Reviewing the chemistry panel: Kidney cases (Proceedings)

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Reviewing the chemistry panel: Kidney cases (Proceedings)

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Aug 01, 2010

Renal Components of the Chemistry Panel

     1. Creatinine
     2. BUN
     3. Electrolytes
               • Sodium: N to ↓
               • Chloride: N to ↓
               • Potassium: ↑
               • Calcium: acute= ↓ Ca: chronic=↑
               • Phosphorus: acute= ↑
               • Acid – base parameters: TCO2: ↓
               • Anion Gap:↑
Creatinine/BUN: Increase means that GFR has decreased (prerenal,renal) or post-renal disease is present

Renal Disease



          • Hyponatremia, hypochloremia
          • Hyperkalemia (normal to high)
          • Metabolic acidemia (Low TCO2)
                o Anion Gap often increases
          • Acute Renal Failure
                o Hypocalcemia
                o Hyperphosphatemia
          • Chronic Renal Failure
                o Hypercalcemia
                o Hypophosphatemia

Causes of acute renal failure: 1. Hemodynamic causes; 2. Toxic causes; 3. Inflammatory causes

          1 Hemodynamic causes
          • Prolonged hypovolemia
          • Coagulopathy Endotoxemia/SIRS

          2 Toxic causes
          • Phenylbutazone
          • Aminoglycosides
          • Tetracycline*
          • Pigments- hgb, mgb
          • Heavy metals
          • Blister Beetle

          3 Inflammatory causes
          • Pyelonephritis
          • Leptospirosis
          • Neoplasia
          • Immune-mediated causes

Glomerulonephritis – Proteinuria
Secondary to Strep equi equi

Prerenal vs Renal Azotemia

          • Horses with prerenal azotemia are dehydrated
                o Urine is concentrated
                o USG > 1.020
          • Horses with renal azotemia are isosthenuric regardless of hydration status
                o USG: 1.008 – 1.020

Prerenal

A rapid decrease in creatinine is expected with fluid therapy. It should be markedly decreased and close to normal within 24 h if prerenal. Persistent elevation of creatinine in the face of fluids indicates renal disease

Prolonged prerenal azotemia will lead to renal failure if not corrected


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