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Urinary Tract Diseases Flashcards

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1
Q

How can you diagnose urethral obstruction?

A 
History and CS
Large, painful bladder on palpation
Post renal azotaemia on bloods
Catheterisation 
Plain radiography
Ultrasound
Retrograde urethrogram
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2
Q

How should you manage a case of urinary tract obstruction?

A

Pain relief and sedate
Cystocentesis to empty bladder
IVFT - improve metabolic status

GA
Pass a urinary catheter and flush with small volume of saline
- clamp penis with doyen intestinal forceps
- flush with saline until calculi are back in bladder
- either medically dissolve or perform cystotomy
- need to re-empty bladder by cystocentesis

If unsuccessful urethrotomy

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3
Q

When is a urethrostomy indicated?

A

Calculi that can’t be removed by flushing
Can’t be kept free of calculi with medical treatment
Urethral strictures
Severe penile trauma

Scrotal urethrostomy is preferred - reduced risk of haemorrhage and stricture formation

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4
Q

Where do cats usually obstruct?

A

Distal penile urethra

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5
Q

What procedure can you not perform in the obstructed cat?

A

Urethrotomy

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6
Q

What is the next step if you can’t clear a blockage in a cat with a catheter?

A

Urethrostomy

Distal narrow portion of the urethra is removed
Urethra spatulted and sutured to the skin

Warn the owner of UTI and stricture formation
Therapy for FLUTD needs to continue

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7
Q

What condition can be diagnosed if there are signs of urethral obstruction but all causes of physical obstruction have been ruled out?

A

Reflex dyssynergia

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8
Q

When does urethral trauma commonly present?

A

Following an RTA / pelvic fracture
Iatrogenic - urethral rupture during catheterisation

CS: dysuria, anuria, haematuria, peritonitis, abdominal effusion

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9
Q

How can you diagnose urethral rupture?

A

Positive retrograde urethrogram

Haematology and biochemistry

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10
Q

How can know manage urethral rupture?

A

Stabilise the patient

Small tears - conservative management
Catheterise with a flexible catheter for 5-10 days
Gentle positive retrograde urethrogram in 10 days

Large tears - surgical repair

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11
Q

What urethral tumours are there?

A

TCC - proximal 1/3 of the urethra
SCC - distal 2/3 of the urethra

Already mets to regional LNs in 50% of cases

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12
Q

How can you diagnose urethral tumours?

A

Rectal palpation
Positive contrast urethrogram
Sublumbar LN enlargement - plain radiography (mets)

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13
Q

How can you manage urethral tumours?

A

Poor px

Palliative
Urethral stent
Urethral anastomoses 
Chemotherapy not very effective
NSAIDs
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14
Q

What is a differential for urethral neoplasia and how can you manage it?

A

Steroids
Urethral muscle relaxants
UTI
Tube cystotomy

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15
Q

What are the clinical signs of a nephrolith and how can you diagnose them?

A

Lumbar / abdominal pain
Haematuria
Azotaemia
Recurrent UTI

Dx: intravenous urethrogram, US, radiography

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16
Q

How can you treat nephroliths?

A

Medical dissolution

Nephrolithotomy - incise the kidney down to the pelvis and remove calculi
Close with 5/0 simple continuous

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17
Q

What are the indications for a ureteronephrectomy?

A

Removal of the kidney

Trauma
Hydronephrosis
Renal abscess
Neoplasia
Ectopic ureter
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18
Q

What renal neoplasia is seen?

A

Feline renal lymphoma

Tubular adenocarcinoma
TCC
Fibrosarcoma
Haemangiosarcoma

Secondary renal neoplasia - relatively common

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19
Q

What are the clinical signs of renal neoplasia?

A 
Non specific
Weight loss
Depression
Fever
Lameness 
Abdominal distension
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20
Q

How can you diagnose renal neoplasia?

A 
Abdominal palpation - most likely
Azotaemia 
US
Radiography +/- contrast
FNA

Tx: ureteronephrectomy
Lymphoma - chemotherapy

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21
Q

What are the indications for a cystotomy?

