Clin Path of Upper and Lower Urinary Tract

True or False: Azotemic and proteinuric renal disease often occur independently as they have different pathophysiologies, but you can have both at the same time.

True!

In order to properly classify renal disease as either azotemic or proteinuric, you must alwaysW perform a ---.

Urinalysis

What THREE things are often increased and collectively referred to as "azotemia?"

1. BUN

2. Creatinine

3. SDMA

Diseases causing decreased GFR is associated with (azotemic/proteinuric) renal disease.

Azotemic

What TWO things characterize azotemic renal disease?

1. Azotemia

2. Hyperphosphatemia

What must be performed to classify an azotemic renal disease as pre-renal, renal, or post-renal?

Specific gravity (USG)

What is the major difference between pre-renal and renal azotemic disease?

Pre-renal: concentrated

Renal: isosthenuric or not concentrated

What is the most common cause of pre-renal azotemia?

Dehydration

True or False: Any time an animal is dehydrated, there is a pre-renal component.

True!

Post-renal azotemic disease is almost always associated with ---------- and is not classified by USG.

Urinary obstruction

True or False: USG should always be taken with the clinical picture of the patient. Dilute urine would be more significant in a PU/PD animal than one apparently healthy.

True!

What is the isosthenuric (same as plasma) urine specific gravity range?

1.008-1.012

True or False: 1.012-1.035 is a "grey zone" of urine specific gravity and should be dependent on the clinical picture.

True!

What is the best way to tell if an azotemic renal disease is acute or chronic?

Acute: high K+

Chronic: low K+

How can you best determine the cause of azotemic renal disease?

History, signalment, diagnostic tests

True or False: Proteinuric renal disease starts with a diagnosis of proteinuria, which always indicates proteinuric disease.

False! Proteinuric renal disease starts with a diagnosis of proteinuria, but does NOT always indicate proteinuric disease.

What are the major differentials for pre-renal, renal, and post-renal proteinuric disease?

Pre-renal: small blood proteins increased; spillover into urine; HgB/myoglobin

Renal: filtration barrier damaged (tubular vs glomerular)

Post-renal: Protein from bladder disease (blood/WBC/bacteria)

What kind of proteinuric disease/classification is the most commonly seen and is associated with UTIs and active sediment?

Post-renal

What TWO things classify proteinuric renal disease?

1. Proteinuria

2. Hypoproteinemia (albumin)

Protein-losing nephropathy and nephrotic syndrome are associated with (azotemic/proteinuric) renal disease.

Proteinuric

What must be performed to confirm a proteinuric renal disease?

UPC (Urine protein:creatinine ratio)

You should NOT do a UPC if there is an ------------.

Active sediment

How do you use UPC to distinguish tubular vs glomerular proteinuric renal disease?

Tubular: UPC 0.8-1

Glomerular: UPC >1 maybe, definite if >2

(Grey zone is 0.5 since normal is 0.1-0.2)

How can you go about determining the cause of proteinuric renal disease?

Further diagnostics (imaging, biopsy)

True or False: Only RBCs will increase the blood parameter on a urinalysis.

False! RBCS, Hemoglobin, and Myoglobin will all increase the blood parameter on urinalysis.

True or False: There will be more of a dramatic acidosis shift in acute urinary disease as opposed to chronic.

True!

What is often low on a chemistry if the patient is severely acidotic?

Bicarbonate (TCO2)

True or False: If you see granular casts and crystals on a urinalysis, you should not perform a cystocentesis due to the active sedment.

False! This is NOT considered active sediment. Active sediment is only RBC, WBC, and bacteria.

-------- crystals are coffin lid-shaped and ----------- are envelope-shaped.

Struvite

Calcium oxalate

What should you think if you see transitional epithelial cells with atypical morphology?

Is this pathogonomic?

Bladder neoplasia

No, it can also be seen with inflammation and other things. It should spur you to do additional diagnostics (u/s, BRAF, etc.)