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1

Briefly describe avian renal anatomy

- large pair of lobulated kidneys surrounded by abdominal air sac
- Reptilian and mammalian nephrons
- No urinary bladder, empty into cloaca
- Reflux of urine into coprodeum and colon aids water reabsorption
- Ischiatic (and others) nerves run through and dorsal to kidneys

2

List the common causes of primary renal disease in birds

- Hypervitaminosis A
- Hypervitaminosis D3
- Dehydration
- Heavy metal toxicity
- Infection (e.g. extension of air sacculitis, systemic spread, ascending infection)
- Neoplasia
- Amyloidosis and lipidosis

3

What condition may lead to amyloidosis in birds?

Bumblefoot

4

Compare the types of nephrons found in the avian kidney

- Reptilian: no LoH, cortex only
- Mammalian: LoH, extends from cortex to medulla

5

Compare visceral and articular gout

- Visceral: uric acid tophi in soft tissues e.g. liver, pericardium, kidney
- Articular: uric acid tophi in and around joints, often feet and hocks

6

Describe the development of gout in birds and reptiles

- Decreased uric acid secretion: dehydration, renal tubular disease, hypovit A, infection/inflammation, post-renal obstruction
- Increased uric acid production: excess dietary protein

7

Outline the typical presentation of avian renal disease

- early signs often subtle
- Advanced signs: non-specific, fluffed up, lethargic, eyes closed
- More specific signs: PUPD, uni or bilateral HL paresis, haematuria, feather picking over kidneys, gout, leaning when standing

8

What factors is the level of dehydration in a bird assessed on?

- PCV/TS
- Skin elasticity
- MM moisture
- Brightness of the eye
- Ulna refill time
- Most sick birds are 5-10% dehydrated at presentation

9

List the diagnostic tests that may be used in the investigation of urinary tract disease in birds

- Uric acid
- Blood biochem and haematology
- Urinalysis
- Murexide test
- Radiogaphy
- Ultrasound
- Endoscopy
- (MRI/CT)

10

Outline the interpretation of haem and biochem in a bird with urinary tract disease

- Uric acid: elevated once >70% renal function lost, post-prandial rise in carnivores
- Urea as indicator of dehydration only
- Creatinine not useful
- Phosphorous: may be elevated in renal failure (and haemolysis)
- Calcium: reduced in renal failure
- Potassium: elevated in acute renal failure
- Sodium: hyper in dehydration, hypo in renal failure

11

Discuss the use of urinalysis in the investigation of urinary tract disease in birds

- Difficult to obtain pure sample
- Normal urine contains crystals and bacteria
- Look for renal casts, abnormal cells, glucose etc.
- USG species specific (aroun 1.005-1.020)

12

Outline the murexide test in birds

- Confirmation of gout
- Sample of material e.g. joint aspirate mixed with nitric acid and dried over flame
- Add 1 drop concentrated ammonium
- Mauve = uric acid (positive)

13

Outline the use of radiography in the investigation of urinary tract disease in birds

- VD and lateral, wings and legs extended
- Normal kidneys difficult to see, but have small rim of air dorsal to kidneys on lateral view (absent in renomegaly)
- May see eggs, cloacaliths, evidence of gout in rest of body

14

Evaluate the use of ultrasonography in the investigation of urinary tract disease in birds

Useful to look at architecture of kidney but often severely hampered by air sacs

15

Evaluate the use of endoscopy in the investigation of urinary tract disease in birds

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

16

Outline the supportive care for the average sick bird

- Keep warm (29-30˚C)
- Quiet, away from predators
- Dim lighting
- Oxygen
- Nebulise saline for 20-30mins
- Fluid therapy (SC, IV, IO but not humerus or femur)
- metoclopramide 0.5-1mg/kg IM q8-12hours if ileus

17

Outline a basic fluid therapy plan for a bird

- Maintenance fluids ~50ml/kg/day
- Rehydrate over 48 hours
- Day 1 and 2: maintenance + half calculated rehydration fluids
- Day 3: maintenance fluids

18

List the treatment factors that should be considered for a bird with urinary tract disease

- General supportive care
- Assessment of dehydration
- Fluid therapy
- Food
- Antibiotics
- Allopurinol

19

Outline the nutrition for a bird with urinary tract disease

- High fat and carb, lower protein
- Ensure balanced diet for species
- Vitamin supplementation may be needed in some

20

Discuss the use of antibiotics in a bird with urinary tract disease

- Aminoglycosides nephrotoxic
- TMPS and amoxyclav can be nephrotoxic if bird is dehydrated

21

Discuss the use of allopurinol in a bird with urinary tract disease

- Xanthine oxidase inhibitor
- May help reduce hyperuricaemia, thereby reducing gout
- BUT may worsen gout in some species e.g. Red tail hawk

22

Briefly outline the reptilian renal anatomy

- Renal portal system similar to birds
- No LoH
- Urinary bladder in chelonia and some lizards
- Urine can be modified in bladder/colon
- Salt glands present in some desert and aquatic species

23

List the common causes of reptile renal disease

- Inadequate husbandry: humidity, temp, diet, supplements
- Chronic dehydration
- Infection e.g. bacterial, parasitic
- Neoplasia

24

How might chronic dehydration occur in a reptile?

Some need to drink from droplets coming down, water bowl useless, will get dehydrated

25

Outline the clinical signs of renal disease in reptiles

- Early signs often subtle
- Advanced signs: non-specific, lethargy, anorexia, weight loss, dysecdysis, abnormal thermoregulation
- Other signs: HL weakness, constipation, gout, oedema

26

List the diagnostic tests that can be used in the investigation of renal disease in reptiles

- Blood biochem and haematology
- Urinalysis
- Murexide test
- Iohexol excretion test
- Radiography
- Ultrasound
- Endoscopy
- (MRI/CT_

27

Outline the interpretation of blood biochem and haematology in reptiles with renal disease

- Uric acid elevated once >70% function lost, post-prandial rise with carnivores, little to no effect of dehydration
- Urea: elevated in dehydration or anorexia, renal disease if uric acid also elevated, more useful in desert tortoises
- Creatinine not very useful
- Phos: may be elevated, renal disease more likely if phos > total calcium , may be elevated as a result of haemolysis
- Calcium: reduced in CRF, normal or increased in ARF
- Potassium elevated in ARF and haemolysis

28

Outline urinalysis in the investigation of renal disease in reptiles

- Try to avoid faecal contamination
- Normal urine contains crystals and bacteria
- Look for renal casts, cells, parasites e.g. Hexamita
- pH may change from normal alkaline to acidic in anorexic herbivores and post hibernation
- Normal USG: 1.003-1.014

29

Describe the iohexol test used in the investigation of renal disease in reptiles

- Excreted solely by glomerular filtration, good indicator of renal function
- Inject iohexol IV, take blood 4, 8 and 24 hours later
- Not routinely used

30

Outline the use of radiogaphy in the investigation of renal disease in reptiles

- 2-3 views, VD, 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, bone density also assessed