A 
Removal of calculi
Investigating haematuria
Bladder biopsy 
Repair of a ruptured bladder 
Surgical treatment of neoplasia 
Ectopic ureters
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22
Q

What are the radiopacities of the commonest calculi?

A

Strivite - most radiopaque
Calcium oxalate - a little less radiopaque
Cystine - slightly radiolucent
Urate - radiolucent

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23
Q

How should you perform a cystotomy?

A

Express bladder before surgery

Incision
Male - cranial to the prepuce - paraprepucial - pubis
Female - caudal to the umbilicus - pubis

Exteriorise bladder and pack around with swabs
Drain the bladder
Place stay sutures
Make an incision in the avascular area of the bladder, near neck
Extend incision with metzenbaums
Place stay suture to keep open
Close - simple apposition all pattern with PDS (polydioxanone)

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24
Q

What might cause a ruptured bladder?

A

Blunt trauma
Urethral obstruction
Neoplastic infiltration
Iatrogenic - move with full bladder whilst performing a cysto

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25
How does a ruptured bladder present?
Absent urination or Dysuria, stranguria, haematuria Abdominal pain and bruising Azotaemia
26
How can you diagnose a ruptured bladder?
History and CS Absence of urination or haematuria on catheterisation Azotaemia and Hyperkalaemia Abdominocentesis Abdominal us Positive contrast retrograde urethrogram Plain radiography - poor serosal detail and loops of distnended intestine = peritonitis
27
How should you treat a ruptured bladder?
``` Small tears - spontaneously heal Larger tears - surgical repair - IVFT to normalise K+ - catheterise bladder - force diuresis - flush abdomen - debride and suture ```
28
When are tube cystotomys indicated?
Decompression of an atonic bladder Urethral tran section Bladder or urethral neck tumour
29
What is the most common bladder tumour?
TCC
30
How do bladder tumours present?
Haematuria Dysuria Stranguria
31
How should diagnose bladder neoplasia?
``` Haematology and biochemistry Urinalysis - particularly sediment to look for TCC cells US Radiography +/- contrast Catheter suction biopsy ```
32
How should you treat bladder neoplasia?
Benign / polyps - surgical excision ``` Malignant Partial cystectomy - palliative NSAIDs Antibiotics for UTI Poor response to chemo ```
33
What tests are recommended for assessing renal function?
Haematology Biochemistry Urinalysis - USG, dipstick, sediment, UPC ratio, fractional excretion Blood gas analysis
34
What can increase urea tell you?
With creatinine = reduced GFR Mild increases - high protein meal - dehydration - GI haemorrhage - dehydration - catabolism - fever
35
What can a decreased urea indicate?
Low protein diet Severe liver disease or PSS Aggressive fluid therapy Urea cycle enzyme deficiency
36
What does increased creatinine suggest?
With urea = reduced GFR | Alone - high muscle mass
37
What are the clinical signs seen with uraemia?
``` Vomiting Anorexia Diarrhoea Weight loss Anaemia Ulcerative stomatitis Muscle tremors Coma ```
38
Pre-renal azotaemia
Dehydration Reduced cardiac output Increased production 1. Due to dehydration / hypovolaemia - clinical evidence - maximally concentrated USG - over 1.030 dogs, 1.035 cats - responds to IVFT 2. Due to increased ammonia load - evidence of GI haemorrhage - anaemia - maximally concentrated USG
39
Renal azotaemia
Renal parenchymal disease Sub-optimally concentrated USG Isothenuria - 1.008-1.012 Intermediate hyposthenuria - 1.0013-1.030 Azotaemia is insensitive - only clinically apparent when 75% of nephron function is lost
40
Post renal azotaemia
Urinary tract rupture or blockage Accompanied by Hyperkalaemia Creatinine in the abdominal fluid
41
What is a better indicator of early renal disease?
SDMA (symmetrical dimethyl agrinine) Increases when 40% of nephron function is lost Can detect animals in stage 1/2 CKD with no azotaemia
