8. Diagnostics, therapy and prevention of urinary diseases

Question 1

What does kidneys produce and its involvement?

Answer 1

Kidneys produce renin, eryhropoietin and PG-E2, and is involved in vitamin D metabolism, catabolism of insulin, parathyorid hormone and calcitonin

Question 2

What is difference between renal insufficiency and renal failure

Answer 2

Renal insufficiency = A degree or relative loss of function, but animal can survive.

Renal failure = Complete loss of renal tissue function, animal may or may not survive. Can be acute or chronic.

Question 3

Name some abnormalities of urinary composition

Answer 3

• Proteinuria
• Hematuria
• Crystalluria
• Glucosuria
• Ketonuria
• Indicanuria
• Polyuria
• Oliguria
• Anuria

Question 4

Describe causes for Acute renal failure

Answer 4

Acute renal failure can occur due to:
- hemodynamic causes (endotoxemia, systemic hypotension, tubular obstruction, sepsis)
- toxic causes (plants - oak, drugs - oxytetracycline, chemicals, mycotoxins)
- Immunological disorders (acute inflammation, obstruction, abnormal protein synthesis)

Question 5

Describe causes for chronic renal failure

Answer 5

Can occur due to:
- Chronic obstruction
- Chronic pyelonephritis
- Interstitial nephritis
- Fibrosis
- Amyloidosis
- Glomerulonephritis

Question 6

What is common side effect of renal failure?

Answer 6

• Uremia - kidneys are unable to filtrate and secrete wast eproducts from bloods causing toxins (urea, nitrogen, total protein etc) to build-up in blood.
• Azotemia - build-up of nitrogen-containing compounds (urea, creatinine)
• Can also lead to metabolic acidosis

Question 7

What are CS of acute renal failure

Answer 7

• Polyuria
• Lethargy
• Diarrhea
• WL
• Neurological signs (electrolyte imbalance)

Question 8

What are CS for chronic renal failure?

Answer 8

More of progressive disease –>
* Cachexia
* Long hoof wall growth
* Ventral body edema
* Halitosis

Question 9

How can acute and chronic renal failure be diagnosed and treated?

Answer 9

Dx:
* Biochemistry - elevated creatinine, BUN.
* Electrolyte imbalance - decreased calcium, potassium, sodium
* USG - below 1.012
* Biopsy - cellular degeneration to kidney

Tx:
Against ARF - fluids, furosemide, diazepam if neuro-signs
CRF - no specific treatment

Question 10

Briefly about Interstitial nephritis

Answer 10

Can occur in a
* hematogenous way (bacteria in blood -> kidneys)
* ascending from lower UT (renal pelvis is often affected first)

From….. Leptospirosis,malignant catarrhal fever, spotted kidney, listeria, E. coli, toxins, urethral obstruction

CS: NOT form abscess or pus. Fever, proteinuria, polyria, fatigue, anemia (chronic). B

Dx: History, CS, biopsy, blood culture, acidosis.

Tx: Correct underlying cause, fluids, ATB

Question 11

Describe pyelonephritis

Answer 11

Bacterial inflammation of the kidney and renal pelvis either by hematogenous spread (Pseudomonas aeruginosa) or ascending infection of lower urinary tract (Corynebacterium renale, E. coli, Trueperella, Staphylococcus, Proteus)

CS: drop in milk production, signs of toxemia, fever, uremia, pyuria, dysuria, stranguria, hematuria, WL.

Dx:
* pH and apperance of urine (above 8.5, pyuria, turbid urine)
* USG might be lower (normal 1.030 - 1.040)
* bacterial culture
* Biochem - elevated gammaglobulins, BUN, creatinine, decreased albumin
* rectal examination - thickening of bladder wall, enlarge ureters, painful enlarged left kidney)
* USG - echogenic/hyperchoic kidneys

Tx:
* Penicillin +3weeks
* Correct fluid/electrolyte and acid-balance imbalances –> monitor and correct hypokalemia, natremia and metabolic acidosis which is a common consequence..
* Consider ruine acidification - inhibits bacterial growth as Corynebacterium renale

Question 12

How does Pyelonephritis differ from Glomerular amyloidosis and Glomerulonephritis?

