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Year 4 > SA Urogenital > Flashcards

SA Urogenital Flashcards

1
Q

What is the definition of feline idiopathic cystitis?

A

Abnormal voiding behaviour after exclusion of other disorders
No obvious cause
May be a one-off, or may be chronic/recurrent

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2
Q

What are the 2 divisions of feline lower urinary tract disease?

A

Obstructive and non-obstructive

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3
Q

Give some causes of non-obstructive feline lower urinary tract disease

A 
Idiopathic cystitis (most common)
Uroliths
Anatomical defects/cancer
Behavioural problems
Bacterial infection (common in dogs, rare in cats)
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4
Q

Give some causes of obstructive feline lower urinary tract disease

A

Idiopathic cystitis
Uroliths
Urethral plus
Bladder stones and bacterial infections

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5
Q

What is feline lower urinary tract disease?

A

Collective term for signs of lower urinary tract disease and abnormal voiding behaviour

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6
Q

What age of cats is more commonly affected by lower urinary tract disease?

A

Young to middle-aged neutered cats, 2-6 yrs old

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7
Q

Give some predisposing factors for feline lower urinary tract disease

A

Obesity
Indoor/sedentary cats
Dry diet
Multi-cat household

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8
Q

Give some clinical signs of feline lower urinary tract disease

A

Dysuria (difficulty urinating)
Pollakiuria (increased frequency)
Haematuria
Inability to urinate (urethral obstruction)
Behavioural changes
Periuria (urinating in inappropriate places)

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9
Q

How could you gauge whether a cat has obstructive or non-obstructive feline lower urinary tract disease?

A

Palpate the abdomen-large, often painful bladder if obstructed

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10
Q

Why should you check the penis of a cat with suspected feline lower urinary tract disease?

A

Can check for signs of self-trauma/crystals/sludge

Penis often blocks at the tip

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11
Q

Describe the pathophysiology of feline idiopathic/interstitial cystitis

A

Alterations in neurotransmission to and from the bladder -> triggers inflammation
Reduced glycosaminoglycan layer (protects bladder lining)

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12
Q

What is the main trigger of idiopathic/interstitial cystitis?

A

Stress
Cat respond badly to stressful events anyway, certain stressful events will trigger cystitis, can look at their history for other stress-induced signs eg over-groooming, GI changes etc

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13
Q

Urethral plugs in cats are more common in which sex?

A

Males

Most common cause of obstruction

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14
Q

What does a urethral plug consist of?

A

Mucus/glycoprotein matrix, often with other substances trapped in the matrix

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15
Q

What types of uroliths are there?

A 
Struvite (magnesium ammonium phosphate) (normally sterile in cats, not in dogs)
Calcium oxalate
Calcium phosphate
Urates (may see with liver disease)
Silica
Mixed composition stones
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16
Q

Is bacterial infection a common or rare cause of feline lower urinary tract disease?

A

Rare

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17
Q

How may infection occur (which can lead to feline lower urinary tract disease)?

A 
Usually iatrogenic (eg catheterisation)
Secondary to urolithiasis, anatomical defects or neoplasia
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18
Q

Which kind of cats are more prone to bacterial infection of the urogenital tract?

A

Older cats with CKD and poorly concentrated urine

Diabetics

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19
Q

Which neoplasia is more common in the bladder of dogs and cats?

A

Transitional cell carcinoma

More rare in cats than dogs

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20
Q

Give some inherited and acquired anatomical defects of the urogenital tract

A 
Inherited:
-Vesico-urachal diverticulae
-Bladder hypoplasia
-Urethral strictures
-Phimosis (inability of the prepuce to be retracted behind the glans penis)
Acquired:
-Strictures due to trauma
-Inflammation
-Iatrogenic damage
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21
Q

What biochem results may you see on a blood sample of a cat with feline lower urinary tract disease?

A

Hyperkalaemia (potassium is normally exreted out in urine)
Hyperphosphataemia (phosphate is normally exreted out in urine)
Metabolic acidosis
Azotaemia

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22
Q

How should you examine the urine of a cat with suspected feline lower urinary tract disease?

A

Dipstick for haematuria, proteinuria, pH
Sediment analysis (RBC are common +/- WBC, epithelial cells)
Crystals are a normal finding
Specific gravity (highly concentrated predisposes to urolith formation, diluted predisposes to bacterial infection)
Culture and sensitivity (recurrent/persistent cases)

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23
Q

What should you make sure you include when radiographing the urinary tract?

A

ALL of the urinary tract, including penile urethra

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24
Q

What does US allow you to see when investigating feline lower urinary tract disease?

A

Thickened bladder walls
Bladder masses
Uroliths and acoustic shadowing
Hyperechoic sediment

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25
Q

When would a cystotomy be indicated in a cat with lower urinary tract disease?

A

Removal of uroliths that can’t be dissolved medically

Biopsy of the bladder wall

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26
Q

How should you approach treatment of feline lower urinary tract disease?

A

Treat specific/underlying cause

If no obvious underlying cause, treat as idiopathic cystitis

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27
Q

How would you treat urethral plugs?

A

Emergency situation

Sedate and use catheter to flush plug back in, then flush bladder 4-5 times with warm saline

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28
Q

What could happen if you don’t treat a urethral plug?