42
Describe the electrolyte changes seen in kidney disease.
Hyperphosphataemia - reduced GFR (can be pre, renal or post) (Horses are hypophosphataemic with reduced GFR) Hyper or hypokalaemia - increased in oliguric/anuric renal failure (H+ exchanged for K+in acidosis) - decreased in CKD Hypochloraemia - increased renal losses - GI losses with vomiting Hyper or hyponatraemia Hyper or hypocalcaemia - hypercalcaemia - renal failure in horses and some smallies - hypocalcaemia = most common (because of phosphate loss)
43
What extra renal factors affect the kidneys ability to concentrate urine? Suspect in a patient suboptimal urinary concentration
``` Diuretics Glucocorticoids Glucosuria Medullary washout Pyelonephritis Low urea Electrolyte imbalances ```
44
What does hyposthenuria suggest?
1.001-1.008 Functional tubules - actively secreting Over-hydration Lack of response to ADH
45
What might cause protein to be in the urine?
Glomerular damage Protein overload Urinary tract inflammation
46
What samples do you need to submit for a UPC?
Serum and urine sample
47
What is the renal threshold for glucose?
10 mmol/L dogs | 16.6 mmol/L cats
48
What casts can be normal in the urine?
Hyaline | Granular
49
What casts are abnormal in the urine?
Granular Cellular Waxy = indicate tubular damage
50
Struvite
``` Magnesium ammonium phosphate Forms in alkali urine Radiopaque Seen with UTI and Urolithiasis - staphylococcus More common in females More common in lower urinary tract ``` Coffin lid / envelope appearance
51
Amorphous crystals
Urate - forms in acidic pH Phosphate - forms in alkali pH No clinical significance
52
Calcium oxalate dihydrate
Neutral to acid urine Square with a cross in Radiodense More common in males Predisposing factors: Hypercalciuria predisposes - malignancy, hyperparathyroidism, Vitamin D toxicosis Increased dietary intake of oxalate Decreased citrate in the urine Can be normal Forms in standing urine samples Ethylene glycol toxicity = rare
53
Calcium oxalate monohydrate
Picket fence appearance Hemp seed Seen in hyperoxaluric disorders - ethylene glycol toxicity Or ingestion of oxalate rich food
54
Ammonium biurate
Portosystemic shunts Liver disease Miniature schnauzer Brown glob
55
Uric acid crystals
Dalmatians and English Bulldogs Hepatic transport of Uric acid is impaired - Uric acid produced - precipitates out in the urine
56
Cystine
``` Metabolic defect in the tubular reabsorption of cystine - Bulldogs Hexagons Form in acidic urine Radiolucent Round or oval Red/yellow ``` Also seen in male daschunds - 3-8y
57
Bilirubin
Cholestasis Haemolytic anaemia Normal in very concentrated urine in male dogs
58
Cholesterol
Nephrotic syndrome
59
How can you most accurately determine proteinuria?
Urine protein to creatinine ratio
60
What can cause hyponatraemia?
Loss - vomiting, diarrhoea, hypoadrenocorticism (addisons), effusions, diuretics Volume overload - CHF, end stage renal failure Increased plasma osmolarity - severe hyperglycaemia
61
What causes hypernatraemia?
Free water loss - heat stroke, DI deprived of water, inadequate access to water, adypsia Hypotonic water loss - GI losses, renal failure, post-obstructive diuresis, DM Excessive intake Excess reabsorption Hyperaldosteronism Iatrogenic - steroids, sodium phosphate enemas
62
What is potassium concentration controlled by in the plasma?
Insulin Aldosterone (adrenal cortex) Sympathetic nervous system
63
Artefactual Hyperkalaemia
Aged samples / samples sent in the post | EDTA contamination - Hyperkalaemia, hypocalcaemia, low ALP
64
True Hyperkalaemia
Urethral obstruction Urinary tract rupture Anuric / oliguric renal failure Hypoadrenocorticism (addisons) Insulin deficiency in DM Tumour lysis syndrome Crush and reperfusion injury Acute acidosis - H+ exchanged for K+ Iatrogenic - beta blockers, ACE inhibitors, K+ sparing diuretics with K+ supplementation
65
How should you treat Hyperkalaemia?
