Urology Study Flashcards: Key Terms & Definitions in Medicine

micturition

the act of urination

dysuria

difficult or painful urination

stranguria/strangury

straining to urinate

pollakiauria

increased frequency of urination (typically smaller volumes each time, adding up to normal daily total)

polyuria

increased total volume of urine

polydipsia

increased water consumption

oliguria

decreased total volume of urine

anuria

lack of urination (no production)

polyuria, polydipsia, anorexia, lethargy, vomiting

What clinical signs are related to the kidneys?

dysuria, strangury, pollakiuria, incotinence

What clinical signs are related to the lower urinary tract?

pigmenturia

What clinical signs can be from both the kidneys and lower urinary tract?

40-60ml/kg/day

What is normal water intake for a large animal?

5-20mL/kg/day

What is normal urine output for a large animal?

depression, weight loss, anorexia, polydipsia, polyuria, pigmenturia, anuria

What are the clinical signs associated with urinary tract disease?

observe urination, observe behavior from a distance, general examination, edema, umbilicus in neonates

What should be examined when performing a large animal physical exam for a urinary tract issue?

kidneys, bladder, ureters, urethra

What urinary structures can be felt on rectal palpation in the horse?

left kidney, ureters, bladder, urethra

What urinary structures can be felt on rectal palpation in the cow?

kidneys for size, shape, symmetry, bladder for size, firmness/flaccidity, discomfort, stones

What urinary structures are abdominally palpated in small animals?

conformation, urine leakage, discoloration/staining, skin health, pale mm, oral ulcers, body condition, muscle mass, edema, ascites, encephalopathy, cardiac changes

What external features should be examined in small animals with urinary issues?

serum chemistry, CBC

What blood tests should be performed for urinary issues?

urinalysis, UPC, cultures

What urine tests should be performed for urinary issues?

intravascular volume, cardiac output, systemic blood pressure, afferent vs. efferent arteriolar tone

Vascular hydrostatic pressure is affected by what?

DCT/collecting ducts

Where does the concentration of urine occur?

concentration gradient and hormone response

What does the concentration of urine require to occur?

creatinine, BUN, SDMA

What lab tests are used as a reflection of GFR?

muscle metabolism, related to muscle mass

What is creatinine produced by?

produced from NH3 in liver, related to protein metabolism

What is BUN produced by?

product of cellular metabolism/proteolysis, not related to muscle mass

What is SDMA produced by?

filtered

Is creatinine filtered, secreted, or resorbed?

filtered, secreted, and reabsorbed

Is BUN filtered, secreted, or resorbed?

filtered

Is SDMA filtered, secreted, or resorbed?

pre-renal

This type of azotemia is characterized by GFR decreased because of reduced blood flow/pressure to glomeruli

renal

this type of azotemia is characterized by GFR decreased due to kidney disease (glomerular or tubular)

post-renal

this type of azotemia is characterized by GFR reduced due to back pressure

pre-renal

What type of azotemia is characterized by concentrated urine?

renal

What type of azotemia is characterized by inappropriate concentration of urine?

post-renal

What type of azotemia is characterized by imaging suggesting obstruction?

loss of >2/3 function

How would you characterize renal insufficiency?

loss of >3/4 function

How would you characterize renal failure?

F

T/F: BUN is very sensitive in large animals as a marker of kidney function

T

T/F: In neonatal foals, creatinine may be highly elevated in the first 2 days of life and it still be normal

hyponaremia, hypochloremia, hyperkalemia, hypocalcemia + hyperphosphatemia

What are the electrolyte abnormalities seen in large animal acute kidney injuries?

hypercalcemia + hypophosphatemia

What are the electrolyte abnormalities seen in large animal chronic kidney disease?

hyponatremia, hypochloremia, hyperkalemia

What are the electrolyte abnormalities seen in large animal uroperitoneum?

neutrophilic, hyperfibrinogenemia, hyperglobulinemia/hyperproteinemia

What are the signs of chronic infection or inflammation of the urinary tract in a CBC?

hypoalbuminemia

What are the signs of glomerulonephritis on a CBC?

free catch, urinary catheterization

How is urine collected in horses?

clear, straw color

What is normal urine color in ruminants?

cloudy straw color

What is normal urine color in horses?

alkaline

What urine pH would a herbivore have?

high protein diet, anorexia, neonate

What would cause a herbivore to have an acidic urine pH?

urine specific gravity

estimates solute concentration in urine

<1.008

A USG of what would indicate hyposthenuria?

