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Michaelmas 5th year > Urinary 3 > Flashcards

Urinary 3 Flashcards

1
Q

What viraemic cause can lead to renal haemorrhage and what does it look like macroscopically

A

Canine herpes virus 1
See multifocal red areas on surface indicating haemorrahge

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2
Q

What organism can cause septicaemia and renal haemorrhage

A

Salmonella

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3
Q

What does cortical necrosis look like grossly and microscopically

A

Gross: pale, swollen areas that stop sharply at corticomedullary junction

Histologically: necrosis of tubular epithelium and glomeruli

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4
Q

What part of the kidney is very sensitive to ischaemia

A

Cortex due to high metabolic demand

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5
Q

Appearance (gross + histo) of acute tubular necrosis

A

Cortex is pale, moist
See patchy necrosis of the prox and distal tubules but glomeruli are spared

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6
Q

How does having acute tubular necrosis caused by ischaemic vs toxic causes affect regeneration

A

Regneneration is dependent on intact basemement membrane
- is intact with Toxic causes but not with ischameic

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7
Q

When do we get renal medullary necrosis as well as cortical

A

Response to ischaemia if
- More than 2 hours ischaemia
- Urinary obstruction
- NSAIDs given which inhibit vasodilation + dehydrated pateitn
- Pyelonpehirits
- Amyloidosis

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8
Q

How can renal medullary necrosis predipose to calculi

A

Necrotic tissue sloughs into ureter and can provide nidus for calculi to form on

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9
Q

What do necrotic cells look like in acute tubular necrosis

A

Brightly eosinophilic, separated from neighbours

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10
Q

are What two toxic causes of acute tubular necrosis

A

Antibiotics (aminoglycosides, tetracyclines, amphotericin)
Ethylene glycol

Others are lillies, heavy metals etc

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11
Q

What do kidneys with ethylene glycol toxicity look like grossly and histologically

A

Gross = swollen, pale kidneys with radial streaks
Histo = tubulointerstitial necrosis, calcium oxalate crystals are pale and radiation in the tubular lumen

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12
Q

What do we see in acute intersittial nephritis

A

Enlarged pale kidney with streaking and small white nodules throughout cortex
= white spotted kdiney

Histo: oedema and neutrophil infiltrate, tubular epithelium degeneration and necrosis

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13
Q

What does white spotted kidney mean

A

Inflammation focussed on interstitium

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14
Q

What do we see in chronic interstitial nephritis

A

Interstitial fibrosis
Fibrosis and atrophy of tubules too
Chronic inflammatory cells; lymphocytes, macrophages, plasma cells packing the space between the (degenerating) tubules

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15
Q

two infectious causes of interstitial nephritis in dogs

A

Canine adenovirus 1
Leptospirosis

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16
Q

What serovars of leptospirosis cause interstitial nephritis in dogs

A

 L interogans serovars canicola (more chronic) and icterohaemorrhagiae (more acute)

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17
Q

When do we see white spotted kidney in lepto cases

A

In those whih have survived acute septicaemia so disease focus moves from liver to kidneys to cause acute inflamation in the interstitium

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18
Q

When is acute leptospirosis most significant in dogs

A

In leptospiraemic phase in puppies

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19
Q

Acute leptospirosis signs

A

Widespread haemorrhages, hepatic lesions, subcapsular real haemorrhages
ANiaml may be icteric, dehydrated, fever etc

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20
Q

Diagnosing leptospirosis

A

Best is immunoflourescence on urine or tissue
Also PCR

[Used to use silver stain called Warthin starry but less common now]

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21
Q

What is the gross and microscopic pathology of leptospirosis (more chronic form)

A

White spotted kidney
Acute diffuse interstitial nephritis; starting with odema, etc then get lymphocytes, plasma cells and fibrosis as it becomes chronic

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22
Q

What infectious agents can cause granulomatous interstitial nephritis

cats

A

FEline infectious peritonitis *****
Fungi
Mycobacteria

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23
Q

Appearance of kidney of cat affected by dry FIP

+histo

A

White spot lesions with fluffy edges that may coalesce and are centred on blood vessels
= sign of interstitial nephritis

HIsto: pyogranulomatous nephritis and vasculitis, neutrophils, macrophages

Clinical history suggestive of FIP e.g uveitis; tends to be dry form

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24
Q

LEsions and Histopath of pyelonephritis

A

Dilated tubules full of neutrophils

ULcers, dilation abscessation of pelvis (this is where lesion starts)
In chronic cases can get scarring and contraction

25
Q

What organisms are commonly involved in pyelonephritis

A

Gram -ve enterics via ascending UTI

  • E coli, staph, strep, pseudomonas, proteus
26
Q

WHat does kidney lymphoma look like

A

White nodules on cortex; well circumscibed (c/f FIP lesions)

Affects older cats compared to FIP

27
Q

What is the most common ureteral abnormality

A

Ectopic ureters

MOre common in females

28
Q

What are females vs males more prone to in terms of lower urinary tract issues

A

Females to UTI due to shorter urethra
Males to obstruction due to convuluted urethra