Potassium depleted fluids eg: NaCl +/- glucose and insulin Calcium gluconate - cardiac effects Treat acidosis
66
What are the clinical signs of hypokalaemia?
``` Muscle weakness - hypokalaemic myopathy PU PD Anorexia Ileus Constipation ```
67
What can cause hypokalaemia?
Decreased intake - anorexia, fluid therapy with K+ depleted fluids ECF --> ICF - insulin, glucose containing fluids, catecholamines, hypothermia Loss - vomiting and diarrhoea, urinary CKD in cats Diet induced - low K+ acidifying renal diets Post-obstructive diuresis Mineralocorticoid excess - hyperadrenocorticism, primary hyperaldosteronism Loop and Thiazide diuretics
68
What can cause hyperphosphataemia?
``` Renal failure Urinary tract obstruction Young animals - released from the bones Osteoclasts Feline hyperthyroidism High phosphate diet Hypervitaminosis D Primary hyperparathyroidism Haemolysis ```
69
What causes hypophosphataemia?
``` Anorexia Treatment of ketoacidosis - shift back into cells Decreased renal absorption Primary hyperparathyroidism Hypercalcaemia of malignancy ```
70
What measurements of calcium are there?
Total calcium - protein bound and ionised Ionised calcium - biologically active
71
What are the clinical signs of hypercalcaemia?
PU PD
72
What causes hypercalcaemia?
``` Malignancy - lymphoma / leukaemia, anal sac adenocarcinoma Primary hyperparathyroidism Renal failure Addisons Bone lesions Young growing animals Vitamin D toxicity Cholecalciferol toxicity Anabolic steroids ``` Artefact - lipaemia, hypovolaemia, haemolysis
73
What are some common causes of hypocalcaemia?
``` Hypoalbuminaemia Ethylene glycol toxicity Intestinal malabsorption Acute pancreatitis Eclampsia Idiopathic hyperparathyroidism Secondary renal hypoparathyroidism Iatrogenic hypoparathyroidism - thyroidectomy in cats ```
74
What are ischaemic causes of renal parenchymal disease?
``` Hypovolaemia Hypotension Renal vasoconstriction DIC and thrombi Pancreatitis Peritonitis Vasculitis ```
75
What are toxic causes of renal parenchymal disease?
``` Aminoglycosides Amphotericin B Cisplatin Heavy metals Thiacertasamide - anti- potozoal Radiographic contrast agent NSAIDs Ethylene glycol Lilies Grapes Paracetamol Leptospirosis FIP Pyelonephritis Septic emboli Glomerulonephritis Trauma ```
76
What are some systemic causes of renal parenchymal disease?
``` Multiple organ failure SLE haemolytic uraemic syndrome Polycythaemia Lymphoma Hypercalcaemia ```
77
What will indicate AKI from your history?
``` Recent onset anorexia, polydypsia CNS signs Toxin exposure Nephrotoxic drug Ischaemic episode Leptospirosis vaccination status ```
78
What will you find on clinical exam in a case of AKI?
``` Dehydration Uraemic breath Hypothermia - unless infectious Ulceration of the oral mucosa Neurological signs Kidney pain and enlargement Tachycardia - dehydration Bradycardia - Hyperkalaemia ```
79
How can you diagnose AKI?
Haematology and biochemistry - azotaemia - increased phosphate - Hyperkalaemia - variable Ca2+ - increased in vit D toxicity / malignancy - decreased in ethylene glycol toxicity - metabolic acidosis - increased PCV and TP due to dehydration Urinalysis - isothenuria - glucosuria, haematuria - cells, casts, crystals - calcium oxalate crystals in ethylene glycol Radiography - renal size, regularity and opacity - dogs - normally 2.5-3.5 x the size of L2 - cats - 2-3 x the size of L2 in cats Ultrasonography - renal size, parenchyma, echogenicity
80
Ethylene glycol toxicity
Metabolised into toxic compound in the liver Bonds with calcium and forms calcium oxalate monohydrate crystals on the renal tubules = AKI Renal failure occurs in 12-24 hours IVFT Induce vomiting or gastric lavage if recent ingestion 4-methylpyrazole - within 3 hours Ethanol - inhibits alcohol dehydrogenase - within 8 hours Poor px if already oliguric or azotaemia
81
How can you diagnose leptospirosis and what antibiotic can you use?
