Logical Approach Uriniary Tract Dz

Question 1

What is normal urine output

Answer 1

• dogs 15-45ml/kg/day

- less than water intake ~1ml/kg/hour (20ml/kg/day) d/t insensible losses

Question 2

Define oliguria and anuria

Answer 2

Oliguria less than normal output

Anuria no urine

Question 3

Define dysuria and stranguria

Answer 3

Dysuria : difficult

Stranguria : slow and painful

Question 4

Define pollakiuria

Answer 4

Frequent small amounts of urine (cf. excessive amount s of urine)

• pollakiuria indicates LUT
• polyuria indicates kidneys/endocrine

Question 5

Define periuria

Answer 5

Inappropriate urination (wrong time and place, due to dysuria, nocturia or behavioural problems)

Question 6

CS related to urinary tract dz

Answer 6

• abdo distension
• collapse
• halitosis
• depression
• vomiting
• suspected constipation
• post trauma
  > Clin path
• azotaemia
• hyperkalaemia
• hyperohosphataemia
• polycythaemia
• proteinuria
• others

Question 7

Hx points

Answer 7

• main concern
• General Hx as well as specific urogenital
• problem (duration, severity, course, response to Tx)
• WHAT IS NORMAL?? (Has animal always drunk excessively)

Question 8

What should be specifically felt on PE?

Answer 8

• kidneys, bladder in cats
• sometimes bladder and kidney in dogs
  > don’t squash obstructed bladder!
• rectal +- vaginal exam
• external genitalia
• NEURO (anal and perineal reflexes, tail and hindlimb function)

Question 9

Signs localising to upper urinary tract?

Answer 9

• PUPD
• abnormal kidney palp
• depression.
• lethargy
• halitosis
• oral ulceration

Question 10

Signs localising to lower urinary tract

Answer 10

• dysuria, pollakiuria
• urinary incontinence
• abnormal palp bladder or urethra
• abnormalities external genital

Question 11

Signs associated with either upper or lower?

Answer 11

Oliguria/anuria

Haematuria

Question 12

Common causes of urinary tract signs UPPER?

Answer 12

• acute kidney injury (ARF)
• CKD
• glomerulonephritis
• neoplasia
• pyelonephritis
• developmental abnormalities
• nephro/ureterolithiasis

Question 13

Common cause urinary tract dz LOWER?

Answer 13

• cystitis
• urolithiasis
• Neoplasia
• urethral obstruction
• trauma
• FLUTD
• functional abnormalities
• developmental abnormalities

Question 14

Further investigations appropriate for urinary dz?

Answer 14

> Clin path 
- blood
- urine 
- calculus analysis 
- aspirate/biopsy 
> imaging 
- plain/contrast rads 
- ultrasound 
- CT 
/MRI 
> others
- endoscopy
- urodynamics 
- nuclear scintigraphy 
- DNA tests

Question 15

Blood work

Answer 15

• routine haem biochemical
• emergency panel (electrolytes, urea creatinine, PCV TS, blood gas)
• abdo fluid analysis

Question 16

What tests can be done on urine?

Answer 16

• SG
• dipstick
• sediment analysis
• culture sensitivity

Question 17

How can urine be collected?

Answer 17

• free catch / catherter / cystocentesis

- first morning / random / post prandial

Question 18

Pros and cons of free catch

Answer 18

• no iatrogenic Haematuria like others
• not good for culture
• can put vet bed in litter tray and collect sample from underneath

Question 19

When is catheter collection useful?

Answer 19

If catheter placed for other reasons (otherwise cysto would be easier)

Question 20

Important consideration when catheterising?

Answer 20

• length of catheter (you can push it in too far and tie a knot!!!!)

Question 21

Considerations for cystocentesis

Answer 21

• not in thrombocytopenia

- not if bladder tumour present (can seed)

Question 22

Imaging useful for urinary tract

Answer 22

>  rads 
- radiodense calculus
- bony change 
- contrast 
- thoracic for mets 
> ultrasound 
- fluid v soft tissue 
- bladder wall thickness
- uretobladder emptying 
- not good for intapelvic, anything gassy, calculi, bony change 
> CT/MRI 
- expensive 
> cytology/biopsy
- very important 
- ultrasound guidance 
> urendoscopy
- therapeutic too 
- expensive 
> scintigraphy 
- rare but very useful for quantitative measurement of GFR kidney 
> urodynamics
- Instill fluid and check resistance 
> DNA tests 
- feline polycysti kidney dz
- familial/juvenile nephropathy
- canine hyperuricouria (excessive excretion of urate)

Question 23

Define polyuria

Answer 23

Greater than Normal urine output