Urinary2- Renal Dz Part 1
Card Set Information
Urinary2- Renal Dz Part 1
Often, cat with chronic kidney disease have concurrent _________; this is less common with dogs.
CKD cats have anemia because of decreased ___________, which is produced by the kidney; the anemia is __(3)__; when they have a normal PCV, this can be due to __(2)__.
erythropoietin; non-regenerative, normocytic, normochromic; anemia and dehydration together
Describe the WBC and platelet finding on CBC with kidney disease?
non-specific: leukocytosis if infection, normal platelet unless infectious cause of kidney disease
With kidney disease, ________ function is often decreased (cell type).
Aldosterone stimulates _________ in _________, and _________ follows.
Na+ reabsorption; principal cells; water
More water intake will dilute ________, causing ________; the converse is also true.
ADH causes _________ without _________.
water loss; sodium loss
Pure water deficit causes _________; causes of this include... (3)
primary hypodipsia; DI, fever/heat, no access to water
What are the 2 types of hypotonic fluid loss? What are examples of each?
Extrarenal (GI loss, third spacing, cutaneous loss), Renal (diuresis, CKD, AKI, post renal)
What are 3 causes of impermeant solute gain?
salt poinsoning, hypertonic fluids, hyperaldosteronism/hyperadrenocorticism
What are 4 GENERAL causes of hypernatremia?
pure water deficit, extrarenal hypertonic fluid loss, renal hypertonic fluid loss, impermeant solute gain
Hyponatremia with normal plasma osmolality can be caused by... (2)
Hyponatremia with high plasma osmolality can be caused by... (2)
hyperglycemia (DM), mannitol
Hyponatremia coupled with low plasma osmolality and hypervolemia can be caused by... (3)
congestive heart failure, protein-losing nephropathy, liver disease
Hyponatremia coupled with low plasma osmolality and normovolemia can be caused by... (1)
Hyponatremia coupled with low plasma osmolality and hypovolemia can be caused by... (3)
GI loss, third spacing, Addison's disease
What is equation for comparison of chloride to sodium?
corrected Cl- = Cl-
Causes of excessive loss of chloride relative to sodium through the GI. (1)
vomiting of stomach contents
Excessive loss of chloride relative to sodium through the renal route. (4)
loop diuretics/thiazide, chronic respiratory acidosis, Cushing's, glucocorticoids
Excessive loss of Cl- relative to Na+ can be caused by...
GI loss, renal loss
Renal chloride retention can be caused by... (6)
renal failure, renal tubular acidosis, Addison's, DM, chronic respiratory alkalosis, spironolactone
Potassium is filtered at the __________, reabsorbed in the __(2)__; its final control is by __(2)__ in the ________.
glomerulus; proximal tubule and loop of Henle; principal cells (Aldosterone-secrete K+) and intercalated type A cells (reabsorb K+); distal tubule
Translocation of K+ causing hypokalemia can be caused by... (5)
alkalemia, insulin/glucose, catecholamines, hypothermia, albuterol
Increased loss of potassium leading to hypokalemia can be caused by...
GI loss, urinary loss, drugs
Hyperkalemia can be caused by... (4)
pseudohyperkalemia, translocation from ICF to ECF, increased intake, decreased urinary excretion
Most phosphorous is located in ______.
GI absorption of phosphorous is _________ that is _________.
passive absorption; carrier-mediated
PTH decreases the function of the __________, which enhances ___________.
NaP cotransporter; phosphate excertion
Hypophosphatemia can cause _______ of RBCs because it decreases ________, increasing _________.
hemolysis; RBC ATP; osmotic fragility
Treatment of DKA can cause _________ because insulin causes ___________.
hypophosphatemia; translocation of Ph
Causes of hypophosphatemia. (4)
maldistribution (translocation from ICF to ECF), reduced renal reabsorption, decreased intestinal absorption, lab error
Hyperphosphatemia can cause __________ as a clinical sign.
soft tissue mineralization
The active fraction of calcium is ________.
