2022.Vol38.Iss1.EqUrinaryTractDisorders Flashcards by Cassie Baumgarten

Q

Imaging of the urinary tract

What is the reported reference size measures in thorough bred adults and foals

A

Adults:
ave length of both kidneys: 15-18 cm
right kidneylarge in width: 13.4-14 cm & depth 6.7-7.4 cm

Foals:
8-10.5 cm length
6.7-10.4cm width

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Q

Acute kidney injury and renal failure in horses

What is the MOA of aminophylline?

A

inhibits adenosine-> a potent afferent arteriole vasoconstrictor

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Q

Acute kidney injury and renal failure in horses

Why is mannitol controversial in the treatment of ARF?

A

can cause severe osmotic injury to the tubules

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Q

Urinary tract disorders of foals

how high can spurious hypercreatinemia syndrome get in foals?

A

occasionally >15 mg/dL
**generally decline to normal concentrations in 1-3 days of life

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Q

Urinary tract disorders of foals

What is the average time to the first urination in foals?

A

6 hours-colts
11 hours-fillies

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Q

Urinary tract disorders of foals

What is the normal urine output in a foal?

A

148 ml/kg per day

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Q

Urinary tract disorders of foals

Why do foals have increased protein in their urine?

A

within the first 36 hours of life
2-3+ proteinuria d/t colostrla ab absorption

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Q

Urinary tract disorders of foals

What is the size of foals kidneys on ultrasound?

A

5x10cm for a 50 kg foal

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Q

Urinary tract disorders of foals

A report in standard bred foals reported what the normal umbilical structures measure?

A

median umbilical vein diameter: 0.83 cm
median umbilical artery diameter: 0.61 cm
median urachal diameter of 1.07 cm

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Q

Urinary tract disorders of foals

When should a urinary catheter be passed in a foal?

A

a bladder diameter >10cm
**dummy foal bladder– poor detrusor tone or bladde sphincter dyssnergia can precede bladder rupture in foals

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Q

Urinary tract disorders of foals

What is the recommended percentage of chlorhexidine solution for dipping umbis?

A

0.5% chlorhexidine

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Q

Urinary tract disorders of foals

What level of creatinine in peritoneal fluid: serum is consistent with bladder rupture?

A

peritoneal fluid: serum Cr ratios >2

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Q

Urinary tract disorders of foals

What are recommended treatments prior to surgical correction for a ruptured bladder?

A

draining urine from abdomen
replace IV fluids wiht 0.9% NaCl to prevent hypotension & rapid fluid shifts
Treat hyperkalemia: 50 ml Ca gluconate added to 1 L bag of 0.9% NaCL and 5-10% dextros esolution

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Q

Urinary tract disorders of foals

When is it safe to take a foal to surgery with hyperkalemia?

A

concentrations <5.5 mEq/L

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Q

Urinary tract disorders of foals

How does hydroureter syndrome present in foals?

A

-present 3-7 days old
C/S: encephalopathy, blindness, seziures
Na Concentrations <110 mEq/L

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Q

Polyuria and polydipsia in horses

List differentials for polyuria in horses

A

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Q

Polyuria and polydipsia in horses

How do you differentiate psychogenic polydipsia from diabetes insipidus?

A

water deprivation test (or modified if long-standing with resultant medullary washout)

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Q

Metabolic disorders associated with renal disease in horses

Signs of cerebral cortical dysfunction is seen in as a rare sequelae of renal failure caused by

A

uremia
**uremic encephalopathy

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Q

Metabolic disorders associated with renal disease in horses

What is the prognosis for foals showing signs of encephalopathy d/t hyponatremia and acute kidney injury?

A

Favorable prognosis– correction of sodium deficit

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Q

Metabolic disorders associated with renal disease in horses

What does uremic encephalopathy pathogenesis seen as histopathologically?

A

diffuse central nervous system Alzheimer type II astrogliosis

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Q

Metabolic disorders associated with renal disease in horses

What is the cause of renal tubular acidosis?

A

kidney unable to maintain normal acid-base homeostasis b/c of tubular defects in acid secretion or bicarbonate HCO 3- reabsorption

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Q

Metabolic disorders associated with renal disease in horses

What is the metabolic disturbance seen with renal tubular acidosis?

A

normal anion gap: hyperchloremic metabolic acidosis

**loss of serum bicarb results in a retention of chloride, so anion gap remains normal

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Q

Metabolic disorders associated with renal disease in horses

What are the types of renal tubular acidosis?