PCR on urine best ELISA Also available Antibiotic - doxycycline - good for removing from kidneys
82
How can you treat NSAID mediated AKI?
Due to reduced prostaglandin synthesis - the kidney requires prostaglandin to auto-regulate - ischaemic damage Tx: misoprostol for 3 days - prostaglandin
83
What lilies are toxic and how does this present?
Easter lily, day lily, tiger lily Gastritis for the first 3 hours - vomiting AKI after 24-72h - vomiting, salivation, tremors, seizures, ataxia
84
What do you want to monitor in patient with AKI?
``` Mm, CRT HR, RR BP PCV Biochemistry Urine output (>2ml/kg/h) Polyuria Acid base balance Electrolytes Hyperkalaemia ```
85
What supportive therapy should you provide for a patient with AKI?
IVFT - choice based on electrolytes, rate based on dehydration (3-5% BWt IVFT if clinically dehydrated) Correct Hyperkalaemia - 0.9% NaCl - calcium gluconate - doesn't reduce k+, antagonises cardiac effects - insulin - dextrose - glucose and K+ into cells - sodium bicarbonate Control vomiting - maropitant, metoclopramide, ondansetron Control hypertension - exacerbates renal damage - turn down IVFT if over-hydrated - amlodipine, hydralazine, ACE inhibitors, nitroprusside Nutrition - consider feeding tube - phosphate binders
86
What should you do if an animal fails to produce urine / oliguric following IVFT (<2ml/kg/h)?
``` Reasses hydration - stop fluids if over-hydrated - place a urinary catheter - therapy to increase urine output * furosemide - improves urinary output but doesn't increase GFR * mannitol - q 4-6h or CRI * dopamine - humans * fenoldopam - humans * diltiazem - improves recovery in dogs with leptospirosis (Causes hypotension) ```
87
What is the reported mortality for AKI?
Dogs 53-60% | Cats 50%
88
What are the clinical signs of pyelonephritis?
``` Pyrexia Abdominal pain PU PD - only with pyelonephritis / nephritis Septicaemia Renal failure ```
89
What are the clinical signs of lower urinary tract infection?
Dysuria Pollakiuria Haematuria Urinary inocontinence
90
What clinical signs are there associated with Prostatitis?
Systemic signs - fever, anorexia
91
What differences will you see on bloods with Lower UTIs vs upper?
Lower - likely none Upper - left shift neutrophillia, degenerative neutrophils Azotaemia
92
How can you diagnose a UTI?
Active urine sediment | Urine culture - gold standard
93
What does an antimicrobial for a UTI need to achieve?
4x the MIC in the urine | - determined by antimicrobial dilution technique (MIC)
94
What first line antimicrobials should you use in urinary tract infection?
Amoxicillin Cephalexin TMPS For 10-14 days, urine culture 1 week after therapy finished (Fluoroquinolones and extended release cephalosporins should be reserved for complicated cases)
95
How should you treat a complicated UTI?
``` Seen in Entire male dogs (Prostatitis) Most cats Diabetes mellitus Hyperadrenocorticism Animals with upper urinary tract infections ``` 4-6 weeks of antibiotics - Fluoroquinolones or extended release cephalosporins
96
Name some complications of urinary tract infections
Polyploid cystitis - chronic infection leads to bladder mucosal proliferation Emphysematous cystitis - accumulation of gas in the bladder lumen, secondary to infection due to glucosuria - E.coli in DM MAP crystals - staphylococcus and proteus Pyelonephritis
97
What is the most common cause of CKD in the cat?
Idiopathic tubulointerstitial nephritis
98
What is the most common cause of CKD in the dog?
Glomerulonephritis
99
What are the clinical signs of CKD?
``` Weight loss Poor appetite Poor coat PU PD Dehydration Vomiting Constipation Neurological signs Hypertension - detached retina Oedema ```
100
What will you find on physical examination in CKD?
``` Dehydration Poor BCS Pale mm Hypothermia Oral ulcerations Uraemic breath Retinal lesions Osteodystrophy Small, firm and irregular kidneys Ascites ```
101
What do you stage renal disease based on?
Creatinine Blood pressure Proteinuria
