Presentation is loading. Please wait.

Presentation is loading. Please wait.

Hematology, Serum Electrolytes and Renal Biopsy Stephen P. DiBartola, DVM Department of Veterinary Clinical Sciences College of Veterinary Medicine Ohio.

Similar presentations


Presentation on theme: "Hematology, Serum Electrolytes and Renal Biopsy Stephen P. DiBartola, DVM Department of Veterinary Clinical Sciences College of Veterinary Medicine Ohio."— Presentation transcript:

1 Hematology, Serum Electrolytes and Renal Biopsy Stephen P. DiBartola, DVM Department of Veterinary Clinical Sciences College of Veterinary Medicine Ohio State University Columbus, OH The Nephronauts

2 Red blood cells Nonregenerative anemia in chronic renal failureNonregenerative anemia in chronic renal failure Effect of dehydration on PCV and TPPEffect of dehydration on PCV and TPP PolycythemiaPolycythemia

3 White Blood Cells Stress of chronic disease may cause lymphopenia in chronic renal failureStress of chronic disease may cause lymphopenia in chronic renal failure Platelets Platelet dysfunction despite normal numbers may occur in uremiaPlatelet dysfunction despite normal numbers may occur in uremia

4 ElectrolytesElectrolytes ECF electrolytesECF electrolytes SodiumSodium ChlorideChloride BicarbonateBicarbonate ICF electrolytesICF electrolytes PotassiumPotassium PhosphorusPhosphorus

5 SodiumSodium Dog 145 ( ) mEq/LDog 145 ( ) mEq/L Cat 156 ( ) mEq/LCat 156 ( ) mEq/L Horse 139 ( ) mEq/LHorse 139 ( ) mEq/L Cattle 142 ( ) mEq/LCattle 142 ( ) mEq/L

6 Serum sodium concentration Serum sodium concentration is an indication of the amount of sodium RELATIVE to the amount of water in ECF and provides no direct information about total body sodium contentSerum sodium concentration is an indication of the amount of sodium RELATIVE to the amount of water in ECF and provides no direct information about total body sodium content

7 Serum sodium concentration Hypernatremia means hyperosmolalityHypernatremia means hyperosmolality Hyponatremia usually means hypoosmolalityHyponatremia usually means hypoosmolality

8 HypernatremiaHypernatremia Pure water lossPure water loss Hypotonic fluid lossHypotonic fluid loss GastrointestinalGastrointestinal Third spaceThird space RenalRenal Gain of impermeant soluteGain of impermeant solute

9 HyponatremiaHyponatremia With hypervolemiaWith hypervolemia Severe liver disease, congestive heart failure, nephrotic syndromeSevere liver disease, congestive heart failure, nephrotic syndrome With normovolemiaWith normovolemia Psychogenic polydipsia, anti-diuretic drugs, hypotonic fluidsPsychogenic polydipsia, anti-diuretic drugs, hypotonic fluids With hypovolemiaWith hypovolemia GI loss, third space loss, hypoadrenocorticism, diureticsGI loss, third space loss, hypoadrenocorticism, diuretics

10 ChlorideChloride Dog 110 ( ) mEq/LDog 110 ( ) mEq/L Cat 120 ( ) mEq/LCat 120 ( ) mEq/L Horse 104 (99-109) mEq/LHorse 104 (99-109) mEq/L Cattle 104 (97-111) mEq/LCattle 104 (97-111) mEq/L

11 Serum chloride concentration Cl - and HCO 3 - are the main resorbable anions in renal tubular fluid and abnormalities in one often result in abnormalities of the otherCl - and HCO 3 - are the main resorbable anions in renal tubular fluid and abnormalities in one often result in abnormalities of the other Normal ratio of Na + to Cl - in ECF is 1.3 to 1 and gain or loss of equal amounts of Na + and Cl - will disturb this relationship. Only a gain or loss of 4 Na + for every 3 Cl - would preserve this relationshipNormal ratio of Na + to Cl - in ECF is 1.3 to 1 and gain or loss of equal amounts of Na + and Cl - will disturb this relationship. Only a gain or loss of 4 Na + for every 3 Cl - would preserve this relationship

