Wk 9 - Uropathies

Signalment

• Breed

  • ______________ tend to get ______________

• gender

  • mares

    • ______________

  • males

    • ______________

arabians; amyloidosis; URI; urethral obstruction

What is pollakuria?

excessive FREQUENCY of urination

Water intake

• adult

  • Drinking: ______________ ml/kg/day

  • Urine: ______________ ml/kg/day

• foal

  • ______________% of BW in milk daily

40-60; 15-30; 20-25

Factors affecting water intake

• ambient ______________

• ______________ level

• ______________

• access to water sources

• ______________ or behavior issues

temp; exercise; diet (e.g. high salt content); boredom

Polydipsia

• fluid intake > ______________

Polyuria

• urine production > ______________

100 ml/kg/day; 50 ml/kg/day

Azotemia

• prerenal

  • decreased renal blood flow

  • causes

    • ______________

    • ______________

    • ______________

• renal

  • decreased GFR from kidney injury

• postrenal

  • failure of excretion due to UT ______________ or ______________

dehydration; hypovolemic shock; heart failure; obstruction; rupture

Azotemia

• continuum between ______________ and ______________ azotemia

• creatinine

  • LARGE decrease in GFR results in SMALL creatinine increase in ______________

  • SMALL decrease in GFR results in LARGE creatinine increase in ______________

prerenal; renal; advanced disease; early renal disease

Azotemia

• BUN

  • multifactorial influences including ______________ and ______________ metabolism

  • less specific estimator of ______________

  • not useful for diagnosing ______________

dietary protein; protein; GFR; AKI

What is the recommended biochemical test to estimate GFR?

creatinine

Stall side urinalysis

• ______________ test strips

• ______________ analysis

• ______________ testing

• ______________ evaluation

reagent; refractometer; biochemical; microscopic sediment

Stall-side urinalysis

• reagent test strips

  • test for ______________, ______________, ______________ and ______________

• refractometer

  • USG

• biochemical testing

  • test for ______________, ______________ and ______________

• microscopic sediment evaluation

  • assessing for crystals, cells and bacT

protein; glucose; ketones; blood; protein; creatinine; GGT (gamma-glutamyl transferase)

Stall-side urinalysis

• fractional excretions

  • assess ______________ of ______________

  • prerenal = azotemia with ______________ and ______________ fractional excretion

tubular reabsorption; electrolytes; normal Na; Cl

USG

• hyposthenuria

  • <______________

  • water ______________

  • causes

    • ______________ polydypsia

    • ______________

    • ______________

1.008; excretion; psychogenic; diabetes insipidus; medullary washout

USG

• Hyposthenuria - next steps

  • ______________ if needed followed by ______________

  • measure plasma ______________ concentration after above test is negative

  • response to admin of ______________

WDT; modified WDT; AVP; exogenous AVP

USG

• isosthenuria

  • ______________

  • NO ______________

  • NO ______________

  • causes

    • ______________

  • next step = further diagnostics

1.008-1.014; excretion; concentration; CKD

USG

• hypersthenuria

  • USG may vary

  • ability to ______________

  • causes

    • ______________ renal function or ______________

  • next step = ______________

concentrate urine; normal; dehydration; assess hydration status

Urine strip

• pH

  • normal = ______________

  • abnormal = ______________

alkaline (8-9); acidic (<7)

Urine strip

• pH

  • causes of aciduria

    • ______________

    • ______________

    • ______________

    • ______________

exercise; metabolic acidosis; bacteriuria; urease-producing bacT

Urine strip

• protein

  • false ______________ will occur in ______________ samples

  • significantly high = ______________

  • chemistry analyzer

    • normal = ______________ mg/dl

positives; alkaline; 2 to 3+; <100

Urine strip

• glucose

  • normal = ______________

  • glucosuria indicates ______________ or ______________

• blood

  • positive result = RBC, Hb, myoglobin

  • ______________ needed

NONE; hyperglycemia; PCT dysfunction; further eval

Sediment evaluation

• examine within ______________ after collection

• microscopic exam

  • low magnification - check for ______________ and ______________

  • high magnification - quantify ______________ and ______________

30-60min; casts; crystals; cells (RBC, WBC, epithelial); bacT

Sediment Evaluation

• Findings

  • granular casts

    • indicate ______________

  • RBC and WBC

    • normal = ______________/hpf

    • ______________/hpf suggests infection

  • bacT

    • absence doesn’t rule out infection

    • consider culture

  • crystals

    • common types = ______________, ______________ and ______________

acute tubular injury; <5; >5; Ca carbonate; phosphate; oxalate

Azotemia

• urine concentrating ability will become compromised once about ______________ of total nephron function has been lost

• azotemia reflects loss of at least ______________ of overal nephron function

2/3; 3/4;

Timing of discoloration of urine

• throughout urination = ______________

• beginning of urination = ______________

• end of urination = ______________

kidney/ureter/bladder; distal urethra; bladder neck/proximal urethra

Renal biopsy

• ______________ mortality rate

• complications in about ______________% of cases

• Diagnostic utility

  • less useful in horses with ______________ disease

low; 11; tubulointerstitial

T/F: Renal biopsies are rarely helpful for getting definitive diagnoses

True

Renal biopsy

• Recommendations

  • NOT recommended for routine evaluation of ______________ or ______________

  • should be performed only if biopsy results will change patient ______________ or ______________

AKI; CKD; management; prognosis

US

• Kidney size

  • normal (throughbred) = ______________ in length

  • may be normal or enlarged with ______________

• parenchymal detail

  • often no detected

  • possible abnormalities

    • diffuse or focal increased echogenicity of renal cortex, subcapsular edema (rare)

• doppler US - intrarenal blood flow

  • assessment of renal resistive index

  • time-consuming and requires skill

  • results unlikely to change patient ______________

15-18cm; AKI; management

Endoscopy

• ureteroscopy

  • small diameter endoscopes (______________)

• pyeloscopy

  • visualizes renal ______________ and ______________

<6mm; pelvis; calyces

Water deprivation test

• gradual water deprivation over 24-48hr

• Interpretation

  • normal response = ______________ USG

  • abnormal response = ______________ USG

    • suggests ______________

increased (>1.020); persistent low (<1.008); diabetes insipidus