Lecture 9 Flashcards by Danika Boltz

Why is it important to observe urination in large animals?

-determine stream strength
-identify stranguria vs. tenesmus
-identify any blood in urine

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What are the external genitalia components in male and female large animals?

-males: sheath and/or prepuce
-females: vestibule

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Which components of the urinary system can be felt on rectal palpation?

-pelvic urethra
-bladder
-left kidney
-ureter (if enlarged)

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Which components of the urinary system can be identified via transcutaneous ultrasound?

-both kidneys in horses, pigs, camelids
-right kidney only in ruminants
-bladder in smaller animals

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Which components of the urinary system can be identified via transrectal ultrasound?

-left kidney
-ureters
-bladder

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What are the characteristics of urine sample collection and handling in large animals?

-free catch can be utilized in all animals
-catheterization possible in all horses and female ruminants, camelids, and sows
-fresh sample is best but not always possible
-want to perform dipstick and USG on farm
-refrigerate sample to do sediment analysis later
-place portion of sample in red top tube for culture

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What prevents catheterization in male ruminants?

sigmoid flexure

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What are the characteristics of urinary catheters used in large animals?

-5 to 28 French
-30 to 55 cm long
-foley catheters used for retention

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What components of blood can be seen in the urine?

-intact RBCs
-hemoglobin
-myoglobin
-bilirubin
-methemoglobin

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What are the characteristics of urine sediment examination?

-necessary to accurately interpret dipstick findings and complete urinalysis
-can see casts, cells, crystals, and organisms

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Which crystal type is normal in horse urine?

calcium carbonate crystals

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What are the characteristics of radiology as a tool for assessing the urinary tract?

-can do lower urinary tract imaging in small ruminants, foals, camelids, pigs, and calves
-can do cystography or urethrography contrast studies

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What are the uses of endoscopy in assessing the urinary tract?

-identify the source of blood
-determine if one kidney is outperforming the other

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What are the characteristics of advanced imaging for the urinary tract?

-CT and MRI can be done in smaller large animals only
-nuclear scintigraphy used for anatomic detail studies and GFR calculation

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What are the causes of AKI in large animals?

*pre-renal:
-hemodynamic or vascular nephropathy

*renal:
-toxic nephropathy
-inflammation
-immunologic disorders

*post-renal:
-acute inflammation
-obstruction

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What can cause hemodynamic or vascular nephropathy?

-decreased circulating volume
-endotoxic direct vascular injury
-NSAIDs
-ischemia

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Which inflammatory conditions can cause renal injury?

-pyelonephritis
-interstitial nephritis

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Which immunological disorder can cause renal injury?

glomerulonephritis

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Which plants cause tubular necrosis or pigment nephropathy?

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-oak
-red maple
-wild onion
-white snake root
-oxalate-containing plants

Which heavy metals can cause renal injury?

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-mercury
-arsenic

Which nephrotoxic drugs can cause renal injury?

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-aminoglycosides
-oxytetracyclines
-sulfonamides

What are the post-renal causes of AKI?

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-urinary calculi/obstruction
-urinary bladder or urethral rupture
-trauma

What are the specific clinical signs of AKI?

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-anuria
-oliguria
-polyuria (acute tubular necrosis)
-edema (PLE)

What are the characteristics of lab data and AKI?

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-no lab tests are pathognomonic for AKI
-azotemia + isosthenuria = decreased function
-will see hypoNa, hypoCl, and hyperK as tubules fail
-hypoCa and hyperP seen
-SMDA is validated for horses

What are the characteristics of urinalysis in AKI?

-USG < or = 1.020 in face of dehydration or azotemia -urine discoloration -proteinuria; mild if tubule dz, moderate/severe if glomerular or pyelonephritis -granular casts, WBC, and/or RBCs on sediment

What are the normal values for fractional clearance of sodium and phosphorus in horses and cattle?

-sodium: 0 to 1% -phosphorus: 0.04 to 0.5%

What are the characteristics of urine GGT/creatinine ratio?

-GGT released from damaged proximal tubular cells into urine -not prognostic but good screening test for tubular damage -normals validated for horses; < 100 mg/dl

What are the characteristics of kidney dz in neonates?

-foals are born with non-functional kidneys -want to use age-appropriate normals for lab tests -look for congenital or peri-partum causes of AKI -urine should be hyposthenuric if nursing adequately after 2 to 3 days of age

What are the keys to preventing and treating AKI?

-correction of fluid, acid/base, and electrolyte imbalances -oral/enteral fluids if GI functions well -IV fluids if severe dehydration or ileus

What are the specific treatments for oliguria despite 10-12 hours of IV fluids?

-furosemide -dopamine in 5% dextrose -mannitol 20% -electrolytes and glucose as needed

What are the specific treatments for anuria?

-fluids -monitor urine output via catheterization -measure central venous pressure -electrolytes and glucose as needed

What are the supportive care measures for AKI?

-good quality protein diet -monitor hydration closely -no nephrotoxic drugs

What is the process for peritoneal dialysis?

-abdominal drain placed in peritoneal cavity -abdomen filled with sterile fluids -fluids drained out after long enough time

What is the pathophysiology of CKD?

-progressive loss of nephron function and/or population -sequela to AKI if not reversible

What are the characteristics of amyloidosis?

-deposition of beta-pleated sheet fibrils -occurs in kidneys, liver, adrenal glands, GI tract, sinuses, and skin -sporadic in cattle; occasional in sheep and goats; rare in horses

What are the characteristics of immune-mediated glomerulonephritis?

-deposition of Ag/Ab complexes -most common in dairy cattle -associated with pregnancy toxicity in small ruminants -seen in horses with history of severe infection or vasculitis

What are the clinical signs of CKD?

-chronic weight loss -PUPD -nephrotic syndrome signs -enlarged kidneys -diarrhea -liver failure

What are the characteristics of tubulointerstitial CKD?

-sequela to acute tubular necrosis, hemodynamic AKI, nephritis, or nephrotoxin -initial cause often unknown

What are the clinical signs of tubulointerstitial CKD?

-chronic weight loss -anorexia -PUPD -possible changes in kidney size; based on cause

What are the characteristics of azotemia?

*if accompanied by polyuria: -stable -compensating -better prognosis *if accompanied by oliguria: -acute on chronic issue or end-stage

What are the lab finding suggestive of glomerular failure?

-persistent proteinuria -hypoproteinemia/hypoalbuminemia

What are the other laboratory findings seen in CKD?

-tubulointerstitial failure -hypophosphatemia -hypercalcemia

What are the diagnostics for CKD?

-clinical findings -blood work -UA -ultrasound of kidneys -renal biopsy

Which conditions require renal biopsy for confirmatory diagnosis?

-glomerulonephritis -amyloidosis

What are the steps to CKD therapy?

-determine if acute component is present -correct underlying problem(s) first -provide fluids and electrolytes as needed -provide forage and concentrate with good bioavailable protein -add fat to diet to increase caloric intake -supplement with NaCl and sodium bicarb. as needed unless edema present -remove high calcium feeds if hypercalcemic -control severe edema with diuretics

What are the characteristics of CKD in the oliguric phase?

-often treated with fluid therapy and supportive care -poor prognosis -dialysis prolongs life for short time but is not often practical

Lecture 9 Flashcards

(46 cards)