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URI 2 > Urinary Tract Disease in Reptiles and Birds > Flashcards

Urinary Tract Disease in Reptiles and Birds Flashcards

1
Q

Outline Avian Renal Anatomy?

A
  • Large, paired, lobulated kidneys (1-2.6% of bwt)
  • Surrounded by abdominal air sac
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2
Q

What are the two types of nephron in the reptile?

A
  • Reptile Type → no loop of Henle; in cortex only
  • Mammalian Type → loop of Henle extends from cortex to medulla
  • Birds have limited ability to concentrate urine
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3
Q

Do birds have a urinary bladder?

A
  • Lack a urinary bladder
  • Ureters empty into the cloaca
  • Reflux of urine into coprodeum and colon aids further water reabsorption. Mixing of urine with faeces which complicates urinalysis
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4
Q

How does the blood supply to the kidney differ in the avian?

A

They have a renal portal system (are able to divert blood away or through kidney has effects on drug metabolism)

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5
Q

What do some desert and aquatic species have?

A

Salt glands

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6
Q

How is uric acid excreted in birds?

A

Nitrogenous waste excreted as uric acid

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7
Q

How do the nerves run pass the kidney in the avian?

A

Nerves run through and dorsal to kidneys (ischiatic nerve particularly therefore enlargement of kidney has direct effect on nerves that supply hindlimbs)

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8
Q

Common causes of primary renal disease in the avian include:

A
  • Hypovitaminosis A (primary cause diet)
  • Hypervitaminosis D3 (Usually comes about as innapropriate supplementation)
  • Dehydration (not eating or drinking)
  • Heavy metal toxicity (parrots and raptors and water foul from things like lead etc)
  • Infection (either extending from ureter, extension of air sacculitis or systemic spread)
  • Neoplasia (20% all male budgies develop renal neoplasia in lifetime (
  • Amyloidosis (predominantly in falcons after bumblefoot) & Lipidosis (merlins commonly get)
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9
Q

What is a hallmark of renal disease in birds?

A

Hallmark of renal disease in birds is gout

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10
Q

What are the two different kinds of gout?

A

Visceral gout → accumulation of uric acid tophi in soft tissues → liver, pericardium and kidney (effects functioning of organs)

Articular gout → accumulation of uric acid tophi in and around joints; often feet and hocks (clinically seen as large white swollen nodules around the joints)

  • Occurs when uric acid secretion is decreased and/or uric acid production is increased.
  • As a rule can get birds with both forms.
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11
Q

What are the causes of decreased Uric Acid Secretion in avians?

A
  • Dehydration (results in sludging of urine so less flow)
  • Renal tubular disease (swollen and disease reducing movement if uric acid)
  • Hypovitaminosis A → squamous metaplasia of ureteral mucosa and collecting ducts
  • Infection/inflammation (blockage e.g septic thrombi)
  • Post-renal obstruction e.g. uroliths, egg binding (more caudal towards cloacal directly obstruct outflow of ureters)
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12
Q

What causes Increased Uric Acid Production?

A

•Excess dietary protein

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13
Q

Avian Renal Disease: Clinical Signs

A
  • Early signs of disease are often subtle
  • Advanced disease → non-specific signs → fluffed-up, lethargic, anorexic
  • If they don’t have the energy to pretend to be well then they are at deaths door
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14
Q

Avian Renal Disease: Clinical Signs

More specific clinical signs may include:

A
  • PU.PD (loss of concentrating ability in the kidney)
  • Unilateral or bilateral hindlimb paresis/paralysis
  • Haematuria
  • Feather picking/plucking over kidneys
  • Articular (& visceral) gout (remember can get articular gout without kidney disease)
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15
Q

BEFORE HANDLING PATIENT for Clinical Examination need to?

A
  • Assess patient from afar before it starts pretending it is ok when you get close
  • Ensure have everything to hand
  • Inspect cage, droppings, food etc
  • History from owner → husbandry, diet, supplements, treatments, treatments from any other vets, other birds…
  • If bird looks really awful may need to place in warm, humidified oxygen cage first!
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16
Q

What would help if the owner brought this to consult?

A

Get owner to bring cages with them as the cage can be very informative how that bird lives.