1.008-1.012

A USG of what would indicate isosthenuria?

>1.014

A USG of what would indicate hypersthenuria?

albumin, globulin

What proteins are excluded in the normal kidney?

alkaline pH, hemoglobin

What can cause false positives for proteinuria?

1:1

What is a normal urine protein:creatinine?

>2:1

What urine protein:creatinine indicates significant proteinuria?

tubular damage

What do casts in the urine indicate?

infection, inflammation

What do WBCs in the urine indicate?

inflammation, infection, neoplasia, exercise

What do RBCs in the urine indicate?

free catch, cystocentesis, catheterization

How is urine collected in small animals?

>1.030-1.035

What is considered concentrated urine for dogs?

>1.040-1.045

What is considered concentrated urine for cats?

T

T/F: There is no normal value for specific gravity in dogs and cats

glucose, ketones, bilirubine, blood

What dipstick parameters do we evaluate in small animals?

BRAF

test for transitional cell carcinomas that detects this mutation

F

T/F: Water deprivation tests should be readily used to evaluate the concentrating ability of the kidneys

inadequate renal perfusion

What is the mechanism of pre-renal azotemia?

>1.025

What is the USG finding in a large animal pre-renal azotema?

<1%

What is the FENa finding in a large animal pre-renal azotemia?

50%

A pre renal azotemia should be reduced how much within 24 hours of fluid therapy in large animals?

dehydration, GI fluid loss, acute blood loss, hypotension, endotoxemia

What are the typical causes of pre-renal azotemia in large animals?

decreased GFR due to loss of functional nephrons

What is the mechanism of renal azotemia in large animals?

isosthenuria

What is the USG of renal azotemia?

T

T/F: renal azotemias are typically minimally fluid responsive

acute kidney injury, acute tubular necrosis

What are the causes of renal azotemia in large animals?

obstruction of urine/filtrate flow, reversal of forces responsible for GFR

What is the mechanism of post-renal azotemia?

usually lack of urination or dysuria/stranguria

What is the typical findings of post-renal azotemia in large animals?

neonatal uroabdomen, obstructive urolithiasis, bladder necrosis

What are the typical causes of post-renal azotemia in large animals?

antimicrobials, NSAIDs, pigment nephropathy, heavy metals, vitamin D, vitamin K, cantharidin, acorns

What are the toxins that may cause acute kidney injury in horses?

hypoperfusion/ischemia

Vasomotor nephropathy is characterized by what changes?

Hb-induced renal vasoconstriction, intraluminal cast formation leading to tubular obstruction, direct renal cytotoxicity by heme-protein derivatives

What are the characteristics of hemoglobinuria-induced anuric renal failure?

acute tubular necrosis

What is the most common pathologic lesion in acute kidney injury?

brush border of proximal tubule

What do aminoglycosides bind to in the kidney to cause toxicity?

pinocytosis, accumulate in renal cortex, inhibit phospholipase activity, impair organelle function, proximal tubular epithelial cell damage

What is the pathogenesis of aminoglycoside nephrotoxicity?

neomycin

What is the most nephrotoxic aminoglycoside?

peak and trough leaves, serial creatinine, urine GGT, proteinuria, glucosuria

What should be monitored if you are administering an aminoglycoside to a horse?

decreases renal blood flow and GFR

What is the end result of NSAID nephrotoxicity?

10-20%

What percent of renal blood flow does the medulla receive?

medulla

What is the first place in the kidney that suffers the effects of NSAID nephrotoxicity?

oxytetracycline, polymyxin B, amphotericin B

Other than aminoglycosides, what other antimicrobials are nephrotoxic to horses?

rhabdomyolysis, crush injury, heat stroke

Horses with what issues do you see myoglobinuria in?

anemia, intravascular hemolysis

Horses with what issues do you see hemoglobinuria in?

cortex

What area of the kidney is most susceptible to pigment nephropathy?

clear

What color would the serum of a horse be with myoglobinuria?

pink

What color would the serum of a horse be with hemoglobinuria?

ischemia, tubular obstruction by protein casts, hydroxyl radicals

What is the pathogenesis of pigment nephropathy?

Leptospira interrogans

What bacterial disease can cause acute kidney injury in horses?