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Approach to urinary tract disorders Flashcards

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1
Q

Polydipsia

A

A water intake >90-100ml/kg/day in dogs

> 50ml/kg/day in cats

Any more than normal for that individual can be clinically relevant

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2
Q

Polyuria

A

Urine output >50ml/kg/day

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3
Q

What is osmolality determined by?

A

Plasma sodium concentration

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4
Q

What is increased osmolality detected by?

A

Osmoreceptors in the hypothalamus

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5
Q

What is the response to increased osmolality?

A

ADH is released from the posterior pituitary and acts upon the collecting duct of the kidney leading to insertion of water permeable channels (aquaporins).

Water then moves from the lumen of the collecting tubules to the hypertonic renal medulla along a concentration gradient.]

Net effect is water reabsorption and increased unrine concentration in response to dehydration and hypovolaemia.

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6
Q

Incontinence

A

The involuntary leakage of urine characterised by intermittent or continuous leakage of urine.

Unaware, and often while resting.

Are able to void normally and have normal water consumption and urine volume

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7
Q

Most common causes of PU/PD in dogs

A

Diabetes mellitus

Hyperadrenocorticim

CKD

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8
Q

Most common causes of PU/PD in cats

A

Diabetes mellitus

Hyperthyroidism

CKD

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9
Q

Causes of primary polyuria with secondary polydipsia

A

Nephrogenic diabetes insipidus (NDI)

Osmotic diuresis

Central diabetes insipidus (CDI)

Low renal medullary tonicity

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10
Q

Primary nephrogenic diabetes insipidus

A

Rare condition caused by congenital lack of ADH receptors in a young animal

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11
Q

Secondary nephrogenic diabetes insipidus

A

Many causes- most common mechanism of PU/PD in small animals

Hyperadrenocorticism
Hyperthyroidism
Hypercalcaemia
Liver disease
Hypoadrenocorticism
Pyelonephritis
Drugs
Pyometra
Hypokalaemia
Erythrocytosis
Leptospirosis
Acromegaly
Hyperaldosteronism

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12
Q

Osmotic diuresis

A

When the concentration of an osmotic solute in the glomerular filtrate exceeds proximal tubular capacity for reabsorption

Impairement of passive reabsorption of water and increased obligatory water loss

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13
Q

Causes of osmotic diuresis

A

Glucosuria (DM, primary renal glucosauria, Fanconi’s syndrome)

CKD

Post-obstructive diuresis

Osmotic diuretic administration (mannitol)

High salt diet

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14
Q

Central diabetes insipidus

A

Caused by complete or patial deficiency in ADH hormone

Causes of CDI include idiopathic, head trauma, neoplasia (brain), radiation treatment, post-hypophysectomy

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15
Q

Low renal medullary tonicity

A

Can be caused by renal medullary washout due to increased renal tubular flow and volume which decreases the reabsorption of sodium and urea.

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16
Q

Causes of low renal medullary tonicity

A

Renal medullary washout (PU/PD due to increased tubular flow, IV fluid therapy, hyperthyroidism)

CKD (inadequate function of countercurrent mechanism of loop of Henle)

Hyperadrenocorticism

Low protein diet

Liver disease

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17
Q

Primary polydipsia with compensatory polyuria

A

Psychogenic polydipsia - cause is poorly understood

Hyperthermia

Pain, stress, exercise

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18
Q

DDx for PUPD based on age

A

Puppies:
- familia nephropathies

Older dogs:
- CKD
- Primary hyperparathyroidism
- Diabetes
- Paraneoplastic hypercalcaemia
- Hyperadrenocorticism

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19
Q

Signalment of PUPD based on sex

A

Female entire
- pyometra
- Diabetes mellitus

Male entire
- Prostatic abscessation

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20
Q

Breeds predisposed to diabetes

A
  • Keeshonds
  • Samoyeds
  • Beagles
  • Schnauzers
  • Poodles
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21
Q

Breeds predisposed to hyperparathyroidism

A

Keeshonds

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22
Q

Breeds predisposed to hyperadrenocorticism

A

Terriers
Miniature poodles

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23
Q

What endocrine disease can lead to irregular oestrus intervals?

A

Hyperadrenocorticism

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24
Q

What USG makes PUPD unlikely?