A

Could develop post-renal azotaemia within 24hrs

Bladder may rupture

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29
Q

How could you investigate whether or not fluid in the abdomen was urine from a ruptured bladder?

A

Take some fluid and measure creatinine (not urea as this travels quickly across perioneum)

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30
Q

How would you treat struvite uroliths?

A

Dissolve with medical dissolution diet

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31
Q

How would you treat calcium oxalate uroliths?

A

Surgical removal

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32
Q

How would you treat other uroliths?

A

Encourage water intake

Use diet to prevemt recurrence

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33
Q

How would you treat feline interstitial/idiopathic cystitis?

A

Most cases resolve spontaneously within 5-10 days
Corsticosteroids and antibiotics have no positive effects!
Reduce stress (eg feliway)
Encourage water intake to create dilute urine (wet diet, water fountain etc)
Could give GAG supplements (decrease bladder permeability) but no significant difference
Analgesia and anti-inflammatories (eg butorphanol)
Tricyclic antidepressants (amitriptyline), chronic cases

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34
Q

Give some causes of stress for a cat

A 
Changes in diet
Weather
Overcrowding
Environment
Owner stress
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35
Q

Which tricyclic antidepressant may be used in cases of feline interstitial/idiopathic cystitis?

A

Amitriptyline 2.5-20mg/cat q 24hrs (evenings)
Reserve for long-term treatment
Anticholinergic (increases bladder capacity)

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36
Q

Give some side effects of amitriptyline (tricyclic antidepressant used to treat feline idiopathic cystitis)

A

May cause drowsiness or urinary retention

Raised liver enzymes, neutropenia and thrombocytopenia

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37
Q

How would you treat a urethral spasm?

Give a negative side effect

A

Smooth muscle antispasmodics
eg acepromazine
May help reduce severity of signs and prevent urethra re-blocking
May cause hypotension

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38
Q

When does azotaemia occur?

A

When 75% of nephrons are damaged and not working

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39
Q

Can you have end-stage glomerulopathy without azotaemia?

A

Yes, as nephrons can function with a damaged glomerulus

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40
Q

Define acute kidney injury

A

Any damage to the kidney present for less than 3 months

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41
Q

Give some clinical signs of acute kidney injury

A 
Nausea/vomiting
Normuria/oliguria/anuria
Hyperkalaemia
Hypertension
Azotaemia/uraemia
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42
Q

Give some causes of acute kidney injury

A 
Toxins
Infectious
Vascular
Post-renal obstructuve
Secondary to systemic disease
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43
Q

Define chronic kidney disease

A

Any structural or functional change that is present and stable for over 3 months

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44
Q

In which 5 ways can CKD become apparent?

A

Slow deterioration of renal function over time
Previously healthy kidney -> episode of AKI -> progresses to CKD
A congenital condition becomes a problem
Acute or chronic episode -> accelerating decline
A neoplastic process expands/invades

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45
Q

Give some causes of renal damage that would be staged as Stage 1 CKD

A 
Reduced renal concentrating ability
Early neoplastic change
Structural change (eg renal cyst)
Tubular problems
Presence of renal proteinuria
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46
Q

Define glomerular filtration rate

A

Amount of ultrafiltrate that passes through the glomerulus

Measured in ml/kg/hr

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47
Q

What is the most accurate way to assess glomerular filtration rate?

A

Measure the renal clearance of an exogenous substance eg insulin, iohexhol, or injected/exogenous creatinine clearance
However, these are all affected by pre-renal factors eg dehydration, hypotension

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48
Q

What 3 things must an animal be before you assess glomerular filtration rate?

A

Hydrated
Normovolaemic
Normotensive

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49
Q

How do urine and serum creatinine levels change with renal and pre-renal damage?

A

Pre-renal: high urine excretion of creatinine

Renal: low urine excretion of creatinine and high serum creatinine

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50
Q

What is the definition of a glomerulopathy?

A

Any damage to the glomeruli of the nephrons

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51
Q

What is the classical clinical sign of a glomerulopathy?

A

Proteinuria (used a method of diagnosis; >2.0)

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52
Q

Which dog breeds are prediposed to glomerulopathies?

A

Golden retrievers

Labradors

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53
Q

Give the pathophysiology of glomerulopathies

A

Deposition of immune complexes in the glomeruli (Type III hypersensitivity reaction) or
Antibody production against the glomerulus (Type II hypersensitivity reaction)
-> complement
-> local damage to the glomerulus by inflammation
-> leakage of proteins through glomerulus into urine
Can also get amyloid plaque deposition- high levels of proteinuria

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54
Q

Which breeds are more prone to amyloid plaque deposition in their glomeruli (renal amyloidosis)?

A

Shar pei
Siamese
Burmese cat

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55
Q

Give some causes of glomerulopathies

A

Familial (eg shar pei, beagle)
Acquired
Infectious (eg Lepto, sepsis, pyometra, pyelonephritis)
Inflammatory (eg severe pancreatitis)

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56
Q

When would you suspect a glomerulopathy?

A

Sick animal with proteinuria that does not resolve with treatment (eg has pancreatitis/sepsis)
Animal with newly diagnosed azotaemia and/or high urine protein
Hypertension of unknown origin
Thromboembolic event
At risk breeds

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57
Q

What is the gold standard method for diagnosing glomerulopathies?
Give some problems with this method

A

Biopsy, but is expensive, high risk of bleeding, doesn’t change tx options

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58
Q

What should you do after getting a positive dipstick result for proteinuria?