Answer 12

In pyelonephritis there is painful kidney

Question 13

Briefly about Glomerulonephritis

Answer 13

Rare. Inflammation of glomerulus.

Can occur due to liver flukes, metritis, BVDV, pregnancy toxemia in sheep, septicaemia, Maedia visna.

Enlarged mottled kidneys which in chronic stages -> glomerulus/renal atrophy and fibrosis.

Enlarged but not painful kidney upon rectal palpation

Question 14

Briefly about Glomerular amyloidosis

Answer 14

Protein amyloids accumulates in tissues from increased serum Amyloid A protein in blood/glomerulus.

Enlarged left kidney, not painful upon rectal palpation.

Question 15

Briefly about Renal ischemia

Answer 15

Decreased blood flow through the kidney due to decreased cardiac output or BP.

CS: oliguria -> anuria, urmemia; has same clinical picture as ARF.

Can be reversible if blood flow is restored, but may result in permanent damage.

Question 16

Briefly of Nephrosis

Answer 16

Degenerative and inflammatory disorder of renal tubules.

Can occur for many reasons.

CS: oliguria, uremia, polyuria, dehydration, WL

Dx: CS, PM, biochem, urinalysis

Tx: treat underlying cause, fluids, ATB

Question 17

Describe Leptospirosis

Answer 17

Transmitted: Direct/indirect contact, rodents, urine/aborted material/semen/milk.

CS: depend on serovar.
* HAS = rare cause disease, mild symptoms. Reproductive problems (abortion, stillbirth, infertility, weak calves, fever, agalactia, soft udder, yellow/red milk)

*NHAS = more in calves. Fever, hemolytic anemmia, icterus, interstitial nephritis, hepatitis, agalactia, mastitis, abortion.

Dx: Intermittent shedding!
* Blood / MAT - presence of bacteria in organs or body fluids.
* Urinalysis - hemoglobinuria, proteinuria, pyuria, casts
* Biochem - increased creatinine
* Biopsy - levaditii silver staining

Tx: penicillin/oxytetracycline, symptomatic.

Px: VACCINATION - bovilis leptavoid - L. hardio, rodent control, disinfection of environment, clean water

Question 18

Describe Urinary calculi/Urolithiasis

Answer 18

Develop due to:
- unbalanced feed (excess minerals)
- decreased water intake
- alkaline urine
- vitamin A deficinecy
- gender (more common in male - obstructive urolithiasis cause of longer urethra), castration, age.

Common stones to find in ruminats: phosphatic, siliceous, oxalates, carbonates

1) Phosphatic type: Originating from feedlot diets (high levels of carbohydrates which increases mucoproteins) –> promotes alkaline urine + increased Ps excretion.
Ca be prevented by: Try and decrease Ps levels, maintain Ca:P ratio, acidification of urine by NH3Cl, increase water intake (= increase urine volume) and give adequate vitamin A.

2) Siliceous type: In grazing animals on pasture, from plants with high levels of silicon dioxide.
Can be prevented by: Increase water intake and restrict time spent on pasture.

CS: depend on location, size of stones and number, and if rupture.

• Nephrolithiasis and ureterolithiasis - commonly bilateral, progress to chronic renal failure as it go by unnoticed. If complete partial blockage -> hydronephrosis, anuria, oliguria and anuria.
• Cystic calculi - asymtpomatic/irritation, cystitis, hematuria, stranguria, dysuria, urinary incontinence
• Urethral calculi - sigmoid flexure in cattle and urethral process in sheep/goat. Same as cystic + mineral deposits on urethral hair, attempts to urinare but nothing comes out. May rupture –> urethral sweeling and cold necrosis.

Dx: CS, history, USG, rectal exam, hematology, biochemistry, abdominocentesis if rupture, urinalysis

Tx: fluids, tranquilizers/antispasmodics, NSAIDs, ATB, acidifiers (ammonium chloride), surgery (cystotomy, bladder marsupilzation, cystocentesis, perineal urethrostomy, urehrotomy, laparotmy etc.)

Question 19

What can Bovine enzootic hematuria be caused by?

Answer 19

Bracken fern intoxification