drink enough to keep self feeling well and eating?
Supplemental fluids SQ (100-200 mL QD or EOD) or via gastrostomy tube
Treatment for hypokalemia seen in CRF
Oral supplementation with potassium gluconate (2-4 meq/day)
IV KCl if severe
Treatment for hyperphosphatemia seen with CRF
Restrict dietary P
AlOH (Rolaids)
CaCO3 (Tums)
Ca acetate
How can metabolic acidosis seen with CRF be addressed?
K citrate or NaHCO3
Anti-hypertensives useful in managing CRF
Ca-channel blockers like amlodipine
ACE inhibitors
When should anemia associated with CRF be treated?
Hct under 20%
Fatigue, weakness, depression, tachypnea
How can anemia associated with CRF be treated?
Transfusion
Epogen (risk cross reaction with existing EPO)
Darbapoietin (fewer SE)
Why does chronic renal failure sometimes cause a patient to develop a puffy face, decreased bone density, and microfractures in bones?
Secondary hyperparathyroidism due to hyperphosphatemia and loss of renal vitamin D. Causes bone reabsorption via excess PTH to maintain blood Ca.
Drug used to decrease PTH and hyperparathyroidism in CRF patients
Calcitriol
Is calcitriol more beneficial in cats or dogs with CRF?
Dogs
Benefits of using ACE inhibitors in CRF.
Reduce BP, intraglomerular pressure, and proteinuria
Prolongs life
Two ACE inhibitors used in treatment of CRF
Enalapril
Benazepril
How does glomerular disease lead to thrombosis?
Loss of AT III
Anti-platelet therapy used in cases of CRF with glomerular disease
Aspirin
Animals with CRF who are doing well should be re-evaluated every...
3-6 months
What should be monitored at a CRF recheck?
BP
PE
Body weight
Hct
Biochem and electrolytes
UA
UPC if there is glomerular disease
Px for azotemic renal failure with dietary therapy and initial stable function for dogs? Cats?
Dogs: 0.5-2 years
Cats: 1-3 years
Negative prognostic factors with CRF.
Initial systolic BP > 160 mmHg in dogs
UPC ratio > 1 in dogs, >0.2 in cats
Also: CS uncontrollable, needs parenteral fluids, hypertension in cats, increasing serum creatinine
Criteria for IRIS staging includes:
Creatinine
Proteinuria
Blood pressure
Evidence of organ damage
Benefits of renal US over contrast urogram
Can visualize a non-functional kidney
Which kidney is usually more cranial and much more difficult to visualize on US?
Right kidney
This organ can be used as an "acoustic window" to visualize the R kidney on US
Spleen
Organ often evaluated ultrasonographically at same time as R kidney
Caudate lobe of liver
Which part of the kidney on US is the most hyperechoic?
Renal pelvis (full of fat)
Is the renal medulla or the renal cortex more hyperechoic on US?
Renal cortex
Does the normal renal cortex appear hyperechoic or hypoechoic compared to the spleen on US?
Hypoechoic
True or false: Fluid in the renal pelvis is a definite sign of pyelonephritis on US.
False. May be seen in many animals.
Size of ultrasonographic fluid pocket in renal pelvis considered normal in dog and cat
Dog: 2.0 mm (1-3.8 mm)
Cat: 1.8 mm (0.08-3.2 mm)
Length of the normal cat kidney on US
3.0-4.5 mm
Normal renal length: aortic diameter ratio in dog, as seen on US
5.5-9.1
Renal length in the dog is compared to what on US?
Aortic diameter
Rank the echogenicity of these organs: Spleen, kidney, liver
Spleen> kidney = liver
True or false: It is possible to have diffuse renal disease without any ultrasonographic change
True
Ultrasonographic signs of diffuse renal disease include...
Hyperechoic renal cortex with enhances cortico-medullary distinction
Hyperechoic renal cortex AND medulla
Change in size
Ddx for increased renal size and diffuse changes on US
Amyloidosis
Lymphoma
FIP
Ethylene glycol toxicity
Ddx for decreased renal size and diffuse changes on US
Acute interstitial nephritis
Pyelonephritis
Glomerulonephritis
Hypercalcemic nephropathy
Congenital renal dysplasia
Two conditions in which a hypoechoic halo may be seen on US around a hyperechoic kidney.