A

Quantify this result using the urine protein:creatinine ratio
Most easily confirmed by taking a cystocentesis sample and analysing haem and biochem
Should also confirm persistence of proteinuria by having proteinuria in 3 samples, 2 weeks apart

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59
Q

You should only start treatment for a glomerulopathy after proteinuria is confirmed to be which 3 things?

A

Persistent (3 measurements, 2 weeks apart)
Renal
Quantified (do UP:C)

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60
Q

Which values for proteinuria suggest glomerulopathy and which suggest tubulointerstitial lesions?

A

> 2.0 suggests glomerulopathy

<2.0 suggests tubulointerstitial lesions

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61
Q

For which values of proteinuria for dogs and cats would you start treatment?

A

Dogs: >0.5
Cats: >0.4

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62
Q

How do you treat proteinuria?
How does it work?
What may happen as a result?

A

Ace inhibitors (benazapril)
Reduces efferent arteriole pressure -> reduced GFR -> reduced pressure in glomerulus
Mild effect on BP
Reduced GFR may cause an increase in azotaemia, phosphate, potassium, serum creatinine (monitor?)

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63
Q

Why does hypercoagulability occur with glomerulopathies?

A

Due to loss of anti-thrombin III

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64
Q

Give some treatment options for hypercoagulability associated with glomerulopathies

A

Low-dose aspirin (diluted)
Clopidogrel (inhibits platelets)
Dalteparin (inhibits factor X)

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65
Q

Give a problem with hypertension

A

Can cause end-organ damage (eyes, heart, kidneys, liver, CNS)

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66
Q

What is the standard treatment for hypertension?

What is the target value?

A

Amlodipine

Target: 150mmHg systolic

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67
Q

How can you alter diet when treating glomerulopathies?

A 
Restrict protein (reduces proteinuria and azotaemia)
Omega-3 supplementation (reduces glomerular inflammation)
Renal diet if azotaemic (stage 3 in dogs, stage 2 in cats)
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68
Q

Why is it important that an animal eats when it has azotaemia?

A

Starvation results in catabolism of body proteins -> increased protein through kidneys

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69
Q

Summarise how you’d treat a glomerulopathy

A

Ace-inhibitors or angiotensin receptor blockers (eg benazepril, to reduce proteinuria)
Anti-hypertensive medication (amlodipine)
Anti-thrombotic medication (loss of anti-thrombin III)
Diet (restrict protein, omega 3 supplementation)

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70
Q

What is the general prognosis time for dogs with a glomerulopathy and no azomtaemia?

A

6m-1yr

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71
Q

What would you suspect in a dog with a 24hr history of severe vomiting, collapse, intense abdominal pain and mild diarrhoea?

A

Acute pancreatitis

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72
Q

Why should you sometimes be skeptical when measuring urine P:C ratio in the vets?

A

UP:C will increase in the vets due to stress

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73
Q

What would you give to a dog with CKD with increased phosphate?

A

Phosphate binder

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74
Q

Renal amyloidosis in Shar peis can result in what?

A

High levels of proteinuria
Commonly preceded by episodes of ‘Shar pei fever’-self-limiting swollen hocks/pyrexia
Rapidly progressive
Commonly leads to nephrotic syndrome

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75
Q

How would you treat renal amyloidosis (Shar peis)?

A

Typical treatment for a glomerulopathy plus colchicine +/- DMSO

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76
Q

What is the method of inheritance of polycystic kidney disease?

A

Depends on breed (persian, ragdoll, british short hair, WHWT)
Is autosomal dominant

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77
Q

How is polycystic kidney disease characterised?

A

Cysts in the kidney and also liver (slowly progressive)

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78
Q

What is nephrotic syndrome?

When is it seen?

A

Severe loss of protein from the glomerulus

Often seen in severe/end-stage glomerulopathies and common in amyloidosis

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79
Q

How is nephrotic syndrome characterised?

A

Hypoalbuminaemia
Peripheral oedema
Hypercholesterolaemia
+/- azotaemia

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80
Q

What is the prognosis like for nephrotic syndrome?

A

Very poor-12.5 days (due to low oncotic pressure)

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81
Q

Which fluids should you avoid in dogs with nephrotic syndrome?

A

Colloids

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82
Q

Give some pre-renal causes of acute kidney injury

A 
Decreased renal blood flow caused by:
-Dehydration
-Hypovolaemia
-Hypotension
(Causes decreaed GFR and mild azotaemia)
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83
Q

Is pre-renal acute kidney injury reversible?

