Hallmark Signs of Lower Urinary Tract Disease
- Stranguria (straining)
- Pollakiuria (multiple small volume voids)
- Hematuria (blood in urine - typically macroscopic)
Gram ___ bacteria predominate in LUTIs.
negative
What bacterial agent is the most common in LUTIs?
E. coli
Are yeast or fungal infections possible in UTIs?
Yes
Signalment for LUTI
- Females > males
- Young or geriatric (lower natural defense)
- Intact males (prostate)
- Cats - isosthenuria predisposes (thereofre, older cats)
Common risk factors for LUTI
- PU/PD (bacteria like isosthenuric urine)
- Endocrine: DM, hyperadrenocorticism, primary hyperparathyroidism)
- Urinary catheterization
- Urine retention (secondary to micturtion disorders, bladder atony)
Hallmark test for LUTI
Urinanalysis (pH typically >7, sediment shows blood cells or bacteria, but sediment and culture findings not always 100% correlated)
What is normal bladder residual volume?
<1/4 mL/kg after complete voluntary voiding
Failure to void completely allows …..
ascending bacteria to attach and grow
What diagnostics should be done in healthy first-time offender?
U/A, urine culture (desired)
What diagnostics should I do in a repeat offender?
U/A with urine culture - very improtant to do a urine culture in a repeat offender compared to a first-time patient
What diagnostics should I do in a sick animal?
U/A, urine culture, and look for underlying disease
Empirical treatment options for first-time offenders
Antibiotics with gram-negative spectrum and wide safety margin for an appropriate dose and duration.
Augmented penicillins, higher-generation cephalosporins, fluoroquinolones, trimethoprim-sulfa)
Signs should improve in 2-3 days
Treatment options fo recurrent UTI or UTI with concurrent illness
Culture is imperative and anitbioitcs should be based on clinical signs and symptoms.
Look for underlying predisposing cause.
Avoid the trap of ‘first antibioitc must not have worked, so I will try another one…’
Long term follow up for recurrent UTI
Negative C&S after treatment, and then 2 more negatives over the next 2 months.
If urine pH persisently >7 after resolving infection, consider urine acidifcation.
Why do bladder stones form?
- Nidus of infection
- Bacteria
- Debris
- Crystalline nidus
- Bladder mucosal damage
- Loss of glycosaminoglycans
- Unusual accumulation of crystals
Clinical signs of cystic calculi
- Similar to LUTI
- Urinary obstruction
- LUTI that does not respond to conservative treatment
- predisposed breed/signalment?
Four most common calculi types
- Magnesium ammonium phosphate (aka ‘struvite’)
- Calcium oxalate
- Urate
- Cystine
Which calculi are radiodense? Radiolucent? Echodense?
- Radiodense: struvite, calcium oxalate
- Radiolucent: urate, cystine
- Echodense: All of them!!
Which urine crystals are always abnormal?
- Ammonium biurate
- Cystine
Why is urinary obstruction a medical emergency?
- Bladdre rupture
- Bladder (detrusor) atony
- Hyperkalemia
- Acute renal failure
Facts about struvite
- Bacterial infection predisposes!!!!
- Females >>>>> males
- Urine pH > 7.0 (alkaline)
- High protein diet (aka table food) predisposes
- Intact males can get struvite secondary to bacterial prostatitis
Struvite: Therapy
- Surgical removal = immediate fix
- Medical dissolution possible
- Hill’s S/D diet = low protein, low phosphorus, high salt (for diuresis causing hyposthenuria)
- 95% response rate in 1-2 months
- DO NOT USE > 4 months!!!
- Concurrent antibiotics
Struvite prevention
- Monitor for, and educate client about, preention of infection
- Diagnose and treat infections early and completely
- Good quality diet if on table food
- Consider prevention diet (hill’s C/D, royal canin stone diet)