A

T1: impaired acid secretion, potassium wasiting; defect in H secretion by H-atpase or H/K ATPase or increased H permeability of the luminal membrane of the alpha intercalated cells results in a net H secretion

T2: proximately RTA: defect in reabsorption of filtered HCO3 d/t impaired HCO3 transport across basolateral membrane or d/t carbonic anhydrase inhibition

T3: RTA is rare (features of both T1 & T2)

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Q

Metabolic disorders associated with renal disease in horses

What are causes of renal tubular acidosis?

A

primary (inherited)
Secondary: meds, such as amphotericin B, ibuprofen, lithium or systemic diseases; recurrent nephrlithiasis, nephrocalcinosis,

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Describe fanconi syndrome.

Subset of T2 renal tubular acidosis -widespread PCT dysfunction, with defective resorption in glucose, aa, phosphate, potassium, sodium, calcium, mg uric acid, other organic acids Smith: p979

Metabolic disorders associated with renal disease in horses Besides, hyperchloremic metabolic acidosis, what other electrolyte abnormality is observed?

hypokalemia-- d/t anorexia **also during treatment with bicarb-- will lead to hypokalemia

Metabolic disorders associated with renal disease in horses At what rate can potassium chloride be supplemented?

maintenance: 20-40 mEq/L, not to exceed the rate of 0.5 mEq/kg/h

Metabolic disorders associated with renal disease in horses List causes of severe hyponatremia in foals

(serum <122mEq/L) diarrhea, uroperitoneum, renal disease, rhabdomyolysis, suspected transient pseudohypoaldosteronism, adrenal insufficiency, excessive water intake, iatrenogenic from excessive water enemas & hypotonic fluids

Metabolic disorders associated with renal disease in horses What are C/S seen with hyponatremia in foals?

obtundation, ataxia, seizures, dec suckle reflex, hyperreactivity, central blindness, head tilt, opisthotonos, continuous chewing/tongue movement, grimacing, head pressing, circling, comatose

Metabolic disorders associated with renal disease in horses Describe the two approaches to fluid therapy in the treatment of hyponatremic encephalopathy in foals.

1. 3% hypertonic saline via infusion pump & remained met with 10% dextrose n water; restrict water/milk ingestion. once serum reaches 120 Meq/L, treat with balanced polyionic fluids 2. calculate the deficit & replace.

Relevant equine renal anatomy, physiology, and mechanisms of acute kidney injury: a review NSAID toxicity pathogenesis at the kidney

focal coagulative ischemic necrosis of the renal crest & corresponding inner medulla **prostaglandins are protective to the kidney causing vasodilation of afferent arteriole & inc renal perfusion

Chronic renal failure- causes, clinical findings, treatments & prognosis What are the most common C/S of chronic kidney disease?

weight loss pu/pd ventral edema

Relevant equine renal anatomy, physiology, and mechanisms of acute kidney injury: a review What is the reference standard for evaluating kidney function & can be obtained using iohexol clearance time?

glomerular filtration rate

Relevant equine renal anatomy, physiology, and mechanisms of acute kidney injury: a review Creatinine is only elevated when what percentage of the nephrons are dysfunctionaL?

75%

Relevant equine renal anatomy, physiology, and mechanisms of acute kidney injury: a review Why is creatinine a better measurement of kidney function than urea?

urea: produced from protein catabolism, is reabsorbed in the PCT VS creatinine: produces from muscle, is filtered unhindered in the glomeruli

Relevant equine renal anatomy, physiology, and mechanisms of acute kidney injury: a review Marked proteinuria is considered a hallmark of what disease in horses?

glomerulonephritis

Relevant equine renal anatomy, physiology, and mechanisms of acute kidney injury: a review On bloodwork what should make you highly suspicious of chronic kidney disease?

high creatinine & calcium

chronic renal failure- causes, clinical findings, treatments & prognosis what is the most common cause of chronic renal disease in horses?

glomerulonephritis

chronic renal failure- causes, clinical findings, treatments & prognosis List etiologies of chronic kidney disease

chronic renal failure- causes, clinical findings, treatments & prognosis If renal biopsy identifies glomerulonephritis as a cause of CRD, what treatment is recommended

-resolve primary infection -immunosupprsesive therapy: dex: -.1 mg/kg IV or IM daily for 3-5 days, followed by oral prednisolone 1 mg/kg BID for 2 weeks then tapered to 25% level

chronic renal failure- causes, clinical findings, treatments & prognosis What are management suggestions in chronic kidney disease? (what is the primary focus)

proteinemia, hypertension, electrolyte derangements, nutrition

Discolored urine in horses and foals how to differentiate hematuria/hemoglobinuria/pigmenturia on centrifugation?