A

Yes if corrected in time

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84
Q

Give some causes of renal parenchymal disease

A

Ischaemia
Toxins
Intrinsic renal parenchymal disease
Systemic diseases targeting kidney

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85
Q

Give some causes of ischaemia which can then lead to renal parenchymal disease

A 
Hypovolaemia
Hypotension
Renal vasoconstriction (prostaglandin inhibitors)
Thrombi, DIC
Pancreatitis, peritonitis, vasculitis
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86
Q

Give some toxins which can cause renal parenchymal disease

A 
Antibacterials (aminoglycosides)
Chemotherapy drugs (cisplatin)
Radiographic contrast media
NSAIDs (eg ibuprofen)
Organic compounds (ethylene glycol)
Easter lily
Paracetamol
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87
Q

Give some intrinsic conditions that cause acute kidney injury

A

Infectious (leptospirosis, FIP, leishmaniasis)
Pyelonephritis, septic emboli
Glomerulonephritis
Trauma

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88
Q

Give some systemic diseases that cause acute kidney injury

A

Multiple organ failure
Polycythaemia
Lymphoma
Hypercalcaemia

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89
Q

Describe the 4 stages of acute kidney injury

A

Initiation phase: damage starts
Extension phase: ischaemia, hypoxia, inflammatory response, ongoing cellular injury, cell death
Maintenance phase: GFR stabilises, azotaemia, uraemia, variable urine production
Recovery phase: azotaemia improves, tubules undergo repair, can have marked polyuria

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90
Q

How do you diagnose acute kidney injury?

A

History (recent anorexia, PD, vomiting, diarrhoea, toxin exposure? Signs of infection?)
Physical exam (dehydration, uraemic breath, hypothermia, tongue/buccal ulceration, +/- kidney pain/enlargement, occasional neuro signs)
Bloods (azotaemia, hyperkalaemia, metabolic acidosis, increased PCV, TP)
Urine (isosthenuria, can see glucosuria and haematuria, look at sediment for casts, WBCs, bacteria, crystals)
Imaging (radiography: kidney size, shape, opacity, ureter, bladder, urethra. US: renal size, parenchyma, echogenicity)

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91
Q

How big should the kidney be in dogs?

What about cats?

A

Dogs: 2.5-3.5 x L2
Cats: 2-3xL2

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92
Q

How can you differentiate between acute and chronic kidney injury?

A 
Chronic:
Weight loss
Previous history of PUPD/poor appetite/GI signs
Non-regenerative anaemia
Kidneys typically small, firm, irregular
Often not ill
Normal or low potassium 
Poor hair coat
Acute:
Good BCS
Acute onset of signs +/- history of toxin exposure
Kidneys may be enlarged/painful
May be ill +/- hyperkalaemia
May be casts in urine
Good hair coat
93
Q

What is the antidote for ethylene glycol poisoning in cats?

A

4-methylpyrazole (fomepizole)
Ethanol (needs to be given within 8 hours)
Prognosis poor if already azotaemic/oliguric

94
Q

Which crystals can you see in the urine of a cat with ethylene glycol poisoning?

A

Calcium oxalate monohydrate

95
Q

Which supportive treatment can you give animals with acute kidney injury?

A

Correct hydration status, acid-base status, electrolytes
Monitor hydration, MM, PCV, CRT, HR, RR, BP, biochemistry
IVFT

96
Q

What treatment can you give to increase urine output?

A

Furosemide (increases urine output but does not inprove GFR or outcome)
Mannitol

97
Q

How can you correct hyperkalaemia?

A 
Fluid therapy (0.9% NaCl or Hartmanns)
Calcium gluconate 10% (doesn't lower K but is an antagonist of the cardiac effects of hyperkalaemia)
Dextrose (stimulates insulin secretion)
Insulin (facilitates the uptake of glucose into the cell, which brings potassium with it)
Sodium bicarbonate (K+ moves into cells in exchange for H+)
98
Q

Which drugs could you give to reduce vomiting?

A 
H2 antagonists (eg ranitidine), proton pump inhibitors (eg omeprazole)
Maropitant, metoclopramide, ondansetron
99
Q

Which drugs could you give to reduce hypertension?

A

Exacerbated by overhydration; reduce IVFT and give diuretics
If persistent, can give antihypertensives (most are oral)
-Nitroprusside
-Hydralazine
-Amlodipine

100
Q

What should you consider if you can’t induce diuresis in a pet with acute kidney injury?

A

Euthanasia

Dialysis (referral; haemodialysis or peritneal dialysis)

101
Q

Whar is the prognosis for acute kidney injury in cats and dogs?

A

Dogs: 53-60% mortality
Cats: 50% mortality

102
Q

What is the definition of pyuria?

A

WBCs in urine

103
Q

What is the definition of a UTI?

A

The adherence, multiplication and persistence of an infectious agent in the urogenital system

104
Q

Give some routes of infection of a UTI

A

Ascending infection
Upper urinary tract infections are most commonly infected by:
-Pyelonephritis
-Nephritis

105
Q

Give some clinical signs of an upper UTI

A

Abdominal pain
Renal failure
Septicaemia

106
Q

Give some clinical signs of a lower UTI

A

Dysuria
Pollakiuria
Haematuria
Urinary incontinence

107
Q

How may blood results differ between upper and lower UTIs?

A

Lower UTIs: unremarkable

Upper UTIs: bloods may be consistent with septicaemia or renal failure

108
Q

How do you diagnose a UTI?

A

Urine culture=gold standard (bacteria)
Urinalysis
Urine sedament exam (WBC >5 per hpf, microburia, pyuria)

109
Q

How do we choose an appropriate antibiotic for a UTI?

A

Agar disk diffusion

Antimicrobial dilution technique (MIC)

110
Q

An antimicrobial agent must be able to attain a urinary concentration that exceeds the MIC of the uropathogen by how much?

A

At least four times

111
Q

How do we treat UTIs?