A

> 1.030 (dogs)
1.035 (cats)

Indicates it is concentrated

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25
What is common to both PUPD and incontinence?
Urination in inappropriate places Nocturia Normal voiding
26
What features are indicate PUPD (rather than incontinence)?
Incontinence if severe Increased urine volume Increased water consumption
27
What features are indicate incontinence (rather than PUPD)?
Lack of awareness Soiled hair coat Puddles of urine where lying/soiled bedding Normal water consumption and urine volume
28
Which neoplasias can lead to PUPD?
Lymphoma Anal sac adenocarcinoma Multiple myeloma paraneoplastic hypercalcaemia
29
Clinical signs of hyperadrenocorticism
Pot-bellied appearance, dermatological changes (thin skin, hyperpigmentation, comedones, bruising, pyoderma, bilateral symmetrical alopecia)
30
Hyposthenuria
Can be seen in dogs with PUPD 1.001 - 1.007
31
Isosthenuria
Can be seen in dogs with PUPD 1.007 - 1.013
32
Minimally concentrated urine
Can be seen in dogs with PUPD 1.013 - 1.030
33
Which PUPD causing disease can be ruled out if urine is hyposthenuric?
CKD - renal function cannot be impaired if kidney is able to actively dilute their urine
34
When can glucosuria be seen?
Diabetes mellitus Primary renal glucosuria Fanconi syndrome
35
When can proteinuria be seen?
Hyperadrenocorticism Pyelonephritis Pyometra Glomerulonephritis
36
How can you rule out pyelonephritis?
Culture the urine
37
What might you see on bloods in a HAC patient?
Stress leukogram Elevated liver enzymes Hypercholersterolaemia
38
What might hyperglycaemia on bloods in a PUPD animal suggest?
Diabetes Pancreatitis HAC
39
What might low urea on bloods in a PUPD animal suggest?
Liver disease Marked PUPD
40
What might hypercalcaemia on bloods in a PUPD animal suggest?
Hyperparathyroidism CKD Paraneoplastic Cholecalciferol toxicity Hypoadrenocorticism Idiopathic Granulomatous disease
41
What might you see on bloods in a case of pyometra or pyelonephritis?
Neutrophilia +/- left shift
42
What might you see on bloods of an animal with hypoadrenocorticism?
Azotaemia Lack of stress leukogram/inverse stress leukogram Electrolyte changes
43
What might the bloods of an animal with CDI, Primary NDI, or primary polydipsia look like?
Unremarkable or reflect dehydration
44
When might you want to do thoracic radiographs in a PUPD case?
Hypercalcaemia - Metastasis (AGASAC) - Cr. mediastinal mass (lymphoma) HAC - cardiomegaly - bronchial mineralisation
45
What might you radiograph in an animal with hypercalcaemia?
Thorax - mets - mediastinal lymphoma Urinary tract - calcium oxalate urolithiasis Survey - lytic bone lesions (multiple myeloma)
46
What can you look for using ultrasound in a PUPD patient?
Pyometra CKD Pyelonephritis Small or enlarged adrenal glands - Hypoadrenocorticism - Hyperadrenocorticism Enlarged intra-abdominal lymph nodes - Lymphoma - Metastasis Liver - Liver disease - Hepatic lymphoma
47
What additional tests can you run for hyperadrenocorticism?
Urine cortisol:creatinine ratio Low dose dexamethasone suppresion test ACTH stimulation test
48
What additional tests can you run to assess liver function?
Bile acid stimulation test
49
What can assessing SMDA look for?
Early CKD
50
What will insulin like growth factor-1 suggest?
Acromegaly
51
How can you test for leptospirosis?
Blood and/or urine PCR
52
How can you test for hyperaldosteronism?
Aldosterone and renin measurement Blood pressure
53
Water deprivation test
Only if all other causes of PUPD ruled out Need to be in contact with a specialist Used to differentiate CDI, NDI, and primary polydipsia
54
Complications of the water deprivation test
Severe dehydration Renal failure Urosepsis
55
Therapeutic desmopressin trial
Consult specialist Can be used instead of water deprivation test Monitor water intake and urine output following administration of desmopressin (synthetic ADH) Dramatic reduction suggests CDI
56
Dysuria
Difficult and/or painful urination
57
Stranguria
Slow and painful urination
58
Pollakiuria
Abnormal frequency of passing urine
59
Haematuria
Presence of blood within urine
60
Differentials for dysuria
Bladder - cystitis - cycstic calculi - feline idiopathic cystitis - neoplasia - rupture Urethra - dyssynergia - calculi - plugs - stricture - urethritis - rupture - neoplasia Penis/prepuce - Neoplasia Vagina - Neoplasia - Vaginitis Prostate - BPH - prostatitis - abscess - cyst Neurological
61
What to check on clin exam of a dysuric patient