The majority of calcium in the body is in _________; we measure the __________.
bone; extracellular calcium
To convert calcium in mg/dL to mmol/L,...
divide by 4.
With hypoalbuminemia, the protein-bound fraction of ________, which is reflected as low _________; in this case, __________ is not reflected and might still be normal.
calcium; total calcium; ionized calcium
With renal failure, calcium is decreased because of decreased _________; consequently, _________ is increased due to the Law of _______.
calcitriol; phosphate; Mass Action
Common causes of hypocalcemia include... (5)
hypoalbuminemia, CKD, AKI, eclampsia, acute pancreatitis
Clinical signs of hypercalcemia. (6)
PU/PD, anorexia, dehydration,lethargy, weakness, vomiting
Hypercalcemia causes _________ azotemia.
What are the renal effects of hypercalcemia in acute kidney injury? (1)
intrarenal vasoconstriction that can be rapidly reversed
What are the renal effects of hypercalcemia in CKD? (1)
mineralization of tissue
Hypocalcemia can lead to increased ___________ and may culminate in ___________.
excitability of nerves; hypocalcemic tetany or seizures
Hypercalcemia can depress ____________ and lead to ___________.
neuromuscular excitability; cardiac arrhythmias
Hypercalcemia impairs the action of ________, which can lead to __________.
ADH; calcium oxalate stones
Causes of hypercalcemia. (8)
Ionized calcium causes intrarenal __________, which can lead to intrinsic acute kidney injury.
What are the 2 mechanisms by which hypercalcemia impairs urine concentrating ability?
reabsorption in the LoH decreases Na
impairs action of ADH on the collecting duct
If total hypercalcemia is mild, measure __________ to help determine if...
ionized calcium; it is clinically significant.
In late CKD, there is decreased _______, leading to decreased _________ clearance; this causes increased plasma _______ and decreased __(2)__; all of this causes an increase in _______ and.. (3)
GFR; phosphate ion; phosphorous; calcitriol; ionized calcium; PTH; decreased survival, soft tissue mineralization, and demineralization of bone.
Renal secondary hyperparathyroidism occurs with _________.
chronic kidney disease
Refractory hypokalemia or persistent hypocalcemia should prompt evaluation for __________.
Hyperalbuminemia causes ________ and increased ________.
Hypoalbuminemia can be caused by __(2)__.
protein-losing nephropathy, GI loss, liver disease (decreased production), or vasculitis (redistribution).
When renal loss is the cause of hypoalbuminemia, albumin is ________ and globulin is ________.
When GI loss is the cause of hypoalbuminemia, albumin is _________ and globulin is ________.
When liver failure is the cause of hypoalbuminemia, albumin is ________ and globulin is _________.
low; normal to high
When vasculitis is the cause of hypoalbuminemia, albumin is ________ and globulin is _______.
Metabolic acidosis = ________.
What is the equation for anion gap?
What are the 3 steps to evaluating blood gas results?
1. Determine if pH is normal, low (acidosis), or high (alkalosis)
2. Determine is bicarb supports metabolic cause
: low (acidosis), high (alkalosis); if not, it is respiratory, look to PCO2.
3. Determine if compensation is present (ex. metabolic acidosis, bicarb is low, PCO2 should also be low for compensation)
When ________ goes up, bicarb goes down; ________ increases.
lactate; anion gap
Loss of bicarb without a corresponding loss of Cl leads to _________; there is a(n) __________ anion gap.
With CKD, prothrombin time is _________, aPTT is __________, platelet count is __________; patient runs risk of __________, which is detected through __________.
normal; normal; normal; bleeding; buccal mucosal bleeding time
With protein-losing nephropathy, there is an ___________ deficiency.
What are indications for renal biopsy? (3)
proteinuria, suspected neoplasia, FIP
What are contra-indications for renal biopsy? (3)
end-stage CKD, severe uremia (bleeding risk), hypertension (bleeding risk)
When performing a renal biopsy, avoid...
entering the medulla
Creatinine is ________ correlated to GFR.
Grade I AKI grading: _________ blood Cre, __________ clinical description.