A

Eradication of underlying causes if possible (eg diabetes mellitus, CKD, hyperadrenocorticism)
Antimicrobials

112
Q

Which antimicrobials are a first-line treatment for UTIs?

A

Amoxicillin
Cephalexin
Trimethoprim

113
Q

How can we prevent UTIs?

A

Avoid indiscriminate use of urinary catheters (use a closed collection system, avoid indwelling catheters in immunocompromised patients)
Risk of UTI infection increases with duration of catheterisation

114
Q

What is the difference between complicated and uncomplicated UTIs?

A

Uncomplicated=no underlying structural, neurological or functional abnormalities

115
Q

How would you treat an uncomplicated UTI?

A

10-14 days course of antibiotics

If possible, a urine culture should be performed 5-7 days after therapy ends

116
Q

How would you treat a complicated UTI?

A

Antimicrobial therapy for 4-6 weeks

Intact male dogs with UTI should be assumed to have prostatic infection, consider blood-prostate barrier

117
Q

Which type of animals are more likely to have a complicated UTI?

A

Sexually intact dogs
Most cats
Animals with predisposing factors for UTIs
Animals with upper respiratory tract infections

118
Q

Give some possible complications of bacterial urinary tract infections

A

Polypoid cystitis
Emphysematous cystitis
MAP crystals
Pyelonephritis

119
Q

Is bacterial cystitis common or rare in cats?

A

Rare

120
Q

How does the bladder receive sympathetic innervation during the filling stage?

A

Hypogastric nerve

121
Q

How does the bladder receive somatic (voluntary) innervation during the filling stage?

A

Pudendal nerve

122
Q

How is relaxation of the bladder achieved?

A

Sympathetic action on beta-adrenoceptors in detrusor muscle

123
Q

How is contraction of the bladder achieved?

A

Sympathetic action on alpha-adrenoceptors in urethral smooth muscle and trigone
Also somatic innervation of urethral striated muscle and inhibition of detrusor reflex

124
Q

What innervation does the bladder receive during the emptying phase?

A

Parasympathetic nervous system predominates via the pelvic nerve (contraction of detrusor, relaxation of urethral muscle: detrusor reflex)

125
Q

How is urinary continence achieved?

A

Brainstem micturition centre integrates urethral and detrusor function
Cerebral cortex gives voluntary control by over-riding the detrusor reflex

126
Q

How can you investigate urinary incontinence?

A 
Detailed history
Clinical exam
Biochem and haematology
FeLV test (cats)
Urinalysis
Urine culture and sensitivity
Observe patient urinating
Further tests:
-Plain abdominal radiographs
-Intravenous urogram (opacification of kidneys and ureters)
-Retrograde (vagino) urethrogram
-US of urinary tract
-Cytoscopy
127
Q

Give some typical findings of abnormalities of the filling phase of the bladder

A

Patient can urinate normally but dribble urine between urinations
Often have reduced bladder capacity

128
Q

Give some differential diagnoses for abnormalities of the filling phase

A

Ectopic ureter
Reduced pressure at bladder neck
Urge incontinence (can’t hold it in when they need the toilet)

129
Q

Why may an animal have reduced pressure at the bladder neck?

A

Congenital USMI (urethral sphincter mechanism incompetence)
Acquired USMI
Intrapelvic/caudal bladder
Bladder neck mass (polyp/neoplasia/cystic calculus)
Hypoplastic bladder

130
Q

Give some causes of urge incontinence (patient knows it needs the toilet and can’t hold it in)

A 
Bacterial infection
Cystic calculus
Drug-induced
FeLv+ cats
Neoplasia of bladder neck
131
Q

Give some typical findings of abnormalities of the emptying phase of the bladder

A

Distended bladder
Constant dribbling of urine ?
No normal urination
(Overflow incontinence as bladder is full)

132
Q

Give some differential diagnoses for abnormalities of the emptying phase

A

Partial/complete urethral obstruction
Chronic distension of bladder (urethral obstruction, pelvic trauma, intervertebral disc protrusion, feline dysautonomia)
Dyssynergia

133
Q

What is a non-neurogenic incontinence?

A

Urethral sphincter mechanism incontinence
Commonest cause of incontinence in bitch
Intermittent involuntary passage of urine, usually while dog is relaxed
Do not constantly dribble urine

134
Q

Give the aetiology of a USMI

A

Low urethral tone
? Hormonal influence
? Intrapelvic bladder
Obesity

135
Q

Acquired USMI usually affect which dogs?

A

Medium/large breeds (Dobermans, boxers, irish setters)

Usually neutered females

136
Q

Congenital USMI usually affects which dogs?

A 
Juvenile bitches (prior to first season)
50% resolve after first season
137
Q

How do you medically treat a USMI? (urethral sphincter mechanism incontinence)

A

Increase muscle tone (phenylpropanolamine, estriol)

Reduce contributing factors (weight loss, treat secondary UTI)

138
Q

How do you surgically treat a USMI? (urethral sphincter mechanism incontinence)

A

Colposuspension
Urethropexy
Hydraulic occluder

139
Q

How is a colposuspension carried out?

A 
Caudal midline coeliotomy
Pull bladder cranially
Reposition bladder neck in abdomen 
Suture vagina to prepubic tendon
Increases pressure in urethra as it is now sandwiched  between vagina and pubic brim
140
Q

What is the prognosis like for a colposuspension?