29
Q

WHich breeds of dogs have familial inheritance of ectopic ureters

A

Husky
Labrador

30
Q

what drug can cause sterile haemorrhagic cystitis

A

Cyclophosphamide

31
Q

Predisposing factors for cystitis

A

urine stasis, incomplete voiding, bladder trauma, glucosuria (in diabetes mellitus; glucose can act as nidus for infection), dilute or alkaline urine, anatomy

32
Q

What species often cause cystitis

A

E coli
Proteus

33
Q

Post renal causes of azotaemia

A

Blockage
Urinary tract rupture

34
Q

Pre renal causes of azotaemia

A

Hypovolaemia
Reduced cardiac output e.g in heart failure, general anaesthetic

35
Q

Renal causes of azotaemia (= most common type)

A
  • Toxins; ethylene glycol, lillies, grape/raisin, NSAIDs, hypercalcaemia
  • Infection: leptospira, FIP, pyelonephritis
  • Ischaemia
  • Neoplaisa; mostly lymphoma
  • Systemic disease
36
Q

Clinical signs of acute kidney injruy

A

Vague
- Anorexia, lethargy, vomting etc
Fever
Dehydration
Most have reduced urine output
Uraemic breath

37
Q

What will USG be like depending on whether AKI cause is pre-renal or renal

A

Pre-renal will be concentrated; >1.030 in dogs >1.035 in cats
Renal will be suboptimlly concentrated; <1.030 in dogs <1.035 in cats

38
Q

Signs of tubular damage in urine sedimentation

A

Proteinuria, glucosuria, casts
Calcium oxalate = typical of ethylene glycol toxicity

39
Q

Treating leptospirosis as cause of AKI

A

Amoxicillin for 2 weeks then doxy for 2 weeks
Or just 4 weeks doxycyclien

40
Q

Treating ethylene glycol as cause of AKI

A
  • Emesis if recent
  • Fluids
  • Antizol
  • Ethanol to compete with alcohol dehydrogenase enzyme to stop metabolism of EG to toxic compounds
  • Dialysis
41
Q

Dealing with NSAID toxicity as cause of AKI

A

EMesis
ACtivated charcoal
Antacids
Misoprostol (to act as prostaglandin analogue)

42
Q

What is normal urine output

A

2ml/kg/hr

43
Q

How to correct hyperkalaemia in AKI

A

Calcium gluconate
Glucose/insulin
Sodium bicarbonate

Fluids to encourage exretion

44
Q

What is peritoneal dialysis

A

Using osmotic gradients to remove excess water or solutes from plasma; membrane = peritoneal
= expensive but can buy time to deal with AKI

45
Q

How does ethylene glycol cause AKI

A

The metabolites of EG are nephrotocins
+ get calcium oxalate crystals in tubules causing obstruction

46
Q

What might more echogenic kidneys on ultrasound suggest is the cause of AKI

A

= due to calcium deposits
- Calcium oxalate from ethylene glycol toxicity

47
Q

Diagnosis of ethylene glycol toxicity

A

Calcium oxalate crystalluria
Azotaemia, hyperkalaemia, hypocalcaemia because the oxalate is binding the calcium , metabolic acidosis
Test within first 24hrs

48
Q

When do EG patients usually present

A

Once in AKI
- 30 mins post ingestion get ataxia, hypersalivation, vomiting but then look better
- Not until. a day later that see severe AKI signs; anorexia, lethargy, vomiting, seizure, uraemic halitosis

49
Q

Signs of urethral obstruction

A

Straining to urinate, vocalisation, enlarged painful bladder
Male

50
Q

What do we do first to stabilise acute urethral obstruction before going into sugery

A

Use IV fluids to deal with hyperkalaemia (can get bradycardia and death under GA)

Calcium gluconate is cardioprotective

51
Q

What is urohydropropulsion

A

Can be done if catheterisation unsuccessful in blocked cat

  • Advance catheter up to obstruction point; another person puts finger in rectum and pressed ventrally to occlude urethra
  • inject fluid rapidly along cathter to cause urethral dilation
  • Release finger from anus to allow uroliths to be flushed back into bladder
52
Q

What urethral muscle relaxants do we use in cats post-catheter removal

A

Dantrolene for skeletal muscle
PRazosin for smooth muscle

53
Q

What issues to catheters left in predispose to

A

AScending infection
Traumatisation and urethrospasm leading to re-obstruction when removed

54
Q

When might we do perineal urethrostomy

A
  • Obstruction than cannot be relieve
  • Trauma to penile urethra
  • Strictures that occur post-catheterisation
  • Neoplasia
  • Recurrent episodes of obstructive FLUTD
55
Q

Do we recommend prophylactic antibiotics for UTI prevention after removing urethrolith

A

No
Can predispose to becoming infected with persistent, antibiotic resistant bacteria

56
Q

What would be some differentials for bilateral renomegaly in a cat

A

Obstruction at level of bladder/urethra and hydronephrosis
Lymphoma metastasis to both
Nephritis
Dry FIP
AKI

57
Q
A
58
Q
A

Michaelmas 5th year (41 decks)

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