IDEXX Kidney Profile

  1. Kidney functions (5)
    • 1 clearance of waste products
    • 2 H20 balance (hydration)
    • 3 concentration of macromolecules
    • 4 electrolyte/acid-base balance
    • 5 endocrine functions
  2. Primary Kidney Tests (3)
    • 1. BUN
    • 2. Creatinine
    • 3. Urinalysis
  3. BUN basics
    • Formed in liver by conversion of ammonia to urea by the urea cycle
    • Freely filtered through renal glomerulus -> renal glomerular function is primary mechanism of clearance
  4. CREA basics
    • Produced at a constant rate by breakdown of phosphocreatine in muscle tissue
    • Cleared primarily by kidneys - change dependent on renal glomerular filtration rate
  5. Secondary Kidney Tests (11)
    • 1. PCV
    • 2. RBC
    • 3. HGB
    • 4. RETIC
    • 5. Phos
    • 6. Ca
    • 7. Na
    • 8. K
    • 9. tCO2 (Bicarb)
    • 10. Anion Gap
    • 11. CHOL
  6. Azotemia is ___________
    • Increased concentration of non-protein, nitrogenous waste products (creatinine or BUN) in blood
    • May be due to renal or nonrenal causes
  7. Uremia is _____________
    • Azotemia + extrarenal clinical signs
    • Arises from presence of retained waste products due to azotemia
    • No extrarenal signs = NOT uremic
  8. Clinical signs of Uremia (4)
    • 1. Nausea
    • 2. Vomiting
    • 3. Oral ulceration
    • 4. Lethargy
  9. Chronic muscle wasting can cause (increased/decreased) levels of creatinine
    Decreased
  10. ____________ is preferred analyte to characterize GFR because ___________
    • Creatinine
    • Does not reabsorb by renal tubules
  11. BUN variable due to (3)
    • 1. Diet (^)
    • 2. GI bleed (^)
    • 3. Hepatic function (v)
  12. Urea (is/is NOT) reabsorbed by renal tubules
    is
  13. Ammonia is largely from ______________
    Digestion of proteins
  14. ^ BUN causes (3)
    • 1. ^ protein in diet
    • 2. GI bleed
    • 3. metabolic states causing ^ muscle breakdown
  15. ^ ammonia, v BUN cause
    Hepatic insufficiency
  16. (^/v) unrine flow = (^/v) BUN reabsorbed
    • v, ^
    • BUN reabsorption indirectly linked to rate of urine flow
  17. Types of azotemia (3)
    • 1. Pre-renal
    • 2. Renal
    • 3. Post-renal
  18. Pre-renal azotemia basics
    • Renal function is normal 
    • All causes besides diet -> reduced renal perfusion (v bloodflow to kidneys)
  19. USG with pre-renal azotemia
    • Concentrated urine
    • >/= 1.030 dogs
    • >/= 1.035 cats
  20. Causes for v bloodflow to kidneys (3)
    • 1. mod-severe dehydration
    • 2. hypotension
    • 3. v cardiac output (cardiac insufficiency)
  21. Exceptions to concentrated urine with pre-renal azotemia (2)
    • 1. ^ Protein catabolism (^ protein diets, GI bleed, muscle breakdown)
    • 2. ^ formation of UREA
  22. Renal azotemia basics
    • Renal disease/failure
    • Due to loss of functioning nephrons
  23. Azotemia is seen with ___% of renal function lost
    75%
  24. Isosthenuria due to renal disease is seen with ___% renal function lost
    66%
  25. Difference between renal and pre-renal azotemia
    USG
  26. Conditions outside of renal failure that cause urine concentration loss (4)
    • 1. IVF Therapy
    • 2. Certain drugs (Diuretics, glucocorticoids)