Careful bladder palpation - If the animal has a large, distended bladder, and no history of recent urination (obstruction) - catheterise or cysto - Small bladder with thickened wall - inflammation - Large flaccid bladder - atony Rectal exam to feel prostate, pelvic urethra, and caudal abdo/pelvic masses
62
Biochemistry of a urinary tract obstruction
Post renal azotaemia Hyperkalaemia Hyperphosphataemia
63
What might haematuria, pyuria, and proteinuria suggest?
Urinary tract inflammation or infection
64
When should you do a urine culture?
Ideally any dysuria case Definitely if active sediment
65
Indications for plain radiographs in dysuria
Detect radio-opaque uroliths Observe renal size and shape Position and size of bladder and prostate
66
Which uroliths are radiopaque?
Calcium oxalate Calcium phosphate Silica Struvite
67
Indications for contrast radiographs in dysuria
Urethral abnormalities Bladder masses/thickness Radiolucent calculi Renal pelvis Ureteral anatomy
68
Options for contrast radiographs of the urinary tract
Retrograde cystourethrogram IV urethrogram
69
Which calculi are radiolucent?
Cysteine Urate Xanthine
70
What is abdominal ultrasound useful for in cases of dysuria?
To assess bladder wall and urethral thickness Pressence or absence of masses and uroliths (radiopaque and radiolucent)
71
What is cystoscopy useful for in cases of dysuria?
To visualise the entire urethra and to biopsy masses in urethra or bladder Can be used to diagnose and treat ectopic ureters
72
Differentials for haematuria
Extra-urinary disease - coagulopathy - heatstroke Physiological - pro-oestrus Renal disease - cyst - glomerulonephritis - iatrogenic - idiopathic renal haematuria - infarction - neoplasia - pyelonephritis - trauma - uroliths Non-renal urinary tract disease - drugs (cyclophosphamide) - FLUTD - iatrogenic - neoplasia - polyps - trauma - urethritis - uroliths Prostatic disease - abscess - BPH - cysts - neoplasia - prostatitis Penile/vaginal disease - neoplasia - trauma Uterine disease - metritis - neoplasia - pyometra - sub-involution of the placenta
73
Signs indicating that haematuria is caused by lower urinary tract disease
Concurrent signs - dysuria/stranguria/pollakiuria Blleding occurs at beginning or end of urination May be history of drug exposure - cyclophosphamide
74
Signs indicating that haematuria is caused by genital tract disease
Concurrent symptoms - tenesmus, dysuria Blood may occur at beginning of urination, may not be apparent in non-voided sample (cysto/catheter) History - oestrus, breeding, trauma
75
Signs indicating that haematuria is caused by upper urinary tract disease
Concurrent signs - PUPD, systemic disease, bleeding throughout micturition Evidence of nephrotoxic drug exposure
76
Signs indicating that haematuria is caused by coagulopathy
Evidence of previous bleeding - petechiation, ecchymoses History of drug exposure
77
Bloods of an animal with haematuria
May show: Anaemia - persistent or severe bleeding Low platelet count - primary haemostatic disease Azotaemia - pre-renal, renal, post-renal Coagulation profile should be considered
78
Imaging in haematuria cases
Assess renal architecture Assess for bladder, uterine, or prostatic disease, and for uroliths Cystoscopy good for localising source
79
Indications for suction biopsies of the bladder
Thickening Masses
80
How to take suction biopsies of the bladder
Use a urinary catheter with side holes Insert to level of thickness/mass with ultrasound guidance Sample obtained by applying negative pressure with a syringe
81
Advantages of suction biopsies of the bladder
Non-invasive, inexpensive, no need for special equipment, less risk of tumour seeding (compared to FNA)
82
Disadvantages of suction biopsies of the bladder
Small biopsies limit diagnosis, may be considerable haemorrhage
83
Indications for prostatic wash
Investigation of prostatomegaly, asymmetrical prostate glands, prostatic pain, haematuria and pyuria
84
How to do a prostatic wash
Urinary catheter placed in the bladder and bladder emptied Bladder flushed with saline Assistant performs rectal exam Catheter withdrawn to level of prostate Prostatic massage per rectum whilst 1-2ml of sterile saline injected slowly into catheter 5ml syringe used to aspirate prostatic wash fluid
85
Potential complications of prostatic wash
Rupture of prostatic abscess Rectal perforation Development of ascending urinary tract infection

SA Neph/Uro (10 decks)

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