102
IRIS stage 1 CKD
Creatinine up to 125 + other renal abnormality present Inadequate concentrating ability Abnormal renal palpation
103
IRIS stage 2 CKD
Creatinine 125-180 Mild clinical signs PU PD Or no clinical signs
104
IRIS stage 3
Creatinine 180-440 | Many systemic clinical signs present
105
IRIS stage 4
Creatinine over 44O Increasing risk of systemic clinical signs Uraemic crisis
106
How can a cat with proteinuria be sub-staged in renal disease?
Using the UPC ratio Non-proteinuric - 0-0.2 Borderline proteinuric - 0.2-0.5 Proteinuric - over 0.5 Need to rule out UTI or urinary tract inflammation
107
How can you sub-stage using hypertension in CKD?
APO - no risk - systolic BP - <150 mmHg AP1 - low risk - systolic BP - 150-160 AP2 - moderate risk - 160-180 AP3 - high risk - 180+
108
What type of anaemia is seen in cats with CKD?
Non-regenerative, normochromic anaemia
109
How should you manage a uraemic crisis?
IVFT - 0.9% NaCl, hartmanns Monitor electrolytes Reduce IVFT as the animal starts eating
110
How can you manage IRIS stage 1 CKD?
Control dehydration - wet food, water fountains, chicken or fish flavoured water, large bowl, filled right up Reduce proteinuria - reduce dietary protein - ACE inhibitors - low dose aspirin if albumin <20 g/L Control hypertension
111
How can you manage hypertension in dogs?
ACE Inhibitor double dose - good for proteinuria, weak antihypertensive Amlodipine + ACE inhibitor
112
How can you reduce hypertension in cats?
Amlodipine | +/- ACE inhibitors
113
How can IRIS stage 2 be managed?
As for IRIS stage one plus... Start renal diet - protein restriction, phosphate restriction, omega 3 fatty acids, fibre, reduced sodium, water soluble vitamins Control phosphate to less than 1.5 mmol/L - phosphate binder if diet isn't enough to control - aluminium hydroxide, calcium acetate, chitosin / calcium carbonate, pronefra Supplement potassium - IVFT spiked with potassium - don't exceed more than 0.5 mmol/kg/h - potassium gluconate - potassium citrate
114
How can IRIS stage 3 CKD be treated?
As for IRIS stages 1 and 2 plus... Control nausea and vomiting - H2 - cimetidine, ranitidine, famotidine - Sucralfate - anti-emetics - maropitant, metoclopramide - appetite stimulants - mirtazapine, cyprohepatidine - feeding tube Subcutaneous fluids - 10-20 ml/kg every 1-3 days Control constipation - dehydration, lactulose Control metabolic acidosis - renal diet, sodium bicarbonate, potassium citrate Manage anaemia - avoid excessive blood sampling, minimise GI blood loss (omeprazole etc), iron IMm transfusions, anabolic steroids Erythropoietin replacement - severe anaemia (Darbopoetin) Calcitrol
115
How should you manage IRIS stage 4 CKD?
As for IRIS stage 3 Intensity nutrition and fluid therapy Consider euthanasia
116
What initial monitoring should you do in CKD?
Monthly monitoring is indicated - clinical signs, appetite, body weight, blood pressure Biochemistry - urea, creatinine, phosphate, Na+, K+, albumin Urine - UPC, check sediment
117
What crystals form in alkaline urine?
Struvite | Calcium phosphate
118
What crystals form in acid urine?
Cystine
119
What crystals form in neutral to acid urine?
Calcium oxalate Urates Silicates
120
What uroliths respond to medical dissolution?
Struvite Urate Cystine
121
How can you medically manage struvite urolithiasis?
Encourage water intake Frequent opportunities for voiding Treat concurrent UTIs Antibiotics throughout tx - TMPS, amoxicillin Diet - low magnesium, ammonium and phosphate diet Reduced protein Maintain urine pH below 6.4 = acidify the urine High sodium for diuresis - hills s/d - Royal canin urinary
122
How should you monitor medical dissolution?
Monthly radiographs and urinalysis Continue one month past radiographic resolution Clinical signs resolve after 10 days On average takes 3 months
123
How can you prevent struvite crystals recurring?
Encourage water intake Prevent and control UTI Magnesium and phosphate restricted diet
