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Clin Path Quiz 15/16
Lecture 15: Kidneys
| Question | Answer |
|---|---|
| urinary system components | kidneys, ureters, urinary bladder, urethra |
| anatomy of the kidneys | located in the retroperitoneal space, connected to the bladder by the ureter |
| nephron | functional unit of the kidney and consists of glomerulus, proximal tubule, loop of Henle, distal tubule, collecting ducts |
| kidney function | filter plasma and remove wastes, regulate fluid volume in the body, regulate electrolyte concentrations, help maintain acid/base balance, produce erythropoietin which stimulates RBC productions, produce calcitriol (activated vit. D) |
| nephron function | conserves sodium, chloride, bicarbonate, calcium, magnesium, glucose, amino acids, and water; excretes urea, creatinine, potassium, hydrogen, ammonium, phosphate |
| to see normal conservation and excretion there must be a rate of plasma filtration in the glomeruli = | glomerular filtration rate (GFR) and the epithelial cells lining the ducts must be able to reabsorb and secrete these constituents appropriately |
| GFR | the rate of plasma conversion to glomerular filtrate; this is what we aim to measure to determine kidney function, there are expensive, difficult ways to precisely measure this, but we focus on the indirect measures routinely used in practice |
| GFR can be affected by | cardiac output, blood volume, patency of the glomerular arterioles, number of functional glomerul present, hydrostatic present within Bowman's capsule |
| lab testing to measure GFR (kidney function) | blood urea nitrogen, creatinine (inc. = azotemia), SDMA, urinalysis |
| blood urea nitrogen (BUN) | byproduct of nitrogen metabolism, produced by hepatocytes (liver cells) from ammonium and excreted by the kidney was a waste product; routinely measures on in-house blood chemistry tests |
| build up of BUN in the blood indicates... | decreased clearance by the kidneys |
| creatinine | synthesized in muscles from the conversion of creatine and creatine phosphate into creatinine, production at a constant rate in the body, filtered by the glomerulus and is not reabsorbed by tubules |
| creatinine test | more specific test of kidney function. does not increase as quickly as BUN with pre-renal causes |
| azotemia | when BUN and creatinine are both elevated, can be broken down into 3 types: pre-renal, renal, post-renal |
| pre-renal azotemia | elevated BUN and creatinine due to decreased renal blood flow, we will see concentrated urine with pre-renal azotemia b/c body is trying to conserve water |
| common cause of pre-renal azotemia | DEHYDRATION, will see decreased urine production |
| renal azotemia | kidney disease that causes damage to greater than 75% of the nephrons, reduced GFR decreases the excretion of urea nitrogen and creatinine |
| renal azotemia indicates | kidney failure or kidney insufficiency, decreased abilit to do their job |
| post-renal azotemia | outflow obstruction (obstruction could be in kidney, ureter, bladder, or urethra); example is cats w/ urethral blockages due to bladder stone or crystal formation |
| increase of BUN alone | azotemia with creatinine increase, GI hemorrhage (bleeding), protein-rich meals, fever |
| decrease of BUN alone | liver failure, PSS, malnutrition, hyperthyroidism, diuresis |
| increase of creatinine alone | azotemia (pre-renal, renal, post-renal) with BUN increase |
| decrease of creatinine alone | decreased muscle mass from starvation or muscle wasting (cachexia) |
| SDMA | symmetric dimethylarginine, a renal biomarker to be run with BUN and creatinine and urinalysis to diagnose kidney disease, form of amino acid that is released into circulation when protein is broke down |
| SDMA test | increases with 40% kidney damage' a specific indicatory of kidney disease and will indicate kidney disease EARLIER than BUN and creatinine |
| albumin | increased with DEHYDRATION, decreased with kidney disease; same mechanism causes an increase in proteins in the urine (proteinuria) |
| electrolyte abnormalities related to kidney disease | calcium and phosphorous, sodium and chloride, potassium and magnesium |
| PCV | increased with DEHYDRATION, decreased with chronic renal failure (nonregenerative anemia) |
| other values that can be related to kidney disease | cholesterol, parathyroid hormone, vitamin D, lipase and amylase, GGT |
| urinalysis | urine specific gravity, ability of the kidneys to concentrate urine; urine protein, primarily detects albumin in the urine |
| normal canine urinalysis | 1.015 - 1.045 (1.025) |
| normal feline urinalysis | 1.035 - 1.060 (1.035) |
| decreased urinalysis causes | overhydration, decreased renal function |
| increased urinalysis causes | dehydration -> pre-renal azotemia |
| symptoms of older cats with chronic kidney disease (CKD) | decreased appetite or anorexia, weight loss, PU/PD, , greasy or unkempt coat, lethargic, sometimes bad breath, increased vomiting (food or bile) |
| symptoms of acute kidney disease | sudden onset, reversible or irreversible; ammoniacal breath, mucosal ulcers, vomiting, diarrhea, neurological signs, coma, anuria, oliguria, electrolyte and acid-base abnormalities (hyperkalemia) |
| causes of acute kidney disease | toxicity, infectious diseases, decreased blood flow to kidneys (can be caused by sedation and anesthesia) |
| causes of chronic kidney disease | immune mediated diseases, infectious disease, congenital abnormalities, toxins, neoplasia |
| symptoms of CKD | PU until end stage then anuric/oliguric, non-regenerative anemia, hypocalcemia, electrolyte and acid-base abnormalities, steady weight loss, poor BCS, lethargy, PU |
| laboratory findings of acute kidney disease | azotemia, normal to elevated PCV, normal to elevated albumin, increased potassium (hyperkalemia |
| laboratory findings of chronic kidney disease | azotemia, decreased PCV 9non-regenerative anemia), hypoalbuminemia (decreased albumin), hypocalcemia (decreased calcium), hypokalemia (decreased potassium) esp in cats and cows |
| uremia | increased in waste products in the blood WITH clinical signs of kidney disease |
| fluids | treatment for any kidney disease or injury will include some form of fluid therapy for rehydration, dilution, increase glomerular filtration rate |
Created by:
mkroon26
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