A

50% cure
30% improved
20% no better or worse

141
Q

Acquired USMIs in male dogs typically affect which kind of dogs?

A

Older, castrated, medium/large breeds

Usuallu overweight

142
Q

How could you treat an acquired USMI in a male dog?

A 
Phenylpropanolamine 
Oestrogen-based drugs
Weight loss
Vas deferensopexy?
Prostatopexy?
143
Q

Describe ectopic ureters

A

Congenital anomaly, ureter bypasses bladder to empty into urethra, vagina or rectum
Can be intramural (more common) or extramural
Dribble urine all the time
More common in females
Mostly unilateral

144
Q

Which dog breeds are more prone to ectopic ureters?

A

Golden labradors/retrievers, skye terriers, siberian huskies

145
Q

How do you treat an ectopic ureter?

A

Treat associated UTI
Early surgical management (before irreversible secondary changes)
Technique depends on whether uni/bilateral and intra/extramural

146
Q

Which surgery options are available when treating an ectopic ureter?

A

Ureteronephrectomy (removal of kidney and ureter; used for unilateral ectopia, severe hydronephrosis)
Ureteral transection and re-implantation (extramural ectopia)
Intravesical repair (intramural ectopia)

147
Q

How may an acquired ureteral ectopia occur?

A

Ureters may be ligated during ovariohysterectomy, usually by inclusion in the cervical ligature
Severe hydronephrosis may develop (reversible if ligature removed in 1 week)
May develop uretero-cervical fistula

148
Q

What is the most common cause of urinary incontinence in cats?

A

Neurogenic (eg tail pull, sacral fracture, poor prognosis if no improvement after 6 weeks)

149
Q

Give some other less common causes of feline urinary incontinence

A

Juvenile urinary incontinence (ectopic ureter, hypoplastic urethra/vaginal aplasia)
Iatrogenic (eg after perineal urethrostomy)

150
Q

What are the 3 types of ureteric obstruction?

A

All rare
Intraluminal
Intramural
Extramural

151
Q

Give some causes of intraluminal ureteric obstruction

A

Ureteric calculus

Pedunculated mass

152
Q

Give some causes of intramural ureteric obstruction

A

Tumour (v. rare)

Fibrosis/stricture

153
Q

Give some causes of extraluminal ureteric obstruction

A

Compression or invasion by abdominal tumour/mass
Ligation during spay
Uterine stump infection

154
Q

What can happen if there is prolonged ureteric obstruction?

A

Hydronephrosis

Reversible if obstruction is relieved within 7 days

155
Q

How would you diagnose ureteric trauma (avulsion)?

A

May see electrolyte abnormalities as urine accumulates in retroperitoneal space
Renal function tests may be unaffected if unilateral injury
Definitive diagnosis requires IV urography

156
Q

How may ureteric trauma (avulsion) occur?

A

Blunt abdominal trauma, ballistic injuries

157
Q

How do you treat ureteric trauma (avulsion)?

A

Correct electrolyte/metabolic abnormalities
Management depends on site and severity of injury:
-Ureteral avulsion at kidney (ureteronephrectomy)
-Mid-ureteral trauma (mild tears may spontaneously resolve, surgical repair)
-Avulsion at bladder (re-implantation)

158
Q

Define chronic kidney disease

A

Structural or functional abnormalities of one or both kidneys that have been there for 3 months or longer
Adaptive changes have already occurred
Irreversible, slowly progressive

159
Q

Define azotaemia

A

An abnormal concentration of urea, creatinine and other nitrogenous compounds in the blood
Can be pre-renal, renal or post-renal

160
Q

Define uraemia

A

Clinical syndrome that results from loss of kidney function, involving multiple metabolic derangements

161
Q

Give some congenital causes of CKD in dogs and cats

A

Renal dysplasia
Polycystic kidney disease
Amyloidosis
Fanconi-like syndrome

162
Q

Give some acquired causes of CKD in dogs and cats

A 
Idiopathic tubulointerstitial nephritis 
Glomerular disease
Amyloidosis
Sequel to AKI
LUT obstruction
Pyelonephritis
Hypercalcaemia
Renal neoplasia
Nephrotoxic drugs
Hypokalaemia in cats
Hypertension
163
Q

Give the pathology of CKD

A 
Intraglomerular hypertension
Increased GFR
Systemic hypertension
Proteinuria
Precipitation of calcium phosphate in renal tubules
164
Q

Of cats and dogs, which are more affected by glomerular disease and which by tubulointerstitial disease?

A

Dogs: glomerular disease
Cats: tubulointerstitial disease

165
Q

Briefly describe the 4 IRIS stages of CKD

A

Stage 1: Primary renal injury
Stage 2: Mild azotaemia, maladaptions
Stage 3: Uraemia, systemic complications
Stage 4: End-stage renal failure

166
Q

Give the clinical signs of CKD

A 
Weight loss
Poor appetite
Poor coat
Dullness, lethargy, sleeping more
PUPD 
Dehydration
Vomiting
Constipation
Neuro signs
Signs related to hypertension
Oedema/ascites in severe protein-losing CKD
167
Q

What may you see in a physical exam of an animal with CKD?

