CA 2

What clinical signs are associated with uremia?

• Lethargy

• Depression

• Reduce appetite

• Vomiting

• Weight loss

What can cause increase USG?

• Pre-renal azotemia

• Proteinuria→ hypoalbuminemia

• Glucosuria

• Radiographic Contrast Media

What can cause decrease USG?

• Renal azotemia with proteinuria

• Glucocorticoids

• Diuretics

• Anticonvulsants

• Low persistent proteins

• High salt diets

• Aminoglycosides

• Anuria, Oliguria, Polyuria

What disease form is indicative of uroabdomen?

Post-renal azotemia; abdominal fluid creatinine concentration > serum creatinine

What solutes are actively measured in Urine Osmolality?

• Na

• Cl

• Urea

What factors are primary determinant of USG?

• Number

• Molecular size

• Weight of solutes

• Food/Water intake

• Non-renal H₂O loss

Purpose of Refractive index?

• USG

• Osmolality

What are essential for interpreting USG readings?

• Hydration status

• Plasma/Serum concentrations of urea and creatinine

• Drugs

• Urine production

• Water consumption

On chemical examination using reagent strip method, what parameters are assessed for urinalysis?

• pH, proteins, ketones, glucose, heame (occult blood), bilirubin

What can cause acidic urine pH?

• Escaped CO₂ from the sample

• Diet: High protein, milk, and grain

What can cause alkaline urine pH?

• High forage

• Vegetable diet

• Cystitis (urea → NH₃)

• Staphylococcus or Proteus

What can cause proteinuria?

• Hemorrhage in urinary tract

• Inflammation

• Renal disease- glomerular/tubular disease

• Pre-renal- fever, CNS disease, cardiac disease, shock, bence jones proteins in plasma cell myeloma

• Colostral proteins in foals, calves, kids, lambs <40hrs old

What tests are done to assess proteinuria?

• Dipstick

• SSA- Sulfosalicylic acid

• UPC ratio

What are some characteristics of dipsticks?

• Albumin is main marker

• Cannot detect globulins, Bence-jones proteins, mucoproteins

• False positives: alkaline urine and genital secretions

What are some characteristics of SSA?

• Used only in alkaline urine

• Detect Bence-jones proteins

What does not influence UPC ratio?

• Age, sex, activity, and dietary protein

What can cause glucosuria?

• Hyperglycemic states: Diabetes Mellitus, Fluid Therapy, Stress/Epinephrine Induced

• Renal tubular damage: Inability to reabsorb glucose in proximal tubules due to toxins (gentamycin) and ischemia.

What false positives and negatives can occur using glucose reagent strips?

• False positives: Oxidizing agents: H₂O₂, bleach

• False negatives: Low temperature urine with ascorbic acid

What can cause ketonemia?

• Increased lipolysis

• Degradation of fatty acids to ketones in the liver

• Diabetes Mellitus

• Starvation

• Low carbohydrate/ high fat diets

• Pregnancy and lactation

What can cause false ketonemia?

• Aspirin, captopril, and stale urine samples

What are some characteristics of bilirubinuria?

• Ictotest method or reagent strip (dipstick)\

• Bilirubin is not found in the normal urine of horse, sheep, pig, and cat

What four crystals are found in urine normally?

• Calcium oxalate dihydrate

• Triple phosphate (Magnesium ammonium phosphate/struvite)

• Calcium carbonate

• Bilirubin

What four crystals are found in urine that are pathlogical?

• Sulphonamide

• Calcium oxalate monohydrate

• Ammonium biurate and tyrosine

• Bilirubin

When GFR is decreased, what can occur?

• Elevated BUN and Creatinine

• Increase SDMA

What can cause increase urea?

• Decrease GFR- pre,renal,post

• Extra-renal- fever, cachexia, high protein diet, GI hemorrhage

What can cause decrease urea?

• Increase excretion-PU/PD

• Low protein diet

• Hepatic insufficiency

What abnormalities encompasses Nephrotic Syndrome?

• Proteinuria, hypoalbuminemia (decrease in oncotic pressure), hypoproteinemia, hypercholesterolemia, edema, thromboembolism, dyspnea

What are the Creatinine Kinase Isoenzymes and their location?

• (CK-BB) CK₁ in brain, CSF, peripheral nerves, and viscera

• (CK-MB) CK₂ in cardiac muscle

• (CK-MM) CK₃ in skeletal and cardiac muscle

What can cause increase Creatinine Kinase (12hrs)?

• Skeletal muscle injury- necrosis, ischemia, recumbency, trauma, hyperthermia, heat stroke, strenuous exercise, convulsions, injections, myositis (Toxoplasma, Neospora), myopathies (toxic, nutritional, congenital), exertional rhabdomyolysis, nutritional muscular dystrophy, white muscle disease, seizures, captive myopathy

• Cardiac muscle injury

• Muscle catabolism- supply of amino acids for protein and glucose synthesis

• False increases- in-vitro hemolysis, venipuncture

What causes increase in AST (24-48hrs)?

• Muscle or hepatic injury

• In-vitro hemolysis (false)

What is the correlation with CK and AST?

• >CK and AST: muscle injury/myonecrosis

• >CK and normal AST: Myonecrosis

• >AST and normal CK: Hepatic injury

What are some characteristics of the muscle enzymes?

• SDH is the test for AST and ALT

• ALT assesses skeletal muscle

• Myoglobin increases in severe and acute

• Myoglobin is tested using a urine dipstick

• Myoglobin does not discolour plasma, but only causes reddish/brown urine

What are some serum tests used for muscle injury?

• Myosin light chain assay- inflammatory muscle disease and myocardial infarction

• Cardiac troponin I & T assay- myocardial disease and cardiac muscle injury

What can be as a result of increase muscle injury?

• Hyperkalemia

• Hyperphosphatemia

• Hypocalcemia

• Hyponatremia

What are the mandatory information needed for a sample?

• Where the sample was acquired

• Pertinent history

• Physical exam findings

• Animal name and site

What are some risks associated with fine needle biopsy?

• Hemorrhage

• Abscess rupture

• Dissemination of an infectious agent

• Seeding of neoplastic cells