124
How can you manage calcium oxalate uroliths?
Upper urinary tract Can't be dissolved ``` Surgical removal Encourage water intake Identify and treat hypercalcaemia Avoid excess calcium, oxalate, vitamin C or vitamin D Avoid excessive sodium Avoid high protein diet ```
125
How can you manage idiopathic cystitis in a cat?
Reduce stress - multiple, secluded litter trays which are frequently changed - reduce over-crowding and bullying - pheromone diffusers - reassure with physical contact Behaviour referral Dilute urine - wet food, water fountains, fish or chicken stock Urinary diet Gylcosaminoglycan supplements Analgesia - butorphanol, buprenorphine, NSAIDs, steroids Relieve urethral spasm - acepromazine, prazosin, phenoxybenzamine Tricyclic antidepressants - Amitryptiline
126
What magnitude proteinuria does glomerulonephritis cause?
High magnitude >2
127
What magnitude proteinuria does tubulointerstitial nephritis cause?
Low magnitude <2
128
What is the pathophysiology of glomerulonephritis?
Deposition of immune complexes in the glomeruli - type III hypersensitivity reaction Or Antibody production against the glomerulus
129
What are the important causes of glomerulopathies?
``` Severe pancreatitis - most common Leptospirosis Sepsis Pyelonephritis Pyometra FeLV FIV ```
130
What indicates that an investigation of a glomerulopathy is required?
``` Proteinuria that doesn't respond to treatment Newly acquired azotaemia High protein in urine Hypertension of unknown origin Thromboembolic event At risk breeds ```
131
What is the gold standard for diagnosis of glomerulopathy?
Renal biopsy sent for immunomohistochemistry | Rarely done
132
What is one of the key clinical features of a glomerulopathy?
Proteinuria | +/- protein losing nephropathy
133
Realistically, how do you diagnose proteinuria?
Dipstick Urine protein creatinine ratio Rule out other causes of proteinuria Pre-renal - bence Jones proteinuria, haemoglobin, myoglobin Post-renal - inflammation / bacteria Take bloods Perform a blood pressure Persists for 3 measurements 2 weeks apart anti-thrombotic therapy and proteinuria reducing therapy
134
When should you treat a glomerulopathy?
Persistence - 3 measurements over 2 weeks apart Ruled out post and pre renal causes Quantified using the urine protein : creatinine ratio In dogs: Proteinuria >0.5 in dogs Proteinuria >0.4 in cats
135
How should you treat proteinuria?
Benazepril (ACE inhibitor) - reduces GFR (Care increases azotaemia, phosphate and potassium -monitor) Angiotensin receptor blockers - to reduce ACE escape - licensed in cats Combine for better results! ``` Treat hypercoagulability (loss of anti-thrombin III) Low dose aspirin, clopidogrel, Dalteparin ``` Treat azotaemia and phosphate retention as per IRIS guidelines - increase water intake, phosphate restriction, protein restricted diet Hypertension - amlodipine Diet - moderate protein restriction, high omega 3
136
What is the prognosis for glomerulopathies?
Clinically well dogs with no/ mild azotaemia can live 6m to 1y
137
Renal amyloidosis in shar peis
Genetic predisposition to depositing amyloid plaques in the glomeruli = high level proteinuria CP: autoimmune reaction - swollen hocks, Pyrexia - rapidly progresses to nephrotic syndrome Tx: colchicine - anti-fibrotic, DMSO - lyse fibrosis ONE OF THE FEW CONDITIONS WHERE BIOPSY IS INDICATED
138
Polycystic kidney disease
``` Persian Cyst formation in the kidneys and liver Clinically apparent with 75% of functional nephrons are lost Can present at a very hung age Poor px - irreversible Treat as per iris recommendations ```
139
Nephrotic syndrome
Severe / end stage glomerulopathy Common in amyloidosis Hypoalbuminaemia Peripheral oedema Hypercholesterolaemia Azotaemia Grave prognosis Presence of azotaemia worsens prognosis - soya and cottage cheese in diet MST = 12.5 days

Small Animal Urinary (2 decks)

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