12 HyperchloremiaHyperchloremia Excessive loss of Na + relative to Cl - (e.g. diarrhea)Excessive loss of Na + relative to Cl - (e.g. diarrhea) Excessive gain of Cl - relative to Na + (e.g. NH 4 Cl, 0.9% NaCl, hypertonic NaCl, salt poisoning)Excessive gain of Cl - relative to Na + (e.g. NH 4 Cl, 0.9% NaCl, hypertonic NaCl, salt poisoning) Excessive Cl - retention by kidneys (e.g. compensation for chronic respiratory alkalosis)Excessive Cl - retention by kidneys (e.g. compensation for chronic respiratory alkalosis)

13 HypochloremiaHypochloremia Vomiting of stomach contents or sequestration of fluid in stomachVomiting of stomach contents or sequestration of fluid in stomach Diuretics (e.g. furosemide)Diuretics (e.g. furosemide) Compensation for chronic respiratory acidosisCompensation for chronic respiratory acidosis

14 PotassiumPotassium Dog 4.5 ( ) mEq/LDog 4.5 ( ) mEq/L Cat 4.5 ( ) mEq/LCat 4.5 ( ) mEq/L Horse 3.8 ( ) mEq/LHorse 3.8 ( ) mEq/L Cattle 4.8 ( ) mEq/LCattle 4.8 ( ) mEq/L

15 Potassium Balance IntakeECF ICF Translocation Excretion Urinary (> 90%) Urinary (> 90%) Fecal (< 10%) Fecal (< 10%)

16 Translocation of potassium ICFECF

17 HyperkalemiaHyperkalemia Increased intake (alone usually not sufficient to cause hyperkalemia if renal function adequate – unless iatrogenic)Increased intake (alone usually not sufficient to cause hyperkalemia if renal function adequate – unless iatrogenic) Translocation (ICF to ECF)Translocation (ICF to ECF) Acute mineral acidosis, insulin deficiencyAcute mineral acidosis, insulin deficiency Decreased renal excretionDecreased renal excretion Urethral obstruction, uroabdomen, oligoanuric renal failure, hypoadrenocorticism, some drugsUrethral obstruction, uroabdomen, oligoanuric renal failure, hypoadrenocorticism, some drugs

18 HypokalemiaHypokalemia Decreased intake (alone not usually sufficient to cause hypokalemia)Decreased intake (alone not usually sufficient to cause hypokalemia) Translocation (ECF to ICF)Translocation (ECF to ICF) Alkalemia, insulin and glucoseAlkalemia, insulin and glucose Increased lossIncreased loss GI, renalGI, renal

19 Total CO 2 or bicarbonate Dog 21 (17-24) mEq/LDog 21 (17-24) mEq/L Cat 20 (17-24) mEq/LCat 20 (17-24) mEq/L Horse 27 (24-30) mEq/LHorse 27 (24-30) mEq/L Cattle 25 (20-30) mEq/LCattle 25 (20-30) mEq/L

20 Total CO 2 Anaerobically measured, this includes HCO 3 -, dissolved CO 2 and negligible amounts of carbamino-CO 2, H 2 CO 3, and CO 3 -2Anaerobically measured, this includes HCO 3 -, dissolved CO 2 and negligible amounts of carbamino-CO 2, H 2 CO 3, and CO 3 -2 Aerobically measured, it is essentially equivalent to HCO 3 -Aerobically measured, it is essentially equivalent to HCO 3 -