    • 3. Cushing's 
    • 4. Electrolyte abnormalities
  27. How does pyometra cause decreased urine concentration?
    Endo toxin inhibiting ADH (anti-diuretic hormone)
  28. Maximum urine concentration is achieved when __________ (3)
    • 1. Clinically dehydrated
    • 2. Azotemic
    • 3. ^ albumin
  29. Post-renal azotemia basics
    • Adequate # of functioning nephrons
    • Secondary to urinary tract obstruction or rupture, resulting in inability to eliminate waste products
    • Backup continues until pressure in glomerulus equalizes with blood pressure and filtration stops
  30. Hydronephrosis
    • Swelling of kidney due to backup of urine
    • Unilateral or partial long term blockage can cause (complete blockage results in death)
  31. Uroabdomen
    • Urine accumulates in abdomen, BUN & CREA reabsorb to attempt to equilibrate 
    • CREA equilibrates slower, CREA in peritoneal fluid will be >2X CREA in peripheral blood
  32. Post-obstructive diureses
    • Lasts for 2-3 days following relief of obstruction
    • ^ solute load, poor ADH response
    • Concentrating ability returns over time if no renal damage
  33. Secondary renal tests (12)
    • 1. PCV
    • 2. RBC
    • 3. HGB
    • 4. Retic
    • 5. Phos
    • 6. Ca
    • 7. Na
    • 8. K
    • 9. tCO2 (Bicarb)
    • 10. Anion Gap
    • 11. Chol
  34. Azotemia
    • Increased concentration of non-protein, nitrogenous waste product (Creatinine or BUN) in blood
    • May be due to renal or nonrenal causes
  35. Uremia
    • Azotemia + extrarenal clinical signs
    • -Nausea, vomiting, oral ulceration, lethargy
    • Arises from presence of retained waste products due to azotemia
  36. Clearance by _____ is major variable affecting BUN and Creatinine levels
    Glomerular Filtration (GFR)
  37. CREA (does/does not) reabsorb by renal tubules
    does not
  38. (CREA/BUN) is the preferred anolyte to characterize GFR
    CREA - does not reabsorb by renal tubules
  39. Chronic muscle wasting can cause ___ levels of CREA
    decreased
  40. BUN is variable due to (3)
    • 1. ^ Diet
    • 2. ^ GI bleed
    • 3. v Hepatic function
  41. Prerenal azotemia
    • Renal function is normal
    • All causes besides diet = reduced renal perfusion
    • Concentrated urine
    • >1.030 dogs
    • >1.035 cats
  42. USG should be done _________ fluids
    before
  43. Renal Azotemia
    • Renal disease/failure due to loss of functioning nephrons
    • >= 75% renal function lost causes azotemia
  44. Inability to concentrate urine happens with ___% renal function lost
    66
  45. Renal vs. Prerenal azotemia
    USG
  46. Conditions that cause a loss of the ability to concentrate urine (5)
    • 1. IVF therapy
    • 2. Certain drugs (diuretics, glucocorticoids)
    • 3. Cushings
    • 4. Electrolyte abnormalities
    • 5. Pyometra (E. coli endo toxing inhibiting ADH)
  47. Electrolyte imbalances that cause decreased urine concentration (3)
    • 1. Hyponatremia - Sodium <120 (addisons)
    • 2. Hypokalemia - <2
    • 3. Hypercalcemia - >2 above normal
  48. Post-renal azotemia
    • Adequate # of functioning nephrons
    • Secondary to urinary tract obstruction or rupture, resulting in inability to eliminate waste products
    • Backup continues until pressure in glomerulus equalizes with blood pressure and filtration stops
  49. _________ Can occur with unilateral or partial long term obstruction
    Hydronephrosis
  50. post-obstructive diuresis
    • 2-3 days following relief of obstruction
    • Increased solute load, poor ADH response
    • Concentrating ability returns over time if no renal damage
  51. PCV,RBC,HGB, Retic count
    • Kidney produces erythropoietin -> normal RBC development
    • Chronic renal failure -> normocytic, normochromic, non-regenerative anemia
  52. Phos
    • ^ due to v GFR (cleared by kidneys)
    • May remain normal due to active tubular handling
  53. Ca
    • Usually low normal or mildy decreased
    • v ca stimulates release of PTH from parathyroid glands
    • CRF - renal secondary hyperparathroidism
Author
anubis_star
ID
336860
Card Set
IDEXX Kidney Profile
Description
kidney bloodwork
Updated