In these pics can see cage covered in feaces and can see is only being fed pure sunflower seeds. So can see poor nutrition and environment immediately.

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17
Q

Birds dont produce bilirubin what do they produce?

A

biliverdin

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18
Q

What can be seen here?

A

Haemoglobinuria (in this case caused by led poisoning)

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19
Q

What can be seen here?

A

Diarrhoea & Biliverdinuria

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20
Q

What can be seen here?

A

Dehydration & Cyanosis

Lemon shaped eye signs of ill bird.

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21
Q

What can be done here?

A

Ulna Vein (CRT can be done here)

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22
Q

What can be seen here?

A

Flaky beak poor nutrition

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23
Q

What can be seen here?

A

Rhinoliths (squamous metaplasia due to poor nutrition)

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24
Q

Discuss Avian Renal Disease: Diagnostic Tests with regards to uric acid?

A

Uric Acid

  • Elevated only when >70% function lost
  • Mild to no elevation in dehydration
  • Post-prandial rise in carnivorous birds → fast for 24hrs before sample in these species
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25
Q

Discuss Avian Renal Disease: Diagnostic Tests with regards to urea and creatinine?

A

Urea

•May help assess dehydration but NOT kidney dysfunction

Creatinine

•Not very useful in birds

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26
Q

Discuss Avian Renal Disease: Diagnostic Tests with regards to phosphorus and calcium?

A

Phosphorus

•May be elevated in renal failure (& haemolysis)

Calcium

  • May be reduced in renal failure.
  • Measure ionised and total calcium in conjunction with albumin
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27
Q

Discuss Avian Renal Disease: Diagnostic Tests with regards to potassium and sodium?

A

Potassium

•Elevated in acute renal failure (& haemolysis). Normal level in potassium is much lower in birds than mammals

Sodium

  • Hypernatraemia in dehydration
  • Hyponatraemia in renal failure
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28
Q

Discuss Urinalysis in Avian Renal Disease?

A
  • Difficult to obtain ‘pure’ sample → try to collect under perch on clean greaseproof paper or similar
  • Normal urine contains crystals and bacteria
  • Look for renal casts, abnormal cells, glucose etc
  • Specific gravity range 1.005-1.020 but is species specific and not very helpful in most cases
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29
Q

What is the Murexide Test?

A
  • Used to confirm gout
  • Sample of material (e.g. joint aspirate) is mixed with nitric acid and dried over flame
  • Add 1 drop concentrated ammonia
  • If turns mauve = uric acid
  • In practical terms he does not do this that often
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30
Q

Discuss radiography in avian renal disease?

A

Radiography

  • Two views → ventrodorsal and lateral with wings and legs extended
  • Normal kidneys difficult to see especially on VD view
  • Gonad and pelvis may obscure lateral view
  • Normally a small rim of air dorsal (air sac) to the kidneys on lateral view → absent in renomegaly
  • Look for changes in size, density & contour. Eggs, cloacaliths, evidence of gout and rest of body
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31
Q
A
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32
Q

Look at these avian renal disease normal radiographs?

A
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33
Q

What can be seen here?

A

Egg-bound Blue & Gold Macaw

Presented with resp disease as it had complete bloackage of GI, repro and URI tract.

Has full crop with sour crop causing resp distress. Removed bloackage and gave fluid therapy similar treatment to blocked tom cat

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34
Q

What can be seen here?

A

Testicular Tumour

(Budgerigar) This testicular tumour was secreting oestrogen and causing secondary sex characteristic changes

If it was female probaby think it was pre-ovulatory reduction in bone density

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35
Q

Discuss ultrasounding in avian renal disease?

A
  • Useful to look at architecture of kidney but often severely hampered by air sacs in the healthy bird
  • In sick bird with ascites makes it easier to image kidneys and gonads
36
Q

Discuss endoscopy in avian renal disease?

A
  • Most useful to visualise and biopsy kidneys
  • Can assess most other organs at the same time
  • Requires specific training and experience
37
Q

Discuss use of MRI/CT in avian renal disease?