21 Total CO 2 Determination of total CO 2 alone does not allow complete characterization of acid base disturbancesDetermination of total CO 2 alone does not allow complete characterization of acid base disturbances High total CO 2 usually means metabolic alkalosis but compensation for respiratory acidosis could contributeHigh total CO 2 usually means metabolic alkalosis but compensation for respiratory acidosis could contribute Low total CO 2 usually means metabolic acidosis but compensation for respiratory alkalosis could contributeLow total CO 2 usually means metabolic acidosis but compensation for respiratory alkalosis could contribute

22 Serum total calcium concentration Dog 10.1 ( ) mg/dLDog 10.1 ( ) mg/dL Cat 9.2 ( ) mg/dLCat 9.2 ( ) mg/dL Horse 12.4 ( ) mg/dLHorse 12.4 ( ) mg/dL Cattle 11.0 ( ) mg/dLCattle 11.0 ( ) mg/dL

23 Components of serum total calcium concentration Ionized Calcium (50%) Complexed Calcium (10%) Protein-bound Calcium (40%)

24 Normal serum calcium concentrations in dogs Total: 9 to 11 mg/dlTotal: 9 to 11 mg/dl Ionized: 5.1 to 5.7 mg/dlIonized: 5.1 to 5.7 mg/dl Routine serum biochemical profile returns serum total calcium concentration

25 Effect of acid base balance on serum calcium concentration Acidosis tends to increase the ionized fraction and decrease the protein-bound fractionAcidosis tends to increase the ionized fraction and decrease the protein-bound fraction Alkalosis tends to decrease the ionized fraction and increase the protein-bound fractionAlkalosis tends to decrease the ionized fraction and increase the protein-bound fraction These results are due to the effects of acid base balance on the net charge of plasma proteins

26 Effect of hypoalbuminemia on serum calcium concentration Ionized Calcium (mg/dL) Complexed Calcium (mg/dL) Protein-bound Calcium (mg/dL) Hypoalbuminemia Normal

27 Correction of hypocalcemia for hypoalbuminemia Corrected Calcium = Calcium – Albumin + 3.5Corrected Calcium = Calcium – Albumin Works reasonably well in dogsWorks reasonably well in dogs Unreliable in catsUnreliable in cats

28 Hypercalcemia in chronic renal failure (example) Ionized Calcium (mg/dL) Complexed Calcium (mg/dL) Protein-bound Calcium (mg/dL) CRFNormal

29 HypercalcemiaHypercalcemia DehydrationDehydration Various malignanciesVarious malignancies HypoadrenocorticismHypoadrenocorticism Renal failureRenal failure Hypervitaminosis DHypervitaminosis D Primary hyperparathyroidismPrimary hyperparathyroidism

30 Hypercalcemia in horses with renal failure May be related to fact that horses normally absorb large amounts of calcium from their GI tract and rely on their kidneys to excrete it (calcium carbonate crystals are common in horse urine)May be related to fact that horses normally absorb large amounts of calcium from their GI tract and rely on their kidneys to excrete it (calcium carbonate crystals are common in horse urine)

31 HypocalcemiaHypocalcemia HypoalbuminemiaHypoalbuminemia Renal failureRenal failure Ethylene glycol poisoningEthylene glycol poisoning EclampsiaEclampsia Acute pancreatitisAcute pancreatitis Primary hypoparathyroidismPrimary hypoparathyroidism

32 PhosphorusPhosphorus Dog 4.2 ( ) mg/dLDog 4.2 ( ) mg/dL Cat 6.3 ( ) mg/dLCat 6.3 ( ) mg/dL Horse 4.3 ( ) mg/dLHorse 4.3 ( ) mg/dL Cattle 6.0 ( ) mg/dLCattle 6.0 ( ) mg/dL

33 Serum phosphorus Largely a mixture of H 2 PO 4 - and HPO 4 -2Largely a mixture of H 2 PO 4 - and HPO 4 -2 The net valence and number of mEq of phosphorus in ECF are influenced by pH hence it is easier to talk about phosphorus in terms of mMol or mg of elemental phosphorusThe net valence and number of mEq of phosphorus in ECF are influenced by pH hence it is easier to talk about phosphorus in terms of mMol or mg of elemental phosphorus

