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5 functions of the kidneys.
excretion of waste products, retention/reabsorption, water and electrolyte balance, urine concentration, hormone production
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What waste products are secreted by the kidneys? (2)
urea and creatinine
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What do the kidneys retain/ resorb? (2)
amino acids, glucose
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How do the 3 methods of urine collection potentially affect the UA results?
- Free catch- may contain cells, protein, and bacteria
- Catheterization- increased numbers of epithelial cells and erythrocytes
- Cystocentesis- may produce iatrogenic RBC contaimination
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The color of urine may suggest:
Red-
Dark brown-
Yellow brown to green-
- red- hematuria,hemoglobinuria, myoglobinuria
- dark brown- methemoglobinuria
- ellow brown to green- bilirrubinuria
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Adequate concentrating ability in dogs, cats, and large animals are what SGs?
- dogs- >1.030
- cats- >1.035
- large animals- >1.025
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In the dehydrated animal, urine should be __________, and if it is not, it can be associated with ____________.
concentrated; renal failure/insufficiency
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Reduced ability to concentrate urine can occur with... (4)
renal failure/ insufficiency, medullary washout, osmotic diauresis, dysfunction of ADH pathway
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Isosthenuria implies that...
no concentrating or dilution has been performed by the tubules of the nephron
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Increased RBCs in the urine.
hematuria
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increased numbers of WBCs in the urine.
pyuria
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Pyuria is typically associated with... (2)
urinary tract inflammation, contamination of the sample from the distal urinary tract
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Epithelial cells in the urine sample typically represent...
contamination
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Structures formed in renal tubular lumens and are composed or mucoprotein secreted by tubular cells plus accumulated cellular material; high amounts in urine may indicate renal disease.
casts
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The presence of bacteria in a urine sample without WBCs suggests...
contamination
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The observation of crystals in urine sediment depends on... (5)
extent of saturation with crystal precursors, urine pH, specific gravity, time b/w collection and analysis, refrigeration of sample
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Acidic urine is associated with... (3)
meat-based diet, drugs, acidotic states
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Basic urine is associated with... (5)
herbivorous diet, bacteria (infection/old urine), postprandial alkaline tide, drugs, alkalotic states
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Normal urine is ______ for glucose.
negative
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Glucosuria may occurs with... (3)
diabetes, epinephrine response, treatment
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Ketones may be present in the urine in concurrence with... (3)
diabetes mellitus, starvation, ketosis in cattle
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Only _________ bilirubin is water soluble and will pass into urine.
conjugated
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How do you decide if reddening of urine is caused by hematuria, hemoglobinuria, or myoglobinuria?
- hematuria- urine clears when centrifuged
- hemoglobinuria- urine does not clear and erythrocytes are seen in sediment (caused by intravascular hemolysis)
- myoglobinuria- urine does not clear and no erythrocytes are seen in sediment (muscle disease)
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Urine protein should be interpreted in light of the ___________.
specific gravity
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4 reasons for proteinuria.
hemorrhage (positive occult blood), inflammation (leukocytes in urine), renal disease, pre-renal
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The functional unit of the kidney.
nephron
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What are the components of the nephron?
glomerulus, tubules (PCT, loop of henle, DCT, collecting duct)
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What are the 2 functions of the glomerulus?
filters fluids, retains proteins and cells
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What are the 3 functions of the tubules of the nephron?
reabsorption, secretion, concentration of urine
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Loss of nephron function.
renal failure/ insufficiency
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BUN is a marker of ________________.
glomerular filtration
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If the GFR is reduced, less is ________, and BUN concentration _______.
filtered; increases
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Creatine is synthesized in the _______ and the analyte creatinine is derived from _____________.
liver; energy use in muscle
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Bun is a more sensitive indicator of ________, and creatinine is a more accurate measure of ________.
dehydration; GFR
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Decrease BUN is seen with... (3)
decreased liver ( end stage liver failure, liver shunts, massive necrosis)
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With renal insufficiency/ failure, there is a decreased __________, meaning...
GFR; those things normally filtered by the kidney (BUN, creatinine, phosphorous) are increased
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Increased nitrogenous products in the blood.
azotemia
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GFR us dependent on _______, thus with dehydration, there will be less _____________ and less filtration.
blood flow; blood to the kidneys
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Increased BUN and creatinine that induce clinical disease.
uremia
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With pre-renal azotemia, less _______ is filtered through the kidney due to _______ or _______; urine SG is typically _______.
blood volume; dehydration; shock; high
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Renal azotemia can be due to...(3)
inflammatory, neoplastic, toxic, or other reasons
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Acute kidney disease is associated with ______ or _______ and overlaps with post-renal and renal azotemia.
oliguria; anuria
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Chronic kidney disease is associated with _________ (SG), ________ BUN/creatinine, and _________.
isosthenuria; increased; anemia
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Post-renal azotemia is usually due to... (3)
obstruction, rupture, acute kidney disease
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When urine is formed by the kidney but not removed from the body.
post-renal azotemia
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Hyperphosphatemia, low to normal calcium, normocytic, normochromic non-regenerative anemia, and renal azotemia point to...
chronic kidney disease
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Horses with chronic kidney disease are often _______-calcemic due to decreased renal clearance.
hyper
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With acute kidney disease, body condition is _______, potassium is _______, urine is __________, and there is/is not anemia?
good; increased; anuric/olignuric; no anemia
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With chronic kidney disease, body condition is ______, potassium is ____________, urine is ________, and anemia is/is not present?
poor; normal to low; polyuric; anemia is present and non-regenerative
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When BUN is increased and creatinine is normal, consider... (2)
GI hemorrhage or high-protein diets
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With uroabdomen, you will see... (6)
post-renal azotemia, hyperkalemia, hyponatremia, hypochloremia, usually no urine, distended abdomen
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Differentials for azotemia with hyperkalemia, hyponatermia, and hypochloremia?
urinary tract rupture/obstruction, acute kidney disease, addisons' disease
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The medullary gradient is partially responsible for...
the kidney's ability to concentrate urine
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Diseases that reduce urea or sodium, aka medullary washout, can reduce ______.
urine SG
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6 causes of medullary washout.
polyuria, steroids, diabetes mellitus, polydipsia/ fluid therapy, hyponatremia, low BUN (end stage liver or shunt)
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