A

•May be useful in selected cases; not routine

38
Q

Discuss Supportive Care for the ‘Average’ Sick Bird:

A
  • Keep warm = 29-30oC
  • Quiet, away from predators
  • Dimmed lighting
  • Oxygen
  • Nebulise saline for 20-30 minutes
39
Q

Dicuss fluid therapy in the avian patient?

A
  • Fluid therapy → SC, IV, IO depending on severity of condition and level of dehydration (don’t put IO catheter into femur and humerus as they are pneumatised and you will drown them)
  • Commence oral fluids once bird is more stable
  • Crop feed an easily assimilated food once bird tolerates oral fluids
  • Progress to more substantial feed if bird tolerating so far
  • Metoclopramide 0.5-1mg/kg IM q 8-12 hrs if ileus
  • Specific treatment based on diagnosis
40
Q

In the avian an assessment of the level of dehydration may be made by:

A

−measuring the pcv/ts

−skin elasticity

−mucous membrane moisture

−brightness and position of the eye

−ulna vein refill time.

Practically speaking it may be safe to assume that most sick birds are 5-10% dehydrated or more at presentation

41
Q

What are fluid requirements for avian renal disease?

A

Maintenance fluid volumes are generally assumed to be 50ml/kg/day.

Usually rehydrate avian patients over 48 hrs:-

−Day one → maintenance fluids (50ml/kg) + half calculated rehydration fluids

−Day two → maintenance fluids (50ml/kg) + half calculated rehydration fluids

−Day three → maintenance fluids

Route of fluid administration depends on the severity of dehydration, bird’s demeanour and whether the gastrointestinal tract is functional.

42
Q

Discuss Avian Renal Disease Treatment with regards to food?

A

Food

−High in fat and carbohydrate, lower in protein

−Ensure balanced diet for species

−Vitamin supplementation in ‘stubborn’ birds

43
Q

Discuss Avian Renal Disease Treatment with regards to Antibiotics?

A

Antibiotics:

−Aminoglycosides are nephrotoxic so avoid their use systemically

−Trimethoprim/sulpha & amoxycillin/ clavulanic acid can be nephrotoxic if bird is dehydrated so only use in hydrated birds to prevent worsening renal disease

44
Q

Discuss Avian Renal Disease Treatment with regards to Allopurinol?

A

Allopurinol

−Xanthine oxidase inhibitor

−May help reduce hyperuricaemia

−May worsen and cause gout in some species especially at higher doses e.g. Red-Tail Hawk.

45
Q

Discuss reptile renal anatomy?

A
  • Renal portal system similar to birds
  • Nephrons lack a Loop of Henle (no means of renal concentration of urine)
  • Urinary bladder in chelonia and some lizards e.g. Iguana, chameleon
  • Urine may be modified in bladder/colon by refluxing into the copredeum
  • Electrolyte and fluid exchange can occur across the bladder wall
  • Nitrogen excreted as uric acid +/- Urea +/- ammonia (proportion varies)
  • Salt glands in some desert and aquatic species (don’t misdiagnose as resp infection)
46
Q

Reptile Renal Disease Common causes?

A

•Inadequate Husbandry

−Humidity

−Temperature

−Diet

−Supplements → Ca, Phos, Vit A, Vit D

  • Chronic dehydration (some species only drink from droplets not bowls)
  • Infection – bacterial, parasitic (giardia)
  • Neoplasia
47
Q

Discuss reptile renal disease with regards to gout?

A
  • Visceral gout → accumulation of uric acid tophi in soft tissues particularly liver, pericardium and kidney
  • Articular gout → accumulation of uric acid tophi in and around joints

Occurs when uric acid secretion is decreased and/or uric acid production is increased

48
Q

What causes decreased Uric Acid Secretion?

A
  • Dehydration
  • Renal tubular disease
49
Q

What causes Hypovitaminosis A?

A
  • Infection/inflammation
  • Post-renal obstruction
50
Q

What causes Increased Uric Acid Production?

A

Excess dietary protein

51
Q

Reptile Renal Disease Clinical Signs?

