Urinary disorders Flashcards by Stephanny Orozco

What findings on a CBC indicate inflammation?

Neutrophilia
monocytosis
elevated fibrinogen
elevated total protein

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What findings on CBC indicate dehydration?

Elevated PCV, RBC, and Hb

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Prerenal vs renal vs postrenal azotemia?

prerenal
dehydrated, azotemia
High USG (concentrated)

renal
azotemia
isosthenuric (can’t concentrate or dilute)

postrenal
     azotemia
     USG normal
     anuric
     hyperkalemia (K accumulates)

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Postrenal azotemia?
Dx?
Tx?

Patient blocked
Dx: sedate + cystoscopy 
Tx:
Treat hyperkalemia first!!!
* Fluids w/ glucose
     for hyperK and dehydration
* urethrostomy
antibiotics
NSAIDs

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Calculi?
signalment?
PF?

Calcium carbonate stones
most common in bladder
complete or partial obstruction
Adult geldings
alfalfa diets

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Renal uroliths?
Dx?
Tx?

stone in kidney-ureter
hard to Dx
   * azotemia may be absent
   * colic rare
   * may miss on U/S
Tx: remove affected kidney if no azotemia

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Bladder stones
Signs?
Dx?
Tx?

Signs:
   * hematuria! (post exercise)
   * dysuria, incontinence
   * pyuria, colic
Dx: easy
   * sedate + cystoscopy
Tx
   * female: manual extraction
   * male: urethrostomy

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Urethral stones
signs?
Dx?
Tx?

Signs:
   * dysuria, pollakiuria
   * colic
Dx: endoscopy
Tx: urethrostomy

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Methods for urolith diagnosis?

Cystoscopy
      urethra, bladder, ureters
      requires sedation
Ultrasound
      bladder and kidneys
Rectal palpation
      feel bladder
      caudal pole of left kidney
      ureters NOT palpable

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Important nephrotoxic drugs?

NSAIDs and gentamicin
both highly nephrotoxic

Gentamicin - toxin so corticol lesions

NSAIDs - lead to hypoxia and lesions in medulla, Especially if dehydrated!

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hyposthenuria vs isosthenuria vs concentrated?

hyposthenuria: <1.008
isosthenuria: 1.008-1.015
concentrated: 1.015

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Normal urine pH?

7-9

horse urine is alkalinic

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What might positive blood results on U/A mean?

Presence of myoglobin, Hb, or rbc’s

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What does bilirubin mean on U/A?

Hemolysis

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What do ketones mean on U/A?

Don’t use this result, it’s unreliable

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What enzymes might u find in urine, meaning?

GGT in urine indicates tubular damage

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Describe blood supply in the kidney

blood supply enters thru cortex
most supply is in the cortex
least is in the middle
medulla is hypoxic

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Affect of dehydration on kidney?

decreased perfusion to kidney -> natrually hypoxic medulal becomes more hypoxic

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Affect of NSAIDS on kidneys?

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Lead to ARF
kidney gets 25% of blood supply
when dehydrated, blood supply drops
kidney releases prostaglandins to widen afferent artery

NSAIDs (flunixin) inhibit COX -> block PGE’s -> less blood supply to kidney -> papillary necrosis

Flunixin is nephrotoxic, but especially if dehydrated

Affect of gentamicin on kidneys?

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Leads to ARF
Gentamicin enters kidneys thru blood, gets filtered, taken up by receptors, stays in tubules, results in tubular damage/necrosis

+/- elevated urine GGT

ARF clinical signs?

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None, look for azotemia or will miss
will see signs of the primary problem

mayyyyyy see oliguria, lethargy
but not usually

ARF Dx?

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blood work

azotemia
maybe: vNa, vCl, ^K

isosthenuric
rbc
proteinuria
granular casts
GGT

ARF Tx?