FIP
Lymphoma
Casues of focal renal disease
Renal cyst
Renal infarct
Primary and metastatic neoplasia
Abscess
Hematoma
Are chronic renal infarcts hyperechoic or hyperechoic on US?
Hyperechoic
True or false: A heathy bladder should be full of fluid and located deep in the abdomen on US
False: Full and superficial
Ideal radiographic diagnostic test for ruptured bladder
Positive contrast via retrograde cystourethrogram
Thickness of normal bladder wall in small animals
1-2 mm
Common ultrasonographic artefact in the cranial bladder wall when there is free fluid in the abdomen
"Hole" in the wall of cranial bladder
Most urine stasis occurs at this area of the bladder, where focal thickening of the wall may be seen in cystitis.
Cranioventral
Bladder neoplasia commonly occurs at what site?
Bladder neck
In addition to a thickened bladder wall with protrusions, what other ultrasonographic finding may be associated with bladder neoplasia?
Enlarged regional LN
On IVU, this phase of urinary tract visualization happens almost instantaneously.
Vascular phase
After IV contrast is injected, how long before the kidneys are best visualized.
10-30 seconds, up to two minutes
List four radiographic characteristics of kidney disease
Number
Size, shape, and margination
Location
Opacity
Normal radiographic size of the dog kidney.
2.5-3.5 X L2
Average radiographic size of the male cat.
2.1-3.2 X L2
True or false: Older cats tend to have smaller kidneys.
True
(2.4-3.0 X L2)
True or false: Intact male cats tend to have smaller kidneys.
False
(2.1-3.2 X L2)
Normal radiographic kidney size of a young, castrated cat
1.9-2.6 X L2
True or false: In early or acute kidney disease, the kidneys may appear radiographically normal.
True
Multiple radiolucent filling defects seen in the kindeys of a Persian cat likely means...
Polycycstic kidneys disease
Differentials for bilateral kidney enlargement on radiographs
LSA
Bilateral hydronephrosis
Perinephric pseudocysts
Normal urine output in the average horse
5-15L daily
Factors affecting water intake in the horse
Diet
Environmental temp
Water intake
Does renal disease typically cause signs of colic in the horse?
No
Which kidney(s) is/are palpable on rectal palpation of the horse?
Left caudal pole
What diagnostics can reasonably be done on free-catch urine in the horse?
Cytology
Chemistry
NOT culture
When is cystocentesis done on the horse?
Not done
How is horse urine collected for culture?
Sterile catheterization
Crystal type normally present in horse urine
Calcium carbonate
Normal USG in the horse
Over 1.028
Normal pH of horse urine
7.5-8.5
Azotemia in the horse is defined as...
Creatinine over 2.0 mg/dl
Normal serum creatinine in the foal
0.8-1.2 mg/dL
Normal serum creatinine in the adult horse
1.2-1.8 mg/dL
Significance of creatinine in foals under 8h old...
Reflects placental function. If high, check the mare for placental disease.
Is tubular disease or glomerular disease more common in the horse?
Tubular disease
Renal autoregulatory mechanism by which signals from the nephrons adjust glomerular filtration based on tubular solute flows and tubular fluid pressure. This maintains balance between filtered load and reabsorptive capacity.
Tubuloglomerular feedback
Hyperphosphatemia occurs when the horse's GFR is decreased by...
85-90%
Sources of GGT
Biliary tree, pancreas, and renal tubular cells
Normal urine GGT:creatinine ratio in the horse
10 to 25
Significance of an elevated GGT:creatinine ration in the horse
Renal tubular injury
Normal endogenous creatinine clearance in an adult horse per minute
1.8 mL/kg/min
Fractional excretion in the horse is highest for which electrolyte? Na, Cl, K, P?
K, due to high potassium intake of horses
What are some indications for urethral endoscopy in the horse?