A
  • Early signs of disease often subtle
  • Advanced disease → signs are often non-specific → lethargy, anorexia, weight loss, dysecdysis, abnormal thermoregulation
  • Polyuria and polydypsia are usually not a feature of reptile renal disease because they don’t concentrate urine anyway so never compensate by drinking
  • Classic sick reptile pose below
52
Q

More specific signs of reptile renal disease may include:

A
  • Hindlimb weakness
  • Constipation (renomegaly in pelvic canal common in older iguanas)
  • Gout
  • Oedema
53
Q

BEFORE HANDLING PATIENT what should you do?

A
  • Assess patient from afar
  • Assess dangers to you and the patient
  • Ensure have everything to hand
  • Inspect cage, droppings, food etc
  • History → husbandry, diet, supplements, UVB supplementation, heat gradients, previous treatments, other reptiles…
  • Ensure patient is kept at optimum body temperature
54
Q

Look at this reptile poo?

A
55
Q

What is wrong here?

A

Dysecdysis

(Yemen Chameleon)

56
Q

What is wrong here?

A

Metabolic Bone Disease

(Bosc Monitor)

Malocclusion of jaw

57
Q

What can be seen here?

A

Peripheral Oedema

(Marginated Tortoise)

Often terminal sign either sepsis, renal or neoplasia

58
Q

What is wrong here?

A

Metabolic Bone Disease and Dysecdysis

(Leopard Gecko)

59
Q

What is wrong here?

A

Hemipenal prolapse &

femoral Pore impaction (Green Iguana)

Due to poor low grade dehydration has prolapsed due to urolith presence

60
Q

What is wrong here?

A

Radiograph of same Iguana from previous flashcard showing the large urolith

61
Q

What can be seen here?

A

Yemen Chameleon - note gouty kidneys (white spots)

62
Q

Discuss Reptile Renal Disease Diagnostic Tests with regards to Uric Acid?

A
  • Elevated only when >70% function lost
  • Mild to no elevation in dehydration
  • Post-prandial rise in carnivorous reptiles can occur 24-36hrs after meal → NB most reptiles are presented anorexic!
63
Q

Discuss Reptile Renal Disease Diagnostic Tests with regards to Urea?

A

Urea

  • May be elevated in dehydration or anorexia
  • Renal disease likely if uric acid also raised
  • More useful in desert tortoises e.g. Testudo spp.
64
Q

Discuss Reptile Renal Disease Diagnostic Tests with regards to Creatinine?

A

•Not very useful in reptiles

65
Q

Discuss Reptile Renal Disease Diagnostic Tests with regards to Phosphorus?

A

Phosphorus

May be elevated → renal failure more likely if phosphorus higher than total calcium (look at the ratios) ensure not haemolysed sample that can skew results.

66
Q

Discuss Reptile Renal Disease Diagnostic Tests with regards to Calcium?

A

Calcium

  • May be reduced in chronic renal failure.
  • Normal or increased in acute renal failure
67
Q

Discuss Reptile Renal Disease Diagnostic Tests with regards to Potassium?

A

Potassium

•Elevated in acute renal failure (& haemolysis)

68
Q

Discuss Urinalysis in reptiles?

A

Urinalysis

  • Try to avoid faecal contamination
  • Many tortoises void when handled
  • Normal urine contains crystals and bacteria
  • Renal casts, cells, parasites (Hexamita) etc
  • pH may change from normal alkaline to acidic in anorexic herbivores and post-hibernation
  • Specific gravity range 1.003-1.014 may elevate slightly in dehydration
69
Q

What is the Iohexol Excretion Test:

A

Iohexol Excretion Test:

  • Excreted solely by glomerular filtration
  • Gives good indication of renal function
  • Inject iohexol intravenously and take blood 4, 8 & 24hrs later. Post on ice
  • Validated for the Green Iguana only so far
  • Not used routinely as yet but potentially very useful
70
Q

How should radiography be done in the reptile?

A

Radiography

  • 2 or 3 views → ventrodorsal, horizontal-beam lateral +/- horizontal-beam craniocaudal (chelonia)
  • Kidneys often difficult to see unless enlarged or increased density
  • Look for changes in size, density & contour. Eggs, uroliths, gout and bone density
71
Q

What can be seen here?

A

● Juvenile Marginated Tortoise

● Large cloacalith with secondary substrate impaction of the colon

● Bone density is normal

● Has a urolith probs due to poor environment.