A 
Dehydration
Poor body condition
Pale mm
Hypothermia
Oral ulceration
Uraemic breath
Retinal lesion-hypertension
Osteodystrophy ('rubber jaw')
Palpate kidneys
Ascites/subcutaneous oedema
168
Q

What 3 criteria do you need for the staging of CKD?

A

Creatinine concentration (GFR estimate)
Proteinuria
Blood pressure

169
Q

Give the plasma creatinine concentrations for the 4 stages of the IRIS staging system of CKD in dogs

A

Stage 1: 0-125umol/l
Stage 2: 125-180
Stage 3: 180-440
Stage 4: >440

170
Q

Give the plasma creatinine concentrations for the 4 stages of the IRIS staging system of CKD in cats

A

Stage 1: 0-140umol/l
Stage 2: 140-250
Stage 3: 250-440
Stage 4: >440

171
Q

Give the values of urine protein:creatinine ratio that represent non-proteinuria, borderline proteinuria and proteinuria

A

Non-proteinuria: 0-0.2
Borderline proteinuria: 0.2-0.5
Proteinuria: >0.5

172
Q

Which dog breed is more prone to fanconi-like syndrome?

A

Basenji

173
Q

Which cat breed is more prone to polycystic kidney disease?

A

Persian

174
Q

Sub-stages of CKD are based on what 2 things?

A

Proteinuria

Blood pressure

175
Q

Which criteria must we use when staging CKD?

A

Animal must be hydrated

Creatinine must be stable (ie take 2 samples 2 weeks apart)

176
Q

What are the minimal things you must do when investigating CKD?

A 
History
Physical exam (eyes, thyroid)
Haem and biochem
Urinalysis
Blood pressure
Abdominal radiographs
Abdominal US
177
Q

What are the end-organs?

A

Eyes, brain, heart, kidneys

178
Q

How does muscle mass affect creatinine?

A

Higher muscle mass -> higher creatinine

179
Q

What may you see on a haematology of CKD?

A

Normocytic, normochromic non-regenerative anaemia

180
Q

What may you see on a biochem of CKD?

A

Azotaemia (increased urea and creatinine)
Increased phosphate
Increased or decreased total calcium (usually increased total calcium with normal-low ionized calcium)
Decreased potassium (cats, not usually dogs)
Decreased albumin in protein-losing nephropathies

181
Q

Give some differential diagnoses for high blood urea

A

CKD
High protein diet
GI bleeding
Dehydration

182
Q

What does increased phosphate lead to?

A

Secondary hyperparathyroidism
Metastatic calcification
Linked to increased mortality and progression of CKD (calcium and phosphate interact and can cause tissue damage)

183
Q

Give some clinical signs of low potassium in cats

A 
Neuromuscular signs (ventral neck flexion)
Decreased renal function
Anorexia
184
Q

What happens to blood potassium concentrations during end-stage CKD?

A

Increases

185
Q

What value for urine specific gravity would you expect in a dog or cat with CKD?

A

Isosthenuria

1.008-1.012

186
Q

Isosthenuria with azotaemia usually = renal azotaemia.

What are the 3 exceptions?

A

Hypercalcaemia
Addisons
Animal on diuretics

187
Q

What would you look at on a radiograph when investigating CKD?

A

Kidney size, shape, opacity
Ureters
Bladder
Urethra

188
Q

What should you asses on an US when investigating CKD?

A

Renal size, parenchyma, echogenicity

189
Q

How should you take a BP measurement?

A

Cuff should be 30-40% circumference of leg. Keep pet calm. Discard first reading until you get 3 or 4 consistent readings

190
Q

What other tests could you do when investogating CKD?

A

FNA or kidneys
Renal biopsy
Measure GFR
PTH assay

191
Q

Is CKD reversible?

Is there a cure?

A

No

No

192
Q

How do you generally manage CKD?

A

Stop all potentially nephrotoxic drugs
Treat any pre/post-renal abnormalities
Eliminate any ongoing specific disease
Start supportive medical management (to reduce severity and minimise progression)

193
Q

How would you treat a uraemic crisis?

A

IVFT (Hartmann’s or 0.9% NaCl)
Supply ongoing maintenance requirements
Monitor electrolytes and azotaemia
Reduce IVFT as animal starts to eat and drink

194
Q

How would you reduce proteinuria?

A

Look for any concurrent associated disease
Consider kidney biopsy
Ace inhibitors plus dietary protein reduction
Low-dose aspirin if serum albumin is <20g/L
Monitor response to treatment

195
Q

When are ace inhibitors contraindicated in the treatment of CKD?

A

In dehydrated or hypovolemic patients

196
Q

When treating CKD, what value do you want to reduce BP to?

A

<160mHg

197
Q

How do you reduce blood pressure in dogs?

A

1) ACE inhibitors at standard dose rate
2) ACE inhibitors at double dose
3) Combine ACE inhibitors and calcium channel blockers

198
Q

Give an example of a calcium channel blocker used in the treatment of high blood pressure

A

Amlodipine

199
Q

How do you reduce blood pressure in cats?

A

1) Calcium channel blockers at standard dose rate
2) Increase dose of calcium channel blocker (up to 0.5mg/kg/day)
3) Combine ACE inhibitors and calcium channel blocker

200
Q

How can you address dehydration in cats?

