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Terms in this set (59)
Small amounts of urine frequently
Straining to urinate
urinating where you shouldn't
What are the typical lower urinary tract signs
pollakiuria, stranguria, periuria, +/- hematuria, lack of systemic illness
What are the primary rule outs for lower urinary dz
Infection, urolith, neoplasia, inflammatory, behavioral, extraluminal obstruction, neuro disease
What 2 potentially zoonotic bacterial agents are carried in the genito-urinary tract of animals?
Brucella canis (repro)
What drug do you give in acute cases of lepto
Which stones are radioopaque
calcium oxalate, struvite, silicate (remember I can't CU --cysteine, urate)
Which stones are low pH
calcium oxalate, silicate, cysteine
Which stones are alkaline
Which stones can be medically dissolved
struvite, urate, cysteine
What's the classic predisposition for calcium oxalate
schnauzers and cats on an acidic diet, these are normal in horses
What's the classic predisposition for struvites
UTI or FLUTD cats
What's the classic predisposition for urates
What's the classic predisposition for silicates
Middle-aged G. shep and Goldens. Associated with dietary intake of silicates (dirt, etc.)
What's the classic predisposition for cysteines
Secondary to tubular transport defect. Common in male Dach., Bassetts, E. bulldogs, yorkies, Irish terriers, etc.
Polyuria is defined as urine output in excess of ____ mL/kg/day
Water intake should not exceed ____ mL/kg/ day in a normal animal
USG should always be interpreted in relation to what?
What are the 3 main differentials for PU/PD in a dog?
Chronic kidney disease
What are the 3 main differentials for PU/PD in a cat
Chronic kidney disease
What range is isosthenuria
With what USG can you rule out kidney failure
below 1.004 and above 1.30
How can you determine the origin (pre, renal, or post renal) of the azotemia?
Urine specific gravity
If urine is concentrating fine, it is pre-renal
If urine is dilute, it is likely renal
USG may be varied with post-renal
What are the ranking differentials for pre-renal azotemia?
Shock, hypovolemia, dehydration
clinical syndrome; presence of urine constituents in the blood
There needs to be approximately ____% loss of GFR before azotemia becomes apparent on blood work
Which is better at estimating GFR, BUN or Crea
What else can affect BUN other than GFR
Albumin is the major protein detected on the urine dipstick. What other components may result in a + protein?
Bacteria, white cells, red cells
SSA may be used to detect smaller proteins. What drug history would interfere with this test?
Penicillin & cephalosporin will give a false positive
SSA may help look for Bence-Jones protein. What condition is this associated with?
To get a better evaluation of proteinuria and UPC ratio, how should samples be collected & tested?
ratio, how should samples be collected & tested?
Use a pooled sample; 3 separate days combined
UPC should only be done in "quiet" sediment and at least 2 samples
A UPC >2.0 in quiet sediment is usually associated with what disease process?
A UPC of >____ in cats and >_____ in dogs is considered "abnormal". If UPC is less than 2.0, what area of the kidney is likely affected?
0.4, 0.5, tubules
A UPC >____ is highly suggestive of amyloidosis
What 3 parameters may be increased in the chemistry panel and indicate pre-renal proteinuria?
Increase in globulins (inflammation)
Increase in myoglobin (blood on dipstick will be +)
Increase in hemoglobin (hemolysis on chemistries, dipstick blood +, but no RBC in sediment)
UPC may help differentiate these. If UPC is >2.0, it is likely tubular <or> glomerular
What parameters may indicate tubular damage over glomerular?
Glucosuria with normoglycemia on chemistries,
Urinary casts on microscopic examination, UPC>2.0
What is the only definitive way to differentiate tubular from glomerular
If you see gross hematuria and pyuria and lower UT signs what broad differential is at the top
What further diagnostics would you want to do if you see gross hematuria and pyuria
culture-- could be pyelonephritis (may not see azotemia or clinical signs)
What is the first line of treatment for proteinuria
ACE inhibitors (enalapril), low protein diet, amplodipine, asprin
Important things to tell clients if their animal has chronic kidney disease
This is a progressive,
condition. But animals can live months to years and have excellent quality of life
How does the mechanism differ in dogs vs. cats for chronic kidney disease?
Dogs is typically glomerulopathies
Cats is usually tubulointerstitial nephritis
How is an accurate IRIS stage determined?
2 measurements of CREA in a
What 2 tests are necessary to substage a patient for CKD and why is substaging important?
UPC & blood pressure
Substaging is related to prognosis. Tests that are abnormal should be treated to slow progression of disease
What is IRIS stage 1 CKD
Non-azotemic but some other renal abnormality present (like lack of concentrating ability)
What is IRIS stage 2 CKD
Mild azotemia (CREA 1.4-2.0 in dogs; 1.6-2.8 in cats); usually no or mild clinical signs
What is IRIS stage 3 CKD
Moderate renal azotemia. Many extra-renal clinical signs present
CREA 2.1-5.0 in dogs; 2.9-5.0 in cats
What is IRIS stage 4 CKD
Increasing risk of clinical signs & uremic crises
CREA >5.0 (both dogs & cats)
Arterial blood pressure. What are the high-risk values for systolic & diastolic in IRIS CKD substaging?
Systolic > 180 mmHg
Diastolic > 120 mmHg
What is the main cause of hypokalemia in CKD cats?
Polyuria; so much urination there is no time for reabsorption
When would you begin KCl supplementation?
When serum is low-normal. Do NOT wait until it falls below normal!
What factor complicates interpretation of potassium in CKD cases?
Animals are often acidotic. K may appear "normal" due to shifts to correct metabolic issue
Anemia in chronic kidney disease is regenerative <or> non-regenerative
How do you calculate a fluid deficit?
% dehydrated * kg = Amount in LITERS
Example. A 30 kg animal that is 5% dehydrated has a fluid deficit of : 0.05 (30 ) = 1.5 L * 1000 = 1500 mL
Is proteinuria ever normal?
Can be physiologic/transient
Fever, strenuous exercise, etc.
This is why we do several samples. Check for persistent proteinuria