Hematuria
Suspected pyelonephritis
Urine scalding
Suspected bladder stone
Oliguria, uroperitoneum in foals
Is it normal for a horse to have urethral bleeding when passing an endoscope?
Yes
From where in the urinary tract should urine be sampled via catheter, to rule out pyelonephritis in the horse?
Ureter
Persistent urachus may be normal up to what age in the foal?
10 days
Horse kidney most accessible for biopsy
Right kidney b/c fixed against body wall.
2 reasons that catheterization is impractical in the bovine
Suburethral diverticulum
Sigmoid flexure
Congenital abnormality of hemoglobin that causes discolored urine and pink teeth
Porphyria
A bovine has red urine and normal serum. CK and AST are elevated. What is the source of the red urine?
Myoglobin
Easy way to determine whether red urine is true hematuria
Centrifuge the urine and get a RBC pellet at the bottom of the tube with clear supernatant
Normal range of bovine USG
1.020-1.040
Causes of a urine pH over 8.5 in the bovine
Metabolic alkalosis
Bacterial infections of urinary tract
Causes of urine pH under 7 in the bovine
Lactic acidosis and paradoxic aciduria
Test used to acidify a sample of alkaline urine (with sulfosalicylic acid) so that protein may be more accurately measured
Bumin test
Bacterial count above which a bacterial infection of the bovine urinary tract is suggested
>100,000 (free-catch)
Four parameters on a urinalysis that will usually be elevated in the event of UTI.
WBC, RBC, protein, bacturia
List some of the CS associated with renal disease in the bovine
Dullness
Inappetance
Dysuria
Dehydration
Tachycardia
Fever
Diarrhea
Nephromegaly
Weakness
Bleeding diathesis
Which kidney is usually palpable in the bovine?
Left only
Will the WBC count in bovine with pyelonephritis be elevated or decreased?
Elevated
Will the WBC count in the bovine with an acute septic disorder be elevated or decreased?
Decreased
Two most common kidney diseases in cattle
ATN and glomerulonephritis
Criteria for azotemia in cattle
BUN > 20 mg/dl
Creatinine > 2.0 mg/dl
Is prerenal azotemia usually mild or severe?
Mild
Is BUN or creatinine a better indicator of azotemia in cattle? Why?
Creatinine b/c rumen microflora effectively reduce circulating concentration of BUN by the rumen reutilization cycle
Describe the typical electrolyte abnormalities seen in the bovine with renal disease
Hyponatremia
Hypokalemia
Hypochloremia
Describe the typical mineral abnormalities seen in the bovine with renal disease
Hypocalcemia
Hyperphosphatemia
Hypermagnesemia
In the bovine, is the creatinine clearance ratio or phenosulfopthalein test done more frequently to evaluate renal function?
Creatinine clearance ratio
Test that compared the concentration of an electrolyte or mineral in the serum and urine to the level of creatinine in the urine and serum.
Creatinine clearance ratio
Normal CCR Na in cattle
Under 1%
Caustion should be used when interpreting CCR Na in bovines that have been receiving...
Na rich fluids
Dye excretion test used to evaluate renal function in the bovine
Phenosulfopthalein
How is the left bovine kidney visualized on US?
Per rectum
How is the right bovine kidney visualized on US?
Per-cutaneously
Two causes of acute tubular necrosis in the bovine
Renal ischemia caused by endotoxemia or prolonged, severe hypotension
Nephrotoxins
Diseases that may cause renal ischemia in the bovine include
Mastitis
Metritis
Enteritis
Peritonitis
(Overall, acute septic diseases)
List some mephrotoxic drugs given to the bovine
Sulfonamide, tetracycline, NSAIDs
List some nephrotoxic plants a bovine with ATN may have eaten
Oak, pigweed, halogeton
List some heavy metals that may be nephrotoxic
Arsenic, mercury, cadmium, lead
List two nephrotoxic endogenous substances
Hemoglobin
Myoglobin
CS of acute tubular necrosis in the bovine
Dullness
Inappetance
Dehydration
Oliguria--> polyuria
Weakness--> recumbency
Nephromegaly
Bleading diathesis
Diarrhea
Dye excretion test used to evaluate renal function in the bovine
Phenosulfopthalein
How is the left bovine kidney visualized on US?