<1.6 (increase of >0.3); non-azotemic AKI
Grade II AKI grading: _________ blood Cre, __________ clinical description.
1.7-2.5; mild AKI
Grade III AKI grading: _________ blood Cre, __________ clinical description.
2.6-5.0; mod to severe AKI
Grade IV AKI grading: _________ blood Cre, __________ clinical description.
5.1-10.0; mod to severe AKI
Grade V AKI grading: _________ blood Cre, __________ clinical description.
>10.0; mod to severe AKI
What are 3 etiologies of AKI?
hemodynamic (aka. volume-responsive), intrinsic (renal), post-renal
What are 6 causes of volume-responsive azotemia?
dehydration, hypotension, hypovolemia (or decreased effective circulating volume), anesthesia, shock, renal hypoperfusion (NSAIDs)
Volume-responsive azotemia is usually coupled with a __________; it is potentially rapidly _________.
high USG; reversible
What are the 2 most common causes of intrinsic AKI? What are 2 less common causes?
ischemia and nephrotoxins; inflammatory/infectious, systemic
What are some infectious causes of AKI? (4)
pyelonephritis from an ascending E. coli infection, Lepto, Borrelia (Lyme disease), Ehrlichia (the list goes on and on)
What are some systemic diseases that can cause AKI? (4)
FIP, pancreatitis, sepsis, DIC (and the list goes on..)
What is a short list of the most common nephrotoxins causing AKI? (6)
ethylene glycol, Rimadyl, rodenticides, lillies, grapes/raisins, venom (bee stings, snake bites)
2 causes of post-renal AKI.
nephro-/urolithiasis, bladder rupture
Which types of AKI are reversible?
both pre- and post-renal damage are reversible, but will lead to intrinsic kidney damaged is not addressed properly
What are the 5 stages of AKI?
insult--> initiation--> extension--> maintenance--> repair
When is it ideal to recognize kidney damage and why?
in the insult phase because you are more likely to be able to reverse it before you enter initiation and extension of the damage (caveat: it is HARD to recognize AKI in this stage)
What are the 2 major cellular mechanisms of decreased GFR?
intrarenal vasoconstriction, tubular dysfunction
In the normal renal tubule cytoskeleton __________ hold cells together, __________ on the basolateral side anchor the cell to the basement membrane, and ________ help make the barrier.
adherens junctions (zonula adhrerens); adhesion molecules (integrins); tight junctions
In AKI, the cytoskeleton disruption leads to... (3)
blood leaks into the UF and bypasses glomerulus, the Na+K+ATPase pump moves to luminal side and orientation is backward
Describe how cytoskeleton disruption leads to cast formation.
epithelial cells are not anchored and fall off the basement membrane into the UF; these bind together to form casts
What are categories of risk factors for AKI?
community acquired, hospital acquired
Renal blood flow is determined by... (3)
cardiac output, intravascular volume, real perfusion pressure
Risk factors for volume depletion. (6)
anesthesia, electrolyte disorders, hyperglycemia, expired tetracycline, penicillin, sulfa drugs (cause crystals)
How can you avoid nephrotoxicity associated with aminoglycosides? (3)
give once daily, maintain adequate hydration, monitor fresh urine daily for casts
Aminoglycosides cause nephrotoxicity because...
they concentrate in renal epithelial cells and cause damage and cast formation
Toxicity is more likely to occur with NSAID use when...
renal blood flow is decreased.
Prevention of AKI involves...
avoiding or ameliorating risk factors and use of renoprotective drugs
How do you monitor hydration?
skin turgor, mucous membranes, weight (changes in weight over days to weeks is usually fluid changes)
Monitoring AKI involves... (4)
weight, blood pressure, PCV and total solids
What patients should you not give fluids to and why?
patients with oliguria and anuria because you can cause volume overload and congestive heart failure
Litterpan dry vs wet- the difference in weight can calculate the urine volume by the conversion ________ (assuming they haven't dumped litter out).
What is the most accurate method of monitoring urine output?
When monitoring blood values of an AKI patient, it is most important to look at... (4)
BUN, creatinine, electrolytes, PCV