after centrifugation hematuria will clear, vs hemoglobinuria and myoglobinuria will not

Discolored urine in horses and foals Besides centrifugation of urine, what other diagnostic helps distinguish hematuria/hemoglobinuria

hemoglobinuria-- serum will be pink discoloration d/t intravascular hemolysis

Discolored urine in horses and foals What drugs will cause urine discoloration?

rifampin phenoazopyridine

Discolored urine in horses and foals How does timing of discoloration during micturition help distinguish location of lesion?

beginning to end: renal, ureteral, or bladder lesions beginning only: distal urethra end only: proximal urethra or bladder neck

Discolored urine in horses and foals What should be ruled out with exercise associated hematuria?

cystoliths **dx on rectal, U/S or cystoscopy

Discolored urine in horses and foals Hematuria is a common C/S of a UTI, what bacteria are commonly isolated?

Proteus mirabilis Escherichia coli Klebsiella spp Enterobacter spp

Discolored urine in horses and foals verminous nephritis can be caused by which organism

halicephalobus gingivalis

Discolored urine in horses and foals Halicephalobus gingivalis can enter through mucous membrane, invade and proliferate in what tissues?

kidneys central nervous system long bones eyes

Discolored urine in horses and foals What C/S can be seen with halicephalobus gingivalis infection?

encephalitis renal dysfunction weight loss hematuria polyuria

Discolored urine in horses and foals What treatments are described for halicephalobus gingivalis?

larvicidal treatment can be attempted **death of worms can cause inflammation--> renal failure

Discolored urine in horses and foals Stallions/geldings can present with hemospermia/hematuria due to what condition?

urethral rent

Discolored urine in horses and foals What is the common location for a urethral rent?

convex surface of the urethra at the level of the ischia arch, usu linear & corresponds with corpus spongiosum

Discolored urine in horses and foals Methemoglobinuria is another cause of discolored urine producing brown-tinged color. List causes:

-nitrite & nitrate tox **accumulating plants: red maple leaves, mint weed, sudan grass

Urinary Incontinence and urinary tract infections What are neurologic causes of incontinence in horses?

EHV-1 polyneuritis equi sacral/coccygeal trauma

Urinary Incontinence and urinary tract infections list causes of urinary incontinence in horses

Urinary Incontinence and urinary tract infections After how many days of antibiotic treatment should a patent umbilicus show improvement?

withint 5 to 7 days of treatment

Urinary Incontinence and urinary tract infections What is the most common congenital abnormality of the equine urinary tract?

ectopic ureter

Urinary Incontinence and urinary tract infections What are C/S of UMN bladder and where is the lesion location?

Lesion: Cr to sacral segments C/S: inc urethral pressure-- difficult to catheterize, tought bladder on rectal palpation

Urinary Incontinence and urinary tract infections What are C/S of LMN bladder and where is the lesion location?

lesion: sacral/lumbosacral C/S: urine dribbling-- incomplete bladder voiding; loss of external anal sphincter tone, reduce or absent perineal reflex, tail paralysis, analgesia or hypalgesia of the perineum, atrophy of mm of hip & him limb, paresis of hind limbs; bladder can be evacuated by putting pressure on it per rectujm

Urinary Incontinence and urinary tract infections What are possible treatments for UMN bladder?

sympatholytic drugs: phenoxybenzamine, acepromazine, prazosin (block alpha-1 rece4ptors in smooth mm of internal sphincter) parasympathomimetic: bethanechol: stim detrusor mm skeletal mm relaxants: benzodiazepines or dantroene to block the striated urethralis mm

Urinary Incontinence and urinary tract infections What clinical signs are seen with polyneuritis equi?

perineal hyperesthesia, initially that progresses hypalgesia/analgesia paralysis of tail, rectum and bladder penile prolapse & dribbiln go furine in males mm atrophy of the gluteals & hind leg muscles (usu asymmetric) asymmetric CN signs: paralysis of masticatory & facial mm, head tilt, nystagmus, tongue paralysis, dysphagia

Urinary Incontinence and urinary tract infections What treatments are described for polyneuritis equi?

no effective treatment **steroids may have some temporary improvement

Urinary Incontinence and urinary tract infections C/S of symmetric ataxia, hind limb weakness, flaccid paralysis of the tail and urinary incontinence is consistent with which toxicity?

sorghum pastures, sudan grass and johnson grass