Per rectum
How is the right bovine kidney visualized on US?
Per-cutaneously
Two causes of acute tubular necrosis in the bovine
Renal ischemia caused by endotoxemia or prolonged, severe hypotension
Nephrotoxins
Diseases that may cause renal ischemia in the bovine include
Mastitis
Metritis
Enteritis
Peritonitis
(Overall, acute septic diseases)
Pyelonephritis in cattle is caused by either...
Corynebacterium renale
E. coli
CS of pyelonephritis in the bovine
Dullness/inappetance
Fever
Wt loss
Dysuria (stranguria, hematuria, pyuria)
Abnormal rectal exam with thickened bladder and enlarged ureters and kidneys
CBC abnormalities seen in the bovine with pyelonephritis
Neutrophilia +/- left shift
Monocytosis
Hyperfibrinogenemia
Urinalysis abnormalities in the bovine with pyelonephritis
Increased protein
Increased RBC, WBC
Bacteria (>100,000 per ul)
Occasional leukocyte casts
True or false: Patients with unilateral pyelonephritis will be azotemic.
False
Renal azotemia occurs when what % of nephron function is lost?
75%
Tx of bovine pyelonephritis
Antimicrobials
Fluids
Urinary acidification
Antibiotic used to treat bovine pyelonephritis caused by C. renale
Penicillin
Antibiotic used to treat bovine pyelonephritis caused by E. coli
Ampicillin
Ceftiofur
How long should antibiotic therapy for bovine pyelonephritis continue?
2-4 weeks
Urine acidifying agent used to treat pyelonephritis in the bovine
Ammonium chloride 50-100 mg/kg BID
Good prognostic indicators for bovine with pyelonephritis
Treatment with proper antimicrobial early in the course for 2-4 weeks
List some ways in which bovine pyelonephritis may be prevented.
Isolation of cattle during treatment
Destroy contaminated bedding
Adequate cleaning of vulva prior to examination or treatment of repro tract
Artificial insemination
Normal voiding pressure in the bladder
90 mmHg
Why is lumenal suture contraindicated in equine bladder surgery?
Alkaline urine causes a more rapid breakdown of absorbable suture
This class of anesthetic drugs causes dose-dependent diuresis.
Alpha-2 agonists
The umbilical vein regresses into what structure?
Falciform ligament
The umbilical arteries regress into what structures?
Round ligaments of the bladder
Treatments for a non-infected patent urachus include...
Systemic TMS or gentamycin
Daily cleansing with chlorhexidine
Cautery with silver nitrate sticks
2-3% iodine
Surgery if still patent in 3-4 days
Typical agent causing infected umbilical remnant in the calf.
A. pyogenes
How is umbilical infection diagnosed?
Ultrasound
In the calf, the umbilicus will be large, hot, firm, and painful.
Uroperitoneum typically presents itself at what age in the foal?
2-3 days
Maintenance fluid rate in the foal
2% BW per hour
CS of uroperitoneum in the foal
Lethargy, anorexia, abdominal distension, dehydration, tachycardia, tachypnea, little or no urination
How often should a neonatal foal urinate?
Every time they nurse
Electrolyte abnormalities associated with uroperitoneum in the foal.
Azotemia
Hyponatremia
Hypochloremia
Hyperkalemia
This peritoneum:serum creatinine ratio is indicative of uroperitoneum.
Over 2.1
How do you address hyperkalemia in the foal?
IV NaCl
Dextrose 0.5 mg/kg IV
Repair of a rent in the bladder
Cystoplasty
Closure of a bladder incision
Cystorraphy
List some modes of treatment for umbilical hernia.
Manual reduction
Hernia belt
Surgery
Clamp- RUMINANTS ONLY
Most common large animal uroliths
Type I: CaCO3
Type II uroliths are made up of...
Hydrated Ca salts
Type of urolith associated with high dietary Mg
Type I, CaCO3