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Treat primary cause
FLUIDSSS (2x maintenance)
monitor azotemia on and off fluids

give fluids, check creat in 24 hrs, if good stop fluids, check again in 24 hrs, if not good, more fluids
if creat can’t stay low, there’s permanent damage

Acute renal failure summary

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common in horses
often caused by genta or flunixin
no clinical signs
treat early w/ FLUIDS
REVERSIBLE

Most common reason for prolapsed penis?

In skinny horses, retractor muscle too weak to hold penis in place

Most common cause of polyuria?

psychogenic polydipsia

Psychogenic polydipsia?

Etiology unknow horses drinks a lot, causes medullary wash out, can no longer concentrate so can't stop peeing diluted urine, drink even more

Polyuria differentials?

psychogenic polydipsia renal failure Pituitary Pars Intermedia Dysfxn-PPID Diabetes - rare in horses

How does renal failure cause polyuria?

Horse can't concentrate urine so it pees more, and thus drinks more

how to differentiate renal failure and psychogenic polydipsia?

PP: diluted urine (hyposthenuria) | renal failure: azotemia + isosthenuria

How to Dx polyuria?

50ml/kg/day of urine difficult to measure need 24 h urine collection water consumption easier to monitor

Causes of polydipsia

``` high protein diet hot outside workload (sweating) Primary *psychogenic (low USG<1.005) Secondary * renal failure (azotemia) * Diabetes (rare) ```

Polydipsia?

water intake above 60ml/kg/day

CRF CBC findings?

mild anemia | less EPO production

CRF chemistry findings?

``` low albumin (being lost in urine) severe azotemia * Urea:creatinine ration >10:1 * indicates chronicity hypercalcemica (indicates chronicity) hypoNa, hypoCl hyperK ```

CRF U/A findings?

``` isosthenuria (1.008 - 1.015) Protein ++++ * filtration problem Glucose ++++ * proximal tubules not absorbing it ```

CRF signs?

Poor BCS! lethargy polyuria-polydipsia (50%) ventral edema (50% of horses) CRF uremia * can't clear toxins > ammonia and urea accumulate >cross BBB and toxic to mucosa > oral/stomach ulcers and colon ulcers > diarrhea * ammonia changes bacteria in mouth > tartar buildup

What causes ventral edema in CRF?

``` Decreased oncotic pressure * protein lost in urine Increased hydrostatic pressure * chronic anemia>poor perfusion>hypoxic kidney> renin release>increased bp Endothelial damge from high ammonia ```

ESRD/CRF Tx?

If creatinine > 5 mg/dl Can't fix it, low QOL, slow death so euthanasia ``` if creatinine <5 mg/dl No alfalfa (high Ca) 2 teacups of oil/day NOT olive oil -> fatal colitis oil is to keep weight on or powdered fat no high protein supplements Water access at all times!!!!! Ride w/ care! dehydration w/o h20 acces Don't breed!!! MONITOR - recheck first at 2 wks, then at 6 months 3x, then yearly ```

ESRD diagnosis?

if you want 100% confirmation: biopsy | reveals fibrosis

CRF causes

``` Acquired - most common * from previous injury * cause may be unknown Congenital * <5yo * renal agenesis, hypoplasia, dysplasia ```

CRF prognosis?

Poor: creat >5 mg/dl creatinine <5mg/dl - can live normally! * no clinical signs

Types of diabetes insipidus?

Central: no production of ADH Nephrogenic: not responding to ADH

how to differentiation psychogenic PD from diabetes insipidus?

Water deprivation test DI: will concentrate urine PPD: won't concentrat b/c medullary washout **it's PPD until proven differently

Water deprivation test?

measure water intake in 24 hrs give half that amount for a few days then half of THAT for few days e.g. 140 -> 70 -> 35 ***DON'T do on azotemic animal if azotemia present it's a renal problem no PPD or DI Takes a long time can't cut h20 off abruptly, will cause dehdyration. measure body weight multiple times a day, if greater than 5% weight loss, stop the test! moving too quickly.

Urinary disorders Flashcards

(45 cards)