A

Wet diet
Drinking fountains/dripping taps
Large bowl
Chicken/fish flavoured water

201
Q

What are the 3 recommendations for a cat/dog in Stage 1 CKD?

A
  • Combat dehydration
  • Control hypertension
  • If proteinuric, start ACE inhibitor or ARB (angiotensin-receptor blocker)
202
Q

What are the 3 recommendations for a cat/dog in Stage 2 CKD?

A
  • Start renal diet (if cat, stage 3 if dog)
  • Control phosphate to <1.5mmol/l
  • Supplement potassium if needed
203
Q

Why are renal diets beneficial?

A 
Reduced protein (reduces PUPD, risk of uremic crisis, acid load)
Reduced phosphate
Omega-3 fatty acids
Fibre
Decreased sodium
Water-soluble vitamins
204
Q

When should renal diet be given to dogs and cats?

A

Dogs: Stage 3 CKD, or Stage 2 with phosphate >1.5mmol/L, or all dogs with proteinuric CKD
Cats: Stage 2 CKD

205
Q

How can you maximise the chances of a pet accepting a renal diet?

A 
Implement early
Introduce slowly
Don't introduce during times of stress (eg in hospital)
Consider temperature/texture etc
Add flavour enhancers
Try another brand
206
Q

How can you reduce serum phosphate in pets with CKD?

A

Renal diet best way-restricts phosphate and protein intake

Add phosphate binder if diet alone isn’t enough

207
Q

Give some examples of phosphate binders used in the treatment of CKD

A

Aluminium hydroxide
Calcium acetate
Pronefra

208
Q

What are the target values for serum phosphate in pets in stage 2, 3 and 4 CKD?

A

Stage 2: <1.5mmol/L
Stage 3: <1.6mmol/L
Stage 4: <1.9mmol/L

209
Q

What value for serum potassium would you aim for in pets with hypokalaemia?

A

Potassium >4mmol/L

210
Q

How can you avoid hypokalaemia in pets with CKD?

A 
Supplement IVFT with KCl
Oral supplements (potassium gluconate, potassium citrate)
211
Q

What are the recommendations for a cat/dog in Stage 3 CKD?

A
  • Control dehydration
  • Control hypertension
  • Treat proteinuria
  • Start renal diet (dogs)
  • Supplement potassium if needed
  • Control phosphate to <1.6mmol/L
  • Treat nausea and vomiting
  • Control metabolic acidosis
  • Consider EPO (erythropoietin)
  • Consider SC fluids
212
Q

How can you control vomiting/nausea?

A

Reduce gastric acid secretion with eg ranitidine, famotidine, omeprazole
Antiemetics
Sucralfate (protects the GI tract from stomach acid)

213
Q

Which drugs can you give to stimulate appetite?

A

Mirtazapine
Cyproheptadine
Consider feeding tube

214
Q

Give some possible complications of SC fluids

A

Fluid overload

Hypernatraemia (high blood sodium)

215
Q

How can you control constipation?

A

Correct dehydration
Lactulose 0.5-5ml/cat q 8-24hrs
May need enema

216
Q

How can you control metabolic acidosis?

A

Renal diet
Sodium bicarbonate
Potassium citrate

217
Q

How often does metabolic acidosis occur in cats with CKD?

A

<10% of cats with Stage 2 CKD

50% of cats in uraemic crisis

218
Q

How can you manage anaemia in cats with CKD?

A 
Avoid excessive blood sampling
Minimise GI blood loss
Good nutrition
Treat iron deficiency 
Transfusions
EPO replacement (recombinant human EPO; supplement iron if you give EPO)
219
Q

What should you supplement if you give EPO to an anaemic cat with CKD?

A

Iron

220
Q

Give some side effects of EPO given to cats with CKD

A

Seizures, hypertension, local reactions

221
Q

Why might you give calcitriol in the treatment of CKD?

A

Can promote hypercalcaemia and hyperphosphataemia. Inhibits PTH
May prolong survival and reduce progression of CKD in dogs

222
Q

What must you do before giving calcitriol in the treatment of CKD?

A

Control phosphate

Confirm there is no ionised hypercalcaemia present

223
Q

What are the recommendations for a cat/dog in Stage 4 CKD?

A

As for other stages plus:

  • Control phosphate to <1.9mmol/L
  • Intensify efforts to provide nutrition
  • More likely to require extra fluids (SC or via tube)
  • Consider euthanasia
224
Q

How often should you monitor a patient with CKD?

A

Initially monthly

-Blood tests, urine, BP, appetite, BW

225
Q

What would make you suspect hyperkalaemia on a clinical exam of a pet with acute kidney injury?

A

Bradycardia

226
Q

Describe the urine of a pet with acute kidney injury

A

Isosthenuric
Glucosuria, haematuria
Look at sediment for casts, WBCs, bacteriuria, crystals

227
Q

Give some indications for ovariohysterectomy

A

Elective (prevents unwanted pregnancies/oestrus/risk of mammary neoplasia)
Prevention and treatment of mammary and ovarian diseases
Control of certain diseases (diabetes mellitus, epilepsy, certain dermatoses)

228
Q

What are the benefits of spaying before a first season?

A

Reduced incidence of mammary neoplasia
Uterine/ovarian vessels are smaller (less haemorrhage)
Reduced operating time?
Reduced inconvenience to owner (less seasons)

Year 4 (51 decks)

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