72
Q

What can be seen here?

A
  • Metabolic bone disease in a juvenile Bosc Monitor
  • Decreased bone density
  • Pathological fractures
  • Constipation secondary to hypocalcaemia
  • This could be RSHP or NSHP
73
Q

Discuss ultrasound, endoscopy and MRI/CT in the reptile?

A

Ultrasound

•Very useful to look at architecture of kidney

Endoscopy

  • Most useful to visualise and biopsy kidneys
  • Can assess most other organs at the same time
  • Requires specific training and experience

MRI/CT

•May be useful in selected cases; not routine

74
Q

All sick reptiles require:

A

•Heat → patients should be kept at preferred body temperature (PBT)

•Fluid → ensure correct humidity and appropriate access to water e.g. bath, spray

•Light → appropriate UVB supplementation for the species

75
Q

How can Level of dehydration be estimated in the reptile:

A

−measuring the pcv/ts

−skin elasticity

−mucous membrane moisture

−brightness of the eye

−appearance of the urine and urates

Practically speaking it may be safe to assume that most sick reptiles are 5-10% dehydrated or more at presentation

76
Q

In theory many reptiles isotonicity is thought to be 0.8% compared to 0.9% of mammals

Some do not subscribe to this theory therefore a number of different crystalloids have been recommended which are:

A
  • Hartmann’s → often used for rehydration and maintenance and in cases of metabolic acidosis. In theory, perhaps should be avoided in patients with liver compromise. But generally seems safe and effective
  • 0.9% Saline/electrolyte and amino acid (e.g. Duphalyte) combined at ration of 4:1
  • 2.5% dextrose in 0.45% saline or 4% dextrose in 0.18% saline (should not be given subcutaneously)
  • Nine parts 5% glucose with 0.9% saline to 1 part sterile water
  • All fluids should be warmed to the upper level of the POTZ
77
Q
A
78
Q

Discuss Rehydration of reptilian patients?

A
  • Rehydration of reptilian patients may take 10-14 days in severe cases
  • Overzealous fluid therapy can lead to pulmonary and tissue oedema, hypokalaemia and death
79
Q

At what rate are should fluids be given at reptiles?

A

Generally advised to give fluids at the rate 10 - 30ml/kg/ day for maintenance + 25% of the fluid deficit daily always erring on the side of caution

The route of fluid administration will depend on the species and severity of dehydration

80
Q

What are the routes of administration for fluid therapy for in reptiles?

A
  • Lizards → cephalic, jugular, ventral tail vein
  • Chelonians → jugular vein
  • Snakes → jugularvein, intra-cardiac
  • All species → intracoelomic, subcutaneous and oral routes can be employed depending on severity of dehydration
  • Intraosseous (not snakes)
81
Q

Discuss bathing in reptiles as fluid therapy?

A

Bathing:

  • Should be performed daily in all inpatients
  • Encourages drinking, voiding urine/faeces and some can suck fluid into the cloaca/bladder
  • Close monitoring is essential to prevent drowning even in aquatic species.
82
Q

Discuss use of Oesophagostomy Tube in Reptile Renal Disease:

A
  • Routine procedure
  • Local anaesthetic
  • Sedation or GA
  • Analgesia important!!
  • Lizards = 10-20ml/kg
  • Snakes = 15-30ml/kg
  • Tortoises = 5-15ml/kg
83
Q

Discuss food in treating/managing renal disease in the reptile?

A

Food:

  • Appropriate balanced diet for species → generally high in fat and carbohydrate, lower in protein
  • Omnivores generally treated as herbivores
  • Vitamin supplementation → care with Vitamin D
84
Q

Discuss antibiotics in treating renal disease in the reptile?

A

Antibiotics:

  • Most infections are caused by gram -ive bacteria
  • Aminoglycosides are nephrotoxic
  • Fluoroquinolones and ceftazadime commonly used
85
Q

Discuss further treatment for renal disease in reptiles?

A
  • Allopurinol → may help reduce hyperuricaemia
  • Anabolic steroids
  • B-vitamins
  • Phosphate binders

URI 2 (44 decks)

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