34 HyperphosphatemiaHyperphosphatemia Translocation (ICF to ECF)Translocation (ICF to ECF) Decreased renal excretionDecreased renal excretion Increased intakeIncreased intake Young growing animalYoung growing animal

35 HypophosphatemiaHypophosphatemia Translocation (ECF to ICF)Translocation (ECF to ICF) Decreased renal reabsorptionDecreased renal reabsorption Decreased intestinal absorptionDecreased intestinal absorption Hypophosphatemia may occur in some horses with renal failure

36 Renal Biopsy: Indications Differentiation of renal diseases that may differ in their prognosisDifferentiation of renal diseases that may differ in their prognosis Differentiation of ARF from CRFDifferentiation of ARF from CRF Determination of status of basement membranes in ARFDetermination of status of basement membranes in ARF Determination of response to therapyDetermination of response to therapy Determination of progression of diseaseDetermination of progression of disease

37 Renal Biopsy: Contraindications CoagulopathyCoagulopathy Severe hydronephrosis or perinephric pseudocystSevere hydronephrosis or perinephric pseudocyst Renal or perirenal abscessRenal or perirenal abscess PyonephrosisPyonephrosis Solitary kidneySolitary kidney PyelonephritisPyelonephritis Renal neoplasiaRenal neoplasia Extremely small kidneysExtremely small kidneys

38 Renal biopsy: General considerations Adequate patient evaluationAdequate patient evaluation Choice of techniqueChoice of technique Choice of biopsy instrumentChoice of biopsy instrument Direction of instrument into kidneyDirection of instrument into kidney HemostasisHemostasis AnesthesiaAnesthesia

39 Pre-biopsy evaluation Coagulation ability (role of buccal mucosal bleeding time)Coagulation ability (role of buccal mucosal bleeding time) IV catheter and fluid administrationIV catheter and fluid administration PCV & TPP after fluids but before biopsyPCV & TPP after fluids but before biopsy Fluid diuresisFluid diuresis

40 Methods of renal biopsy Open surgicalOpen surgical True percutaneousTrue percutaneous KeyholeKeyhole LaparoscopyLaparoscopy Ultrasound-guided (currently in use at OSU VTH)Ultrasound-guided (currently in use at OSU VTH) Needle aspirate – NOT a biopsy!Needle aspirate – NOT a biopsy!

41 Renal biopsy: Keyhole technique What do those letters stand for?

42 Renal biopsy: Ultrasound-guided

43 Post-biopsy evaluation Fluid diuresis for 12 hoursFluid diuresis for 12 hours Monitor PCV & TPP at appropriate intervals over 12 to 24 hoursMonitor PCV & TPP at appropriate intervals over 12 to 24 hours

44 Renal biopsy: Complications Microscopic hematuria vs macroscopic hematuria

45 Renal biopsy: Complications HemorrhageHemorrhage InfarctionInfarction HydronephrosisHydronephrosis Other extremely rare (e.g. infection, retention cyst, AV fistula, urine fistula)Other extremely rare (e.g. infection, retention cyst, AV fistula, urine fistula)

46 Handling the biopsy Avoid touching the biopsy specimen at allAvoid touching the biopsy specimen at all Preservation of specimenPreservation of specimen 10% buffered formalin for routine light microscopy and peroxidase- immunoperoxidase immunopathology10% buffered formalin for routine light microscopy and peroxidase- immunoperoxidase immunopathology Michel’s medium for direct immunofluoresenceMichel’s medium for direct immunofluoresence 2% glutaraldehyde for transmission electron microscopy2% glutaraldehyde for transmission electron microscopy


Download ppt "Hematology, Serum Electrolytes and Renal Biopsy Stephen P. DiBartola, DVM Department of Veterinary Clinical Sciences College of Veterinary Medicine Ohio."